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Flashcards in Health Maintenance & Screening Deck (45)
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1

Risk Factors for Colorectal CA

Age >50
Hx of adenomatous polyps
Personal Hx of IBD
Family Hx
African-American or Easter European Jew
Type 2 DM

2

Adenomatous Polyps (Adenomas)

Adenomas increase colon CA risk
Large or multiple polyps increase risk
Hyperplastic polyps do not increase risk

3

Personal Hx of IBD

Ulcerative colitis
Crohn's disease

4

Why is a personal Hx of IBD important?

Chronic inflammation
Dysplasia
CA

5

Lifestyle Related Factors

Diet: high in red meat/processed meats, low fruits/veggies consumption
Physical inactivity
Obesity
Smoking
Heavy alcohol use

6

Family Hx of Adenomatous Polyps or Colorectal CA

1 in 5 have a family Hx of colorectal CA
First degree relative with colorectal CA doubles risk
Family members with adenomatous polyps also increase risk

7

Inherited Syndromes

Family Adenomatous Polyposis (FAP
Hereditary non-polyposis colon cancer (HNPCC)
Turcot syndrome: DNA mismatch repair
Peutz-Jeghers syndrome: dramatic looking polyps; increased risk of CA elsewhere

8

Type 2 DM

Increased risk of colorectal CA
Less favorable prognosis

9

Previous Treatment for Other CA

Testicular CA
Prostate CA

10

Colorectal CA Screening Tests

Flexible sigmoidoscopy
Colonoscopy
Double-contrast barium enema
Virtual colonoscopy
Fecal occult blood test (FOBT)
Fecal immunochemical test (iFOBT or FIT)

11

Pros of Fecal Immunochemical Test (iFOBT or FIT)

More accurate
Less false positives
No dietary restrictions
Uses antibodies to detect HB in stool

12

Flexible Sigmoidoscopy

Quick & safe
Sedation not used
Doesn't require specialist
Done every 5 years
View 1/3 of colon
Can miss polyps
Can't remove polyps
Colonoscopy of abnormal
Small risk of bleeding, infection, or bowel tear

13

Colonoscopy

Preferred method
View entire colon
Biopsy & remove polyps
Every 10 years
Can mis polyps
Full bowel prep needed
Sedation needed
Small risk of bleeding, bowel tears, or infection
Expensive

14

Double Contrast Barium Enema

Usually view entire colon
Relatively safe
Every 5 years
No sedation
Can miss sm. polyps
Full bowel prep
Some false positive results
Can't remove polyps during testing
Colonoscopy if abnormal
Replaced by virtual colonoscopy

15

Virtual Colonoscopy

Quick & safe
Usually view entire colon
Every 5 years
No sedation
Full bowel prep
Can miss sm. polyps
Some false positive test results
Colonoscopy if abnormal
Air enema given
CT scan of colon done times 2

16

Fecal Occult Blood Test (FOBT)

No risk to colon
No bowel prep
Done at home
Inexpensive
May produce false positive tests
Pre-test dietary restrictions
Yearly
3 stool samples
Patient drops off
Colonoscopy if abnormal

17

Restrictions Prior to FOBT

Avoid NSAIDs 7 days
Avoid vitamin C 3 days
Avoid red meats 3 days

18

Difference Between FIT & FOBT

No pre-test restrictions
More accurate
Less false positives
Uses antibodies to detect HB
1 day sample
Automated vs. manual system
Closed system
Better patient compliance

19

Guidelines for Colon CA Screening

Begin at age 50
Colonoscopy every 10 years

20

Unable to Undergo Colonoscopy Then:

Flexible sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Virtual colonoscopy every 5 years

21

If all imaging tests refused or contraindicated then:

FOBT yearly with 3 stool samples
FIT yearly

22

Exceptions to Colon CA Screening Guidelines

African-Americans at age 45
High risk guidelines more aggresive

23

High Risk Colon CA Screening Guidelines

1st degree family with colon CA need colonoscopy 10 years prior to relative's age at diagnosis
IBD- colonoscopy every 1-2 years
Personal Hx of adenomatous polyps or colon CA- colonoscopy 1 year post resection then every 3-5 years
FAP- yearly flex sig beginning at age 10-12 years (positive genetic testing consider colectomy)
HNPCC- colonoscopy every 1-2 years beginning at age 20-25

24

Prevention of Colon CA

Colonoscopy
Decrease the western diet/lifestyle

25

Risks Factors for Hepatocellular Carcinoma (HCC)

Hep B viral infection
Chronic Hep C infection
Hereditary hemochromatosis
Cirrhosis
Nonalcoholic fatty liver disease
DM
Chronic alcohol abuse
Chronic tobacco abuse
Alpha-1 antitrypsin deficiency

26

HCC Screening Needed for:

Patients with cirrhosis
Chronic Hep B infection + Asian, African & African-Americans, family Hx of HCC
Caucasians with chronic Hep B + active inflammation & high viral load for several years, men >40, women >50

27

Screenings Tests for HCC

Liver ultrasound (every 6 months)

28

Summary of HCC

Hep B infection highly associated with HCC
Screening guidelines complex

29

Risk Factors for Esophageal CA

Age >55
Men 3x more likely
ETOH abuse
Tobacco use
Obesity
Diet: high in processed meats, low in fruits/veggies

30

Medical Conditions Associate with Esophageal CA

HPV infection
GERD
Barrett's esophagus: GERD
Achalasia: narrowing of distal esophagus
Tylosis: esophageal papillomas
Plummer-Vinson syndrome: esophageal webs