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Flashcards in Westra: GI Epidemiology Deck (46):
1

Average-risk, asymptomatic individuals-both men and women-should be offered screening for colorectal cancer beginning at age 40.
a. True
b. False

False

2

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

3

About 95% of all colorectal cancers arise in benign adenomatous polyps.
a. True
b. False

True

4

Direct colonoscopy screening should be reserved only for those who are at above average risk for colorectal cancer
a. True
b. False

False

5

Patients with HNPCC (Hereditary Nonpolyposis Colorectal Cancer) do not
develop polyps.
a. True
b. False

False

6

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

7

Genetic testing for HNPCC is a research tool and not available for clinical use.
a. True
b. False

False

8

Colon cancer is the second-leading cause of cancer related deaths in the U.S.
a. True
b. False

True

9

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

10

Stool-based DNA tests detect only about 60% of existing colorectal cancers.
a. True
b. False

false

11

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

12

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

13

What is primary prevention in CRC?

Diet-Exercise (BMI)
ASA/NSAIDs/Cox-2 Inhibitors
Calcium/Vitamin D
Hormone Replacement Therapy
Statins

14

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

15

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

16

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

17

What percentage of americans over the age of 50 undergo screening for CRC?

40%

18

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

19

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)

20

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

21

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)

22

HNPCC Mutation?

Mutation in DNA mismatch repair genes

Few colonic polyps present
Lesions tend to occur in right colon

23

HNPCC is waht percent of CRC?

~3% of all CRC

24

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

25

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)

26

FAP is an AD defect that causes what percentage of CRC?

1 %

27

How does FAP present?

Hundreds of adenomatous polyps @ 39 and extracolonic tumors

28

Screening for FAP?

Flexible sigmoidoscopy or colonoscopy every 1 to 2 years starting at 10-12
Genetic counseling
Consider genetic testing

29

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

30

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.

31

These sxs are signs of....

Change in bowel movements
Rectal bleeding
Stool testing positive
Abdominal pain
Anemia
Weight loss

CRC

32

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

33

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%

34

What are the two types of esophageal cancer?

Squamous Cell (Epidermoid): upper and middle third of esophagus

Adenocarcinoma: lower third related to Barrett’s

35

What percent of GI cancers are esophageal?

6%

36

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

37

How do we screen for Esophageal Cancer?

EGD

Recognition of major risk factors may help target high-risk persons

?Early detection may impact survival

38

A pt presents w/ dysphagia, anorexia, cachexia, pain, hoarseness and couh.

Dx?

Esophageal cancer

39

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

40

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)

41

What are the major causes of liver cancer?

Hepatits B
Hepatitis C
Alcohol leading to cirrhosis
Hemochromatosis

42

What are environmental causes of hepatocellular carcinoma?

Aflatoxin B
Vinyl chloride
Anabolic steroids

43

A pt presents w/: Abdominal Pain
Abdominal Swelling
Weight loss
Weakness
Feeling of fullness and anorexia
Vomiting
Jaundice

Hepatocellular Carcinoma

44

What are physical findings in a pt w/ hepatocellular carcinoma?

Hepatomegaly
Splenomegaly
Ascites
Jaundice
Fever
Hepatic bruit

45

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

46

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.