Westra: GI Epidemiology Flashcards
Average-risk, asymptomatic individuals-both men and women-should be offered screening for colorectal cancer beginning at age 40.
a. True
b. False
False
Which two colorectal cancer screening options are most highly recommended by the US Preventative Task Force?
a. FOBTs annually
b. Flexible sigmoidoscopy every five years
c. Both annual FOBTs and flexible sigmoidoscopy every five years
d. Double contrast barium enema every five years
e. Colonoscopy every ten years
c. Both annual FOBTs and flexible
e. Colonoscopy every ten years
About 95% of all colorectal cancers arise in benign adenomatous polyps.
a. True b. False
True
Direct colonoscopy screening should be reserved only for those who are at above average risk for colorectal cancer
a. True
b. False
False
Patients with HNPCC (Hereditary Nonpolyposis Colorectal Cancer) do not
develop polyps.
a. True
b. False
False
Surveillance colonoscopy for persons in an HNPCC family should occur:
a. every 3 years b. every 5 years c. every two years starting at age 25 annually after age 40 d. every 10 years
c. every two years starting at age 25 annually after age 40
Genetic testing for HNPCC is a research tool and not available for clinical use.
a. True b. False
False
Colon cancer is the second-leading cause of cancer related deaths in the U.S.
a. True b. False
True
Colon cancer screening is currently widely embraced by the general population, with 80% of those over 50 having been screened.
a. True b. False
False
Stool-based DNA tests detect only about 60% of existing colorectal cancers.
a. True b. False
false
52 year old female in good health presents to your office for a yearly examination including pap smear and breast exam. She is on no medications. Her family history is negative for breast cancer, colon cancer and diabetes. Her Hemoglobin is 14.5 gm/dl
What prevention strategies would you recommend for her regarding colorectal cancer?
Flex Sigmoidoscopy + FOBT including rectal exam
Colonoscopy q 10 years including rectal exam
What is the diff bewteen primary and secondary prevention in regards to CRC?
PRIMARY PREVENTION – changing the environment
SECONDARY PREVENTION – attacking the precursor of the disease – benign colonic polyp
What is primary prevention in CRC?
Diet-Exercise (BMI) ASA/NSAIDs/Cox-2 Inhibitors Calcium/Vitamin D Hormone Replacement Therapy Statins
What is secondary prevention in CRC?
Polyp/Cancer Relationship Neoplastic: Adenomatous and Serrated Polyp
Non-neoplastic: Hyperplastic Polyp
95% of CRC arises in adenomatous and serrated polyps over time
What are screening standards for pts at average risk for CRC?
No personal or family history No signs or symptoms Begin at age 50 Begin at age 45 in African Americans Individualize and discontinue when indicated by age, comorbidity-age 75
What are CRC screening measures in regards to stool testing?
Guaic-based fecal occult blood test (gFOBT) every year
Immunochemical-based fecal occult blood test (iFOBT) or fecal immunochemical test (FIT) every year
Stool DNA panel (sDNA): Cologuard every 3 years
What percentage of americans over the age of 50 undergo screening for CRC?
40%
What are RFs for CRC?
Age >50
Personal Hx of CRC or adenomas
Personal Hx of long-standing ulcerative colitis or Crohn’s disease
Personal Hx of ovarian, endometrial, breast ca
First-degree relative with CRC
First-degree relative with adenoma before 60
Screening for Single first-degree relative with colorectal cancer or an advanced adenoma diagnosed at > 60 years of age?
50 years (may start at 45 years in blacks) (10)
Screening if single first-degree relative with colorectal cancer or an advanced adenoma diagnosed at < 60 years of age?
40 years or 10 years younger than affected relative”s age
Screening if Two first-degree relatives with colorectal cancer or an advanced adenoma diagnosed at any age?
40 years or 10 years younger than the youngest affected
relative’s age when diagnosed, whichever is earlier (5)
HNPCC Mutation?
Mutation in DNA mismatch repair genes
Few colonic polyps present
Lesions tend to occur in right colon
HNPCC is waht percent of CRC?
~3% of all CRC
When is HNPCC usually diagnosed and what type of surveillance occurs?
Colorectal cancer at average age of 44 yr
Surveillance for GI, GU, ovarian and endometrial Cancers
What type of screening should occur for an individual w/ HNPCC?
