Screening and Surveillance for Gastrointestinal Cancer Flashcards
Screening
Identification of disease in its preclinical or early stage to facilitate early treatment.
Read the following on when screening is suitable:
– 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
The two different types of screening:
Mass screening
– Whole population or large subgroup
Targeted screening
– High-risk groups
What are the drawbacks of screening?
- Ineffective use of resources
- Large-scale exposure to adverse effects
- Erroneous results – types I and II errors
- Overdiagnosis
What are the two screening programmes in the UK?
- Bowel scope
* National bowel cancer screening
The Bowel scope screening programme involves what?
One off flexible sigmoidoscopy at age 55.
The National bowel cancer screening programme involves what?
From 60-74
Every 2 years FOB test or FIT
- if FIT/FOB is positive then follow up colonoscopy.
FIT / FOB
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
Define surveillance
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.
What criteria would place someone under the surveillance category for colorectal cancer?
Family history Previous polyps Inflammatory bowel disease FAP HNPCC PJS (Peutz Jeghers syndrome)
Pernicious anaemia
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.
Under what criteria would you be under surveillance for gastric cancer?
Atrophic gastritis
Auto-immune gastritis
Pernicious anaemia
H.pylori infection
What are the two types of cancer of the oesophagus?
Squamous cell carcinoma.
What predisposes you to getting oesophageal squamous cell carcinoma?
Smoking
Alcohol
What predisposes you to Barrett’s oesophagus?
Obesity
Smoking
GORD
Barrett’s oesophagus
Intestinal metaplasia in response to GORD.
Where the squamous epithelium changes to columnar epithelium.
What is the endoscopic treatment for neoplasia in the oesophagus?
Endoscopic mucosal resection - band ligation EMR.
Argon plasma coagulation.
HALO radiofrequency ablation.
HALO radiofrequency ablation
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.
Read: Band ligation EMR (endoscopic mucosal resection).
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.
Read: Argon plasma coagulation.
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.
What are the alarm symptoms of GI cancers?
Bleeding Vomiting Fever Weight loss Difficulty swallowing Chest pain Abdominal mass GORD
Peutz-Jeghers syndrome
Multiple hamartomatous polyps occur in the small intestine and colon, as well as melanin pigmentation of the lips, mouth and digits.
What are the symptoms of Peutz-Jeghers syndrome?
Most cases are asymptomatic, although chronic bleeding, anaemia or intussusception can occur.
What are the complicaitons of Peutz-Jeghers syndrome?
There is a significant risk of small bowel or colonic adenocarcinoma and of cancer of the pancreas, lung, testis, ovary, breast and endometrium.
How is PJS diagnosed?
By having 2/3 of the following features:
- small bowel polyposis
- mucocutaneous pigmentation
- a family history suggesting autosomal dominant inheritance.