gastroenterology and hepatology - colorectal cancer screening
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8/22/2019 Gastroenterology and Hepatology - Colorectal Cancer Screening
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Colorectal Cancer
Screening
M3 Teaching Session
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Why do we screen?
Early detection of colorectal cancer
Improved survival at earlier stages
Prevention of colorectal cancer Removal of premalignant lesions
Size, Histology, Number of polyps
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Staging and Survival, US 1999-2005
Jemal, 2010
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Methods of Screening
Non-invasive
FOBT (gFOBT, FIT)
sDNA (stool)
Invasive
Flexible sigmoidoscopy
Colonoscopy
DCBE double contrast barium enema
CTC CT colonography
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FOBT and sDNA
Identify fecal blood or genetic mutations
Collection
Storage Frequency
Detection but not Intervention
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Flexible Sigmoidoscopy and
Colonoscopy
Require bowel prep
Sedation vs non-sedated
Ability to intervene on premalignant(polypectomy) or malignant (biopsies)
abnormalities
Operator dependent Low invasive procedure
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Colonoscopy and Polypectomy
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Case 1
40 yo AA M presents for HTN recheck
Takes HCTZ
Otherwise healthy, asymptomatic
Family history
Mother died of colon cancer
Sister and Aunt had breast cancer
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Case 2
53 yo F presents for routine f/u
Takes Pentasa
History of Ulcerative Colitis
Takes Urosdiol
Recently diagnosed with PSC
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Case 3
55 yo M presents with cough
Does not see a doctor regularly
Not interested in screening procedures
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Who to screen and when
Average risk, asymptomatic pts
Pts with inflammatory bowel disease
Pts with family history of colon cancer Pts with family history of colon polyps
Pts with personal history of polyps
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Average risk, asymptomatic patients
Start at age 50
Patients with inflammatory bowel disease
Start 8 years after onset of disease
Patients with PSC
Start at time of PSC diagnosis
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Patients with family history
First degree relative age 60 or older Start at age 40
First degree relative age 59 or younger
Start at age 40 or 10 yrs earlier than youngest case inimmediate family
Patients with FAP Start at age 10, MANY polyps
APC gene mutation Patients with HNPCC (lynch syndrome)
Start at age 20 or 10 yrs earlier than youngest case inimmediate family
Error in mismatch repair -> accumulation of mutations More prevalent in rapidly dividing tissues
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Risk factors
Modifiable
Obesity
Lack of physical
activity Diabetes
Diet (red / processed
meats)
Smoking Excessive alcohol
Hereditary
Family history of colon
cancer
Inflammatory boweldisease
Diabetes
Race
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The bottom line
Identify risk factors
Family history, Race, Inflammatory bowel ds,
PSC
Which test to use
Discuss with patients
Get your patients screened!!!
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Reference Materials
Screening and Surveillance for the Early
Detection of Colorectal Cancer and
Adenomatous Polyps, 2008: A Joint
Guideline from the ACS, USMSTF, ACR
ACG Guidelines for Colorectal Cancer
Screening 2008
NCCN Clinical Practice Guidelines for
Colorectal Cancer Screening
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