Colonoscopy Screening

Question 1

Average risk patient. No risk factors for colorectal cancer.

Answer 1

• Begin screening at 50.

* Repeat q 10 years, if normal.

Question 2

Single 1st-degree relative with colorectal cancer or tubular adenoma dx > age 60, or 2 2nd-degree relatives diagnosed with colorectal cancer.

Answer 2

• Begin screening at 40.

* Repeat q 5-10 years, if normal.

Question 3

Single 1st-degree relative with colorectal cancer or tubular adenoma dx < age 60, or 2 1st-degree relatives of any age.

Answer 3

• Begin screening at 40, or 10 years before the youngest case in 1st-degree relative (whichever comes first).
• Repeat q 5 years, if normal.

Question 4

Age is > 80 at time of colon screening.

Answer 4

• Consider alternative to colonoscopy for screening.
• No further screening, if normal.
• F/U dependent on results of screening.

Question 5

IBD

Answer 5

• Begin screening 8 years after onset of pancolitis, or 12-15 years after onset of left sided-colitis.
• Repeat q 1-2 years.

Question 6

1-2 adenomas, < 1 cm.

Answer 6

• Repeat in 5 years.

* Repeat q 10 years, if normal.

Question 7

• 3 or more adenomas OR
• 1 adenoma > 1 cm OR
• Adenoma with villous history.

Answer 7

• Repeat in 3 years, if confident all adenomas have been found and resected.
• Repeat q 5 years, if normal.

Question 8

Large sessile (no stalk) adenoma > 2 cm.

Answer 8

• Repeat in 3 months.
• If residual polyp, remove and repeat in 6 months.
• If either of previous exams are normal, repeat in 1 year.
• If normal after 1 year, repeat q 3 years.
• If not normal after 2-3 examinations, then surgery.

Question 9

Adenoma with high grade dysplasia or malignant polyp. Completely resected with clear margins of excision and no invasion of stalk.

Answer 9

• Pedunculated–repeat in 3 years. Sessile–repeat in 3 months.
• If residual polyp, remove and repeat in 6 months.
• If either of previous exams are normal, repeat in 1 year.
• If normal after 1 year, repeat q 3 years.
• If not normal after 2-3 examinations, then surgery.

Question 10

Personal history of curative-intent resection of colorectal cancer.

Answer 10

• Repeat 6 months after cancer resection.
• Repeat in 3 years, if normal.
• If normal after 3 years, repeat in 5 years.

Question 11

Exams done with fair prep that compromises the exam.

Answer 11

Repeat in 1 year.