Term
| when does it start to be cost-effective to screen everyone for colonoscopies? |
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Definition
| @ age 50. incidence of colon CA in this country peaked in 2004 due to more aggressive screening protocols. |
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Term
| what are the diagnostic modalities available for colon CA detection? |
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Definition
| DRE, proctosigmoidoscopy (flexible is better), barium enema (good for pts refusing enema - use double contrast), colonoscopy (gold standard, get a complete one - to the cecum), capsule endoscopy, cytology (good for upper GI, too much contamination in intestine), and bx (always good) |
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Term
| what factors are related to malignancy in colorectal adenomas? |
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Definition
| size, number, villus component, dysplasia, and location |
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Term
| how does size affect colorectal adenoma malignancy? |
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Definition
| since malignancy potential grows from tubular to villous, this means that the bigger the adenoma, the more likely it is to be malignant |
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Term
| how does location affect colorectal adenoma malignancy? |
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Definition
| 55% polypoid lesions are in the sigmoid and rectal areas, but the next biggest number - 13% are in the cecum, which is esp important b/c they are hard to see and cause very little pain - in women bleeding/anemia may be attributed to the menstrual cycle. |
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Term
| how does number affect colorectal adenoma malignancy? |
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Definition
| the higher the number of adenomas, the higher the risk of one of them becoming malignant |
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Term
| how does level of dysplasia affect colorectal adenoma malignancy? |
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Definition
| if a pt has severe dysplasia - they have CA until proven otherwise. lateral or deep to biopsy, there is probably an occult neoplasm. this requires at least 8 bx's. |
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Term
| what are colon CA screening recommendations for pts w/no family history of colorectal cancer? |
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Definition
| *annual fecal occult blood tests and flexible sigmoidoscopy every 5 yrs starting at age 50 OR colonscopy every 10 yrs OR double contrast barium enema every 5-10 yrs* |
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Term
| what are colon CA screening recommendations for pts with 1 first degree relative with colorectal cancer? |
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Definition
| *same protocol as anyone else, but start at age 40* |
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Term
| what are colon CA screening recommendations for pts with >1 first degree relative with colorectal cancer? |
|
Definition
| *colonoscopy every 3 yrs starting at age 40* |
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Term
| what are colon CA screening recommendations for pts with a family hx of Hereditary Nonpolyposis Colorectal Cancer (HNPCC)? |
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Definition
| *colonoscopy every 1-3 yrs, starting at age 21* |
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Term
| what characterizes HNPCC? |
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Definition
| colorectal CA is diagnosed in HNPCC pts at an avg age of 44 yrs, which tend to occur in the R colon and few colon polyps are present. many other kinds of CA are associated with HNPCC. |
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Term
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Definition
| pts with familial adenomatous polyposis start getting polyps early in their teens and become so numerous that their colon looks like a "shag rug". many become malignant - have to screen every 6 mos if colon left in |
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