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
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