Colonoscopy Cancer screening guidelines and follow up

Question 1

pt after colonoscopy and polypectomy gets a follow up in ?

small rectal hyperplastic polyp

Answer 1

10 years

Question 2

pt after colonoscopy and polypectomy gets a follow up in ?

1 or 2 small <1 cm tubular adenomas

Answer 2

5 years

Question 3

pt after colonoscopy and polypectomy gets a follow up in ?

3-10 adenomas

Answer 3

3 years

Question 4

pt after colonoscopy and polypectomy gets a follow up in ?

any adenoma >1 cm

Answer 4

3 years

Question 5

pt after colonoscopy and polypectomy gets a follow up in ?

adenoma with high grade dysplasia or villous features

Answer 5

3 years

Question 6

pt after colonoscopy and polypectomy gets a follow up in ?

more than 10 adenomas

Answer 6

<3 years and consider evaluating for underlying familial syndrome

Question 7

pt after colonoscopy and polypectomy gets a follow up in ?

large >2 cm sessile polyp removed by piecemeal excision

Answer 7

2-6 months or 2-3 months

Question 8

pt after colonoscopy and polypectomy gets a follow up in

polyp with adenocarcinoma (must have minimal invasion and >2 mm margin)

Answer 8

follow up in 2-3 months

Question 9

who gets follow up in 3 years based on these results on colonoscopy?

Answer 9

3-10 adenomas
any adenoma >1 cm
adenoma with high grade dysplasia or villous features

Question 10

who gets 10 year follow up based on these results on colonoscopy?

Answer 10

small rectal hyperplastic polyp

Question 11

who gets 5 year follow up based on their colonoscopy?

Answer 11

1 or 2 small <1 cm tubular adenoma

Question 12

colonic polyps that are neoplastic

Answer 12

serrated

adenomatous (villous greater than tubular)

Question 13

colonic polyps that are non -neoplastic (no risk for cancer)

Answer 13

hyperplastic, inflammatory, juvenile, submucosal

Question 14

what are acceptable alternatives for colonoscopy for average risk individuals if performed every 5 years?

Answer 14

flexible sigmoidoscopy, double contrast barium enema, and CT colonography

Not be used for moderate to high risk pts

Question 15

who are people who are greater risk for colon cancer based on family history?

Answer 15

family history of adenomatous polyps or

colorectal cancer who have 1st degree relative <60 yrs
>2 1st degree relatives at ANY age

Question 16

What conditions make someone at greater risk for colorectal cancer and therefore need modified regimen of colonoscopy surveillance?

Answer 16

inflammatory bowel disease - ulcerative colitis, Crohn’s dx with colonic involvement

Classical familial adenomatous polyposis

HNPCC Lynch syndrome

Question 17

Colonoscopy recommendations for family history of adenomatous polyps or colorectal cancer (1st degree relative <60 or >2 1st degree relatives of ANY AGE)

Answer 17

get colonoscopy at age 40 or 10 years before age of diagnosis of affected relative

repeat every 5 years

Question 18

inflammatory bowel disease (UC and Crohn’s) colonoscopy recommendations and surveillance

Answer 18

8-10 years post diagnosis (12-15 years if dx is only left colon)
repeat every 1-3 years

Question 19

colonoscopy recommendations for classic familial adenomatous polyposis

Answer 19

start at age 10-12 yrs
repeat colonoscopy annually

Need a EGD with duodenoscopy with standard upper scope and side viewing port - age 25 to 30 or onset of colonic polyps. Repeat every 1-5 years as needed.

to screen for periampullary and duodenal adenomas and adenocarcinoma

FAP - small 100’s polyps - start screening when small.

Question 20

HNPCC lynch syndrome colonoscopy surveillance

Answer 20

start at age 20-25 yrs
repeat every colonoscopy 1-2 years.

After 40 yrs need a yearly EGD.

also need an EGD to screen for upper GI cancers

Question 21

if pt had poor quality bowel preparation for one small adenoma the next step is to

Answer 21

repeat colonoscopy within a year.

can miss a small but significant lesion. Aiming to see >5mm polyps and can miss those lesions even if there were no large masses or lesions.

Question 22

CT colonography is done on what time interval?

who is it meant for?

Answer 22

every 5 years and can be done for someone with average risk for colon cancer.

Not recommended for surveillance in pts who have history of polyps as it’s less sensitive than a colonoscopy for detecting small polyps.

Question 23

Annual fecal immunochemical testing can be considered

Answer 23

for colorectal cancer screening in average risk pts when colon imaging or endoscopy is not possible.

Has no role for surveillance post polypectomy.

Question 24

screening colon cancer guidelines for acromegaly

Answer 24

acromegaly pts are at greater risk for colon cancer

screen with colonoscopy at time of diagnosis and every 3-4 yrs after age of 50 yrs

Question 25

what is hyperplastic polyposis syndrome?

Answer 25

rare syndrome associated with increased risk for colorectal cancer

Need to have 1 or more of the criteria:

5 or more proximal (to sigmoid colon) hyperplastic polyps (at least 2 of which are >1 cm)

OR

any number of proximal hyperplastic polyps and family history of 1st degree relative with HPS

OR

> 30 hyperplastic polyps throughout the colon

Question 26

average risk pt colonoscopy screening test is:

Answer 26

colonoscopy at age 50.

acceptable alternatives are:

• CT colonoscopy every 5 years
• flexible sigmoidoscopy every 5-10 years.
• FIT-DNA testing every 3 years

Question 27

Lynch syndrome should be suspected

Answer 27

• three family members affected by a Lynch syndrome cancer
• at least two successive generations, one is affected member is 1st degree and two other are affected family members
• one had a cancer diagnosed <50 yrs

3-2-1-1-0

Question 28

Lynch is associated with this genetic defect:

Answer 28

microsatellite instability testing or immunohistochemistry with mismatch repair

Question 29

Lynch screening schedule for colonoscopy?

Answer 29

start at age 20-25 yrs
repeat colonoscopy every 1-2 years

also need an EGD to screen for upper GI cancers

increased risk for small intestinal cancer.

Question 30

-Three family members are affected with a Lynch syndrome–associated cancer
At least two successive generations are affected
-One affected family member is a first-degree relative of the other two affected family members
-One of the cancers was diagnosed before age 50 years
-Familial adenomatous polyposis has been excluded
-Tumors have been verified histologically

Answer 30

Amsterdam II criteria to screen for Lynch syndrome screening

Question 31

women with lynch syndrome are greater risk for

Answer 31

endometrial cancer

see gastric cancer, small intestinal cancer, urothelial, ovarian and pancreaticobiliary cancers.

Question 32

lynch syndrome women need to have screening for this cancer regardless if symptoms

Answer 32

endometrial cancer

Question 33

Treatment of FAP is

Answer 33

prophylactic colectomy

Question 34

when to end colonoscopy screenings?

Answer 34

75 years or when the pt’s estimated life expectancy is <10 years