GI Cancer Epidemiology and Screening Flashcards
CRC is the ___ most common malignant neoplasm for men and women in the US, and ___ leading cuase of cancer death in the US if you combine across men and women
third
second
What is the lifetime risk for general americans?
5%
What is the difference between primary prevention and secondary prevention?
primary prevention entails changing the enviroment and making lifestyle changes
secondary prevention is attacking the precursor of the disease - in this case removing benign polyps to avoid progression
What are some important aspects in perimary prevention for CRC?
- diet and exercise to lower BMI
- ASA/NSAIDS/Cox-2 inhibitors
- calcium and vitamin D
- hormone replacement therapy in women? estrogen is protective
- statins may be protective - BMI consideration again
What percentage of CRC arises in adenomatous and serrated polyps over time?`
95%
if someone has no personal or family hisotry and no signs or symptoms, what age should screening start? when should it end?
begin at age 50 (45 for african americans)
stop at 75
What are some other screening mechanisms for those with average risk?
- fecal occult blood test
- double contrast barium enema
- flex sig every 5 years
- virtual colnoscopy
- pillcamm colonoscopy
- stools DNA testing
How often would guaice-based testing for fecal occult blood be done?
annually
How often would immunochemical-based fecal occult blood or fecal immunochemical testing be done?
annually
How often would a stool DNA panel with Cologuard be done?
every 3 years
What is the main issue with sDNA testing right now?
we don’t knw the appropriate re-screening interval
What are some risk factors for CRC?
age over 50
personal HX of CRC or adenomas
personal hx of long-standing UC or CD
personal hx of ovarian, endometrial or breast cancer
first degree relative with CRC
first degree relative with adenoma before 60
If you hav ea first degree relative with CRC or adenoma diagnosed at over 60 years of age, when should you start screening?
still 50 (45 for blacks)
If you have a first degree relative with CRC or adenoma diagnosed before age 60, when should you start screening?
40 years or 10 years younger than the affected relative’s age when diagnosed - whichever is earlier
If you have two first degree relatives with CRC or adenoma diagnosed at any age, when should you start screening
40 years or 10 years younger than the yougnest affected relative’s age when diagnosed, whichever is earlier
What percentage of CRC occur in people who have no risk factors?
75%!!! MOST PEOPLE WHO DEVELOP CRC HAVE NO IDENTIFIABE RISK FACTORS
which is why everyone needs to be screened
People with lynch syndrome should have surveillance for what cancers?
GI, GU, ovarian and endometrial
What should the colonoscopy schedule be for someone with lynch syndrome?
every 2 years starting at age 20-25
annual after age 40
also do genetic counseling/testing
What should the screening be for someone with FAP?
flex sig or colonoscopy ever 1-2 years starting at age 10-12
How does a diagnosis of UC affect colonoscopy schedules?
do colonoscopy with biopsy for dysplasia every 1-2 years beginning 7-8 years after diagnosis or 12-15 years after diagnosis of left-sided colitis
What are some symptoms that would switch a colonoscopy from a screening test to a diagnostic test?
change in bowel movements rectal bleeding stool testing positive abdominal pain anemia weight loss
What type of cancer occurs in the upper and middle third of esophagus?
squamous cell
What cancer occurs in the lower third of the esophagus?
adenocarcinoma (related to Barrett’s)
What are the risk factors for esophageal squamous cell carcinoma?
tobacco alcohol african american ethnicity male gender mucosal irritants carcinogen ex[osure poor nutrition and diet
