Wk6 Cancer Screening Westra Flashcards
Group with highest mortality rate from CRC?
African Americans
Only group CRC is not decreasing in:
American Indians and Alaska Natives
Examples of primary prevention of CRC:
- Diet-Exercise (BMI)
- COX-2 inhibitors
- Calcium/vit D
- Hormone replacement therapy
- Statins
Secondary CRC prevention strategies:
GET POLYPS OUT!
95% of CRC comes from adenomatous and serrated polyps
What constitutes “average risk” of CRC:
No personal or FHx
Asymptomatic
When to start screening “average risk” for CRC?
How often follow up?
age 50 (45 for African Americans)
every tens years if scope is normal
Age to discontinue CRC screening:
75
Colonoscopy screening frequency in average risk?
every 10 years
Flex-sig screening for average risk; how often?
every 5 years
+/- fecal occult blood test
Stool DNA panel every three years?
Cologuard
- no dietary prep
- expensive
Cologuard compared to FIT:
More sensitive but more false positives
PillCam vs colonoscopy?
Colonoscopy better
Main patient reason for not having colonoscopy?
Fear, embarrassment
RF for CRC
Age > 50
Personal Hx of CRC or adenomas
UC/Crohn’s
Hx endometrial/ovarian/breat CA
First deg relative with CRC
First deg relative with adenoma before age 60
When to start screening a pt with first degree relative with CRC:
40 … or 10 years younger than relative was at dx… whichever is earlier
Group that 75% of CRC arise in:
Average risk group
What is the “choosing wisely campaign”?
Do not repeat CRC screening for 10 years in average risk group after high quality negative colonoscopy
Symptoms of high suspicion for CRC:
anemia
weight loss
Ethnicity at greater risk for esophageal SCC?
African Americans
Ethnicity at greatest risk for esophageal adenocarcinoma:
Caucasian
RF for SCC:
Tobacco
EtOH
RF for adenocarcinoma:
GERD
Barrett’s esophagus
obesity
male
Only real screening for Esophageal CA:
EGD
Likely causes of HCC in USA:
Hep C
EtOh
Screening options for HCC in high risk:
Alpha-fetoprotein
Abd CT – US if CT not available
Dx for HCC:
biopsy
