High risk population in GI fieldhow we can find them?

Ahmad Shavakhi MD

Associate professor of gastroenterology

Gastric cancerGastric cancer

• Alarm sign in dyspepsia • Weight loss• Blood in stool• Vomiting• FHx positive for gastric cancer• Dysphagia • Mass in PH/E

• Fist degree relatives of gastric cancer patients?

Colon cancerColon cancer

• Second most commonly diagnosed cancer in women and third most common in men

• 90 percent of cases occurring after age 50

Colon cancer : preventable Colon cancer : preventable

Age over 50 years oldAge over 50 years old

FOBTFOBT

Ct colonograghyCt colonograghy

Colon cancerColon cancer

• RISK ASSESSMENT:

• Have any blood relatives had colorectal cancer or a precancerous polyp?

• If so:• How many• Were these first-degree relatives or second-degree

relatives • At what age were the cancers or polyps diagnosed?

• Advanced adenoma ≥1 cm, or high-grade dysplasia, or villous elements

single first-degree relative single first-degree relative was was diagnosed before 60 years with diagnosed before 60 years with CRC or an advanced adenomaCRC or an advanced adenoma

• Colonoscopy is recommended at age 40 or 10 years before the youngest relative's diagnosis, to be repeated every five years

two or more first-degree relatives had colorectal cancer or advanced adenomas at any age

• colonoscopy is recommended at age 40 or 10 years before the youngest relative's diagnosis, to be repeated every five years

 Single first-degree relative was diagnosed at age 60 years or older with CRC or an advanced adenoma

Digital rectal examinationDigital rectal examination

• One in four colorectal cancers is in the rectum, and many are within an examiner’s reach on digital rectal examination.

• Little evidence to support the effectiveness of digital rectal examination for the detection of rectal cancer

• It is not recommended in current colorectal screening guidelines

• 2 or more first degree relatives with hnpcc cancer

• Annual colonoscopy ages of 20 and 25 years, or 10 years prior to the earliest age of colon cancer diagnosis in the family (whichever comes first

• Annual endometrial biopsy and CA 125 and transvaginal ultrasound beginning at age 30 to 35 years, or 5 to 10 years earlier than the earliest age

• Discussion of prophylactic hysterectomy and salpingo-oophorectomy at the end of childbearing years.

• Annual urinalysis beginning at age 25 to 35 years• Annual skin surveillance• Periodic upper endoscopy

 survivors of childhood cancer who received 30 Gy or more of abdominal radiation

• Colonoscopy every five years• Screening beginning 10 years after

radiation or at age 35 years

IBDIBD

• left-sided UC• colonoscopy after 12 years of disease;

examinations are then performed every year thereafter

• Proctits • Do not performing surveillance

• Pancolitis •  

Polyp Polyp

• 1 or 2 small tubular adenomas with LGD• 5-10 yr after initial polypectomy

• 3 to 10 adenomas or 1 adenoma >1 cm or any adenoma with villous features or HGD• 3 yr after initial polypectomy

• >10 adenomas on a single examination• <3 yr after initial polypectomy

• Patients with sessile adenomas that are removed piecemeal• to 6 months to verify complete removal

Fap Fap

• Classic FAP is characterized as the presence of 100 or more adenomatous colorectal polyps