Health Maintenance & Screening Flashcards
Risk Factors for Colorectal CA
Age >50 Hx of adenomatous polyps Personal Hx of IBD Family Hx African-American or Easter European Jew Type 2 DM
Adenomatous Polyps (Adenomas)
Adenomas increase colon CA risk
Large or multiple polyps increase risk
Hyperplastic polyps do not increase risk
Personal Hx of IBD
Ulcerative colitis
Crohn’s disease
Why is a personal Hx of IBD important?
Chronic inflammation
Dysplasia
CA
Lifestyle Related Factors
Diet: high in red meat/processed meats, low fruits/veggies consumption Physical inactivity Obesity Smoking Heavy alcohol use
Family Hx of Adenomatous Polyps or Colorectal CA
1 in 5 have a family Hx of colorectal CA
First degree relative with colorectal CA doubles risk
Family members with adenomatous polyps also increase risk
Inherited Syndromes
Family Adenomatous Polyposis (FAP
Hereditary non-polyposis colon cancer (HNPCC)
Turcot syndrome: DNA mismatch repair
Peutz-Jeghers syndrome: dramatic looking polyps; increased risk of CA elsewhere
Type 2 DM
Increased risk of colorectal CA
Less favorable prognosis
Previous Treatment for Other CA
Testicular CA
Prostate CA
Colorectal CA Screening Tests
Flexible sigmoidoscopy Colonoscopy Double-contrast barium enema Virtual colonoscopy Fecal occult blood test (FOBT) Fecal immunochemical test (iFOBT or FIT)
Pros of Fecal Immunochemical Test (iFOBT or FIT)
More accurate
Less false positives
No dietary restrictions
Uses antibodies to detect HB in stool
Flexible Sigmoidoscopy
Quick & safe Sedation not used Doesn't require specialist Done every 5 years View 1/3 of colon Can miss polyps Can't remove polyps Colonoscopy of abnormal Small risk of bleeding, infection, or bowel tear
Colonoscopy
Preferred method View entire colon Biopsy & remove polyps Every 10 years Can mis polyps Full bowel prep needed Sedation needed Small risk of bleeding, bowel tears, or infection Expensive
Double Contrast Barium Enema
Usually view entire colon Relatively safe Every 5 years No sedation Can miss sm. polyps Full bowel prep Some false positive results Can't remove polyps during testing Colonoscopy if abnormal Replaced by virtual colonoscopy
Virtual Colonoscopy
Quick & safe Usually view entire colon Every 5 years No sedation Full bowel prep Can miss sm. polyps Some false positive test results Colonoscopy if abnormal Air enema given CT scan of colon done times 2
Fecal Occult Blood Test (FOBT)
No risk to colon No bowel prep Done at home Inexpensive May produce false positive tests Pre-test dietary restrictions Yearly 3 stool samples Patient drops off Colonoscopy if abnormal
Restrictions Prior to FOBT
Avoid NSAIDs 7 days
Avoid vitamin C 3 days
Avoid red meats 3 days
Difference Between FIT & FOBT
No pre-test restrictions More accurate Less false positives Uses antibodies to detect HB 1 day sample Automated vs. manual system Closed system Better patient compliance
Guidelines for Colon CA Screening
Begin at age 50
Colonoscopy every 10 years
Unable to Undergo Colonoscopy Then:
Flexible sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Virtual colonoscopy every 5 years
If all imaging tests refused or contraindicated then:
FOBT yearly with 3 stool samples
FIT yearly
Exceptions to Colon CA Screening Guidelines
African-Americans at age 45
High risk guidelines more aggresive
High Risk Colon CA Screening Guidelines
1st degree family with colon CA need colonoscopy 10 years prior to relative’s age at diagnosis
IBD- colonoscopy every 1-2 years
Personal Hx of adenomatous polyps or colon CA- colonoscopy 1 year post resection then every 3-5 years
FAP- yearly flex sig beginning at age 10-12 years (positive genetic testing consider colectomy)
HNPCC- colonoscopy every 1-2 years beginning at age 20-25
Prevention of Colon CA
Colonoscopy
Decrease the western diet/lifestyle
Risks Factors for Hepatocellular Carcinoma (HCC)
Hep B viral infection Chronic Hep C infection Hereditary hemochromatosis Cirrhosis Nonalcoholic fatty liver disease DM Chronic alcohol abuse Chronic tobacco abuse Alpha-1 antitrypsin deficiency
HCC Screening Needed for:
Patients with cirrhosis
Chronic Hep B infection + Asian, African & African-Americans, family Hx of HCC
Caucasians with chronic Hep B + active inflammation & high viral load for several years, men >40, women >50
Screenings Tests for HCC
Liver ultrasound (every 6 months)
Summary of HCC
Hep B infection highly associated with HCC
Screening guidelines complex
Risk Factors for Esophageal CA
Age >55 Men 3x more likely ETOH abuse Tobacco use Obesity Diet: high in processed meats, low in fruits/veggies
Medical Conditions Associate with Esophageal CA
HPV infection GERD Barrett's esophagus: GERD Achalasia: narrowing of distal esophagus Tylosis: esophageal papillomas Plummer-Vinson syndrome: esophageal webs
Screening for Esophageal CA
None for general population
Periodic endoscopies: Barrett’s, achalasia, Plummer-Vinson syndrome
Dietary Fiber can be Beneficial for Treatment
Hemorrhoids
Constipation
Diarrhea
Diverticulosis
2 Types of Fiber
Soluble
Insoluble
Soluble Fiber
Dissolve in water
Foods Containing Soluble Fiber
Oatmeal Oat cereal lentils Apples Oranges Pears Oat bran Strawberries Nuts Flaxseeds Beans Dried peas Blueberries Psyllium Cucumbers Celery Carrots
Insoluble Fiber
Nondigestible
Foods Containing Insoluble Fiber
Whole wheat Whole grains Wheat bran Corn bran Seeds Nuts Barley Couscous Brown rice Bulgur Zucchini Celery Broccoli Cabbage Onions Tomatoes Carrots Cucumbers Green beans Dark leafy veggies Raisins Grapes Fruit Root veggie skins
What can fiber help treat?
Diarrhea (bulking)
Constipation (easier to pass)
Chronic Constipation can Lead to:
Hemorrhoids
Anal fissures
Development of diverticulosis
Dietary Fiber Recommendations
Women: 25 g/day
Men: 38 g/day
Diverticulosis
Starting at age 40
1/2 people btw 60-80
Almost everyone over 80
What can a high fiber diet help with?
Constipation
Diverticular disease
Diverticulitis
Risk Factors for GERD
Eating large meals before lying down
Obesity
Foods: citrus, tomato, chocolate, mint, garlic, onions, spicy or fatty foods
Drinks: ETOH, carbonated drinks, coffee, tea
Smoking
Pregnancy
Hiatal hernia
Medications that can worsen GERD
NSAIDs Beta-blockers CCB Bronchodilators Dopamine active drugs TCAs Some muscle relaxants
Dietary & Lifestyle Counseling to Reduce GERD Symptoms
Maintain healthy weight Avoid tight fitting clothes Avoid trigger foods Eat smaller meals Wait 3 hours after eating to lay down Elevate head of bed 6-9 inches Don't smoke or chew Decrease stress & anxiety
