Gastroenterology and Hepatology - Colorectal Cancer Screening

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

Gastroenterology and Hepatology - Colorectal Cancer Screening

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