Screening and Surveillance for Gastrointestinal Cancer

Question 1

Screening

Answer 1

Identification of disease in its preclinical or early stage to facilitate early treatment.

Question 2

Read the following on when screening is suitable:

Answer 2

– Significant condition
– Effective available treatment
– Available access to healthcare
– Latent disease stage and well-understood natural
history
– A good and acceptable test
– Agreement on who to treat and planned programme
evaluation
– Acceptable cost
– Screening should be continuous

Question 3

The two different types of screening:

Answer 3

Mass screening
– Whole population or large subgroup

Targeted screening
– High-risk groups

Question 4

What are the drawbacks of screening?

Answer 4

• Ineffective use of resources
• Large-scale exposure to adverse effects
• Erroneous results – types I and II errors
• Overdiagnosis

Question 5

What are the two screening programmes in the UK?

Answer 5

• Bowel scope

* National bowel cancer screening

Question 6

The Bowel scope screening programme involves what?

Answer 6

One off flexible sigmoidoscopy at age 55.

Question 7

The National bowel cancer screening programme involves what?

Answer 7

From 60-74

Every 2 years FOB test or FIT
- if FIT/FOB is positive then follow up colonoscopy.

Question 8

FIT / FOB

Answer 8

Faecal Immunochemical Test - a stool test designed to identify possible signs of bowel disease. Detects minute amounts of blood in the faeces to detect abnormalities in the bowel - aka Faecal occult blood

Question 9

Define surveillance

Answer 9

Longitudinal, serial assessment of a disease state or precursor condition to facilitate early treatment in the event of disease development or progression.

• Employed following the identification of individuals at higher risk of disease development.

Question 10

What criteria would place someone under the surveillance category for colorectal cancer?

Answer 10

Family history
Previous polyps
Inflammatory bowel disease
FAP
HNPCC
PJS (Peutz Jeghers syndrome)

Question 11

Pernicious anaemia

Answer 11

Pernicious anaemia is a vitamin B-12 deficiency. It’s caused by an inability to absorb the vitamin B-12 needed for your body to make enough healthy red blood cells.

Question 12

Under what criteria would you be under surveillance for gastric cancer?

Answer 12

Atrophic gastritis
Auto-immune gastritis
Pernicious anaemia
H.pylori infection

Question 13

What are the two types of cancer of the oesophagus?

Answer 13

Squamous cell carcinoma.

Question 14

What predisposes you to getting oesophageal squamous cell carcinoma?

Answer 14

Smoking

Alcohol

Question 15

What predisposes you to Barrett’s oesophagus?

Answer 15

Obesity
Smoking
GORD

Question 16

Barrett’s oesophagus

Answer 16

Intestinal metaplasia in response to GORD.

Where the squamous epithelium changes to columnar epithelium.

Question 17

What is the endoscopic treatment for neoplasia in the oesophagus?

Answer 17

Endoscopic mucosal resection - band ligation EMR.
Argon plasma coagulation.
HALO radiofrequency ablation.

Question 18

HALO radiofrequency ablation

Answer 18

HALO radiofrequency ablation is a treatment used to destroy the abnormal Barrett’s oesophagus lining when precancerous changes, called high grade dysplasia, have developed. The HALO device is passed into the oesophagus and delivers very precise heat to the abnormal area to destroy it.

Question 19

Read: Band ligation EMR (endoscopic mucosal resection).

Answer 19

The band ligation technique of EMR uses the existing technology of variceal band ligation to endoscopically place a band on flat mucosal lesions of the gastrointestinal tract to create a “pseudopolyp” before resection with an electrocautery snare.

Question 20

Read: Argon plasma coagulation.

Answer 20

Argon plasma coagulation (APC) is a medical endoscopic procedure used to control bleeding from certain lesions in the gastrointestinal tract and to debulk tumours for which surgery is not recommended. It is administered during esophagogastroduodenoscopy or colonoscopy.

Question 21

What are the alarm symptoms of GI cancers?

Answer 21

Bleeding
Vomiting
Fever 
Weight loss
Difficulty swallowing
Chest pain
Abdominal mass
GORD

Question 22

Peutz-Jeghers syndrome

Answer 22

Multiple hamartomatous polyps occur in the small intestine and colon, as well as melanin pigmentation of the lips, mouth and digits.

Question 23

What are the symptoms of Peutz-Jeghers syndrome?

Answer 23

Most cases are asymptomatic, although chronic bleeding, anaemia or intussusception can occur.

Question 24

What are the complicaitons of Peutz-Jeghers syndrome?

Answer 24

There is a significant risk of small bowel or colonic adenocarcinoma and of cancer of the pancreas, lung, testis, ovary, breast and endometrium.

Question 25

How is PJS diagnosed?

Answer 25

By having 2/3 of the following features:

• small bowel polyposis
• mucocutaneous pigmentation
• a family history suggesting autosomal dominant inheritance.