GI Cancer Epidemiology and Screening

Question 1

CRC is the ___ most common malignant neoplasm for men and women in the US, and ___ leading cuase of cancer death in the US if you combine across men and women

Answer 1

third

second

Question 2

What is the lifetime risk for general americans?

Answer 2

5%

Question 3

What is the difference between primary prevention and secondary prevention?

Answer 3

primary prevention entails changing the enviroment and making lifestyle changes

secondary prevention is attacking the precursor of the disease - in this case removing benign polyps to avoid progression

Question 4

What are some important aspects in perimary prevention for CRC?

Answer 4

1. diet and exercise to lower BMI
2. ASA/NSAIDS/Cox-2 inhibitors
3. calcium and vitamin D
4. hormone replacement therapy in women? estrogen is protective
5. statins may be protective - BMI consideration again

Question 5

What percentage of CRC arises in adenomatous and serrated polyps over time?`

Answer 5

95%

Question 6

if someone has no personal or family hisotry and no signs or symptoms, what age should screening start? when should it end?

Answer 6

begin at age 50 (45 for african americans)

stop at 75

Question 7

What are some other screening mechanisms for those with average risk?

Answer 7

1. fecal occult blood test
2. double contrast barium enema
3. flex sig every 5 years
4. virtual colnoscopy
5. pillcamm colonoscopy
6. stools DNA testing

Question 8

How often would guaice-based testing for fecal occult blood be done?

Answer 8

annually

Question 9

How often would immunochemical-based fecal occult blood or fecal immunochemical testing be done?

Answer 9

annually

Question 10

How often would a stool DNA panel with Cologuard be done?

Answer 10

every 3 years

Question 11

What is the main issue with sDNA testing right now?

Answer 11

we don’t knw the appropriate re-screening interval

Question 12

What are some risk factors for CRC?

Answer 12

age over 50
personal HX of CRC or adenomas
personal hx of long-standing UC or CD
personal hx of ovarian, endometrial or breast cancer
first degree relative with CRC
first degree relative with adenoma before 60

Question 13

If you hav ea first degree relative with CRC or adenoma diagnosed at over 60 years of age, when should you start screening?

Answer 13

still 50 (45 for blacks)

Question 14

If you have a first degree relative with CRC or adenoma diagnosed before age 60, when should you start screening?

Answer 14

40 years or 10 years younger than the affected relative’s age when diagnosed - whichever is earlier

Question 15

If you have two first degree relatives with CRC or adenoma diagnosed at any age, when should you start screening

Answer 15

40 years or 10 years younger than the yougnest affected relative’s age when diagnosed, whichever is earlier

Question 16

What percentage of CRC occur in people who have no risk factors?

Answer 16

75%!!! MOST PEOPLE WHO DEVELOP CRC HAVE NO IDENTIFIABE RISK FACTORS

which is why everyone needs to be screened

Question 17

People with lynch syndrome should have surveillance for what cancers?

Answer 17

GI, GU, ovarian and endometrial

Question 18

What should the colonoscopy schedule be for someone with lynch syndrome?

Answer 18

every 2 years starting at age 20-25

annual after age 40

also do genetic counseling/testing

Question 19

What should the screening be for someone with FAP?

Answer 19

flex sig or colonoscopy ever 1-2 years starting at age 10-12

Question 20

How does a diagnosis of UC affect colonoscopy schedules?

Answer 20

do colonoscopy with biopsy for dysplasia every 1-2 years beginning 7-8 years after diagnosis or 12-15 years after diagnosis of left-sided colitis

Question 21

What are some symptoms that would switch a colonoscopy from a screening test to a diagnostic test?

Answer 21

change in bowel movements
rectal bleeding
stool testing positive
abdominal pain
anemia
weight loss

Question 22

What type of cancer occurs in the upper and middle third of esophagus?

Answer 22

squamous cell

Question 23

What cancer occurs in the lower third of the esophagus?

Answer 23

adenocarcinoma (related to Barrett’s)

Question 24

What are the risk factors for esophageal squamous cell carcinoma?

Answer 24

tobacco
alcohol
african american ethnicity
male gender
mucosal irritants
carcinogen ex[osure
poor nutrition and diet

Question 25

What are the risk factors for esophageal adenocarcinoma?

Answer 25

gastroesophageal reflux
barrett's esophagus
caucasian ethnicity
male gender
obesity
poor diet

Question 26

What is the screening test for esophageal CA?

Answer 26

EGD

Question 27

What are the symptoms that would switch an EGD from a screening test to a diagnostic test?

Answer 27

dysphagia, anorexia, cachexia, pain, hoarseness, cough

Question 28

Hepatocellular carcinoma is the ____ most comon cancer in the world

Answer 28

fourth

Question 29

What is 5 year survival for hepatocellular carcinoma ifyou don’t get treatment?

Answer 29

5%

Question 30

What countries have the highest rates of hepatocellualr carcinoma?

Answer 30

China, Western Africa and Mediterranean

Question 31

What is the dominant causative agent for hepatocellular crcinoma in asia and africa?

Answer 31

hepatitis B virus

Question 32

What are the two dominant causative agents in the US and europe?

Answer 32

hep C and alcohol

Question 33

What is the common causative agent shared by east asia and africa?

Answer 33

aflotoxins on grains the legumes

Question 34

What industrial carcinogen is associated with hepatocellular carcinoma/

Answer 34

vinyl chloride

Question 35

What are typical symptoms of hepatocellular carcinoma?

Answer 35

abdominal pain, abdominal swelling, weight loss, weakness, feeling of fullness and anorexia, vomiting and jaundice

Question 36

How do you screen for hepatocellular carcinoma?

Answer 36

alpha-fetoprotein
abdominal helical CT
Abd US if CT not available
liver biopsy for diagnosis
screen for Hep C

screen every 6 months