Colonoscopy every 2 yr starting at 20-25 and annual colonoscopy after age 40
Genetic counseling
Consider Genetic Testing (5 HNPCC genes)
FAP is an AD defect that causes what percentage of CRC?
1 %
How does FAP present?
Hundreds of adenomatous polyps @ 39 and extracolonic tumors
Screening for FAP?
Flexible sigmoidoscopy or colonoscopy every 1 to 2 years starting at 10-12
Genetic counseling
Consider genetic testing
What type of screening should occur in a pt w/ ulcerative colitis?
Colonoscopy with biopsies for dysplasia every 1 to 2 years beginning 7 to 8 years after diagnosis or 12 to 15 years after diagnosis of left-sided colitis
What is hte choosing wisely campaign?
Do not repeat colorectal screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
These sxs are signs of….
Change in bowel movements Rectal bleeding Stool testing positive Abdominal pain Anemia Weight loss
CRC
55 year old male presents to your office with recurrent GERD. He is on Nexium with moderate relief. Because of his recurrent symptoms, he had an EGD which revealed Barrett’s esophagus. He smokes 2 packs/day.
Is he at risk of esophageal Ca? How often would you recommend that he be screened?
UGI or EGD – evaluate for Stricture or Esophageal CA - YEARLY
What is esophageal cancer? What is hte survival rate?
Uncommon, highly malignant cancer
Five year survival rate for localized stage 31%
Five year survival rate for all stages combined 15%
What are the two types of esophageal cancer?
Squamous Cell (Epidermoid): upper and middle third of esophagus
Adenocarcinoma: lower third related to Barrett’s
What percent of GI cancers are esophageal?
6%
What are RFs for Esophageal Ca Sq Cell?
ALCOHOL – hard liquor appears to confer higher risk than beer or wine
ETHNICITY – higher risk in African Americans than White Americans
SEX – higher risk in men than women
MUCOSAL IRRITANTS – long-term exposure to very hot tea, radiation-induced strictures, achalasia, ingestion of lye
CARCINOGEN EXPOSURE - Dietary nitrites, Fungal toxins in pickled vegetables
NUTRITION – Zinc deficiency, Vitamin A deficiency, Riboflavin deviciency
How do we screen for Esophageal Cancer?
EGD
Recognition of major risk factors may help target high-risk persons
?Early detection may impact survival
A pt presents w/ dysphagia, anorexia, cachexia, pain, hoarseness and couh.
Dx?
Esophageal cancer
45 year old male presents to your office with a positive test for Hepatitis C. He has a history of IV drug use, but no use for 2 years. He drinks a 6 pack of beer daily.
Is he at risk for Hepatocellular Ca?
If so, what recommendations would you make for screening?
Hepatitis C- Viral Load
Concern regarding cirrhosis and potential for hepatocellular CA
LIVER PANEL and LIVER SPLEEN SCAN and VIRAL LOAD
What is the 4th MC cancer in the world?
Hepatocelluar carcinoma
Men in sub-Saharan Africa and Asia 20x higher than US (related to endemic rates of viral hepatitis and environmental carcinogens – aflatoxins)
What are the major causes of liver cancer?
Hepatits B
Hepatitis C
Alcohol leading to cirrhosis
Hemochromatosis
What are environmental causes of hepatocellular carcinoma?
Aflatoxin B
Vinyl chloride
Anabolic steroids
A pt presents w/: Abdominal Pain Abdominal Swelling Weight loss Weakness Feeling of fullness and anorexia Vomiting Jaundice
Hepatocellular Carcinoma
What are physical findings in a pt w/ hepatocellular carcinoma?
Hepatomegaly Splenomegaly Ascites Jaundice Fever Hepatic bruit
In pts at high risk (cirrhosis, chronic HBV/HCV) for hepatocellular carcinoma, what do you screen?
Alpha-fetoprotein (AFP)
Abdominal helical CT
Abdominal Ultrasound if CT not available
Screen every 6 months?
Liver Biopsy for Diagnosis
What is the recommendation for HCV screening?
The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection. The USPSTF also recommends offering 1-time screening for HCV infection to adults born between 1945 and 1965.
