gballarino
Forum Senior
Topics: 12
Posts: 96
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A 28 year old female patient comes for a consult with a primary care physician. She is in perfect health, but she is concerned about colorectal cancer screening. His father died of colon cancer 2 years ago at age 51, and her grandfather died to cancer (she does not know "which kind"). Her 52 year old uncle has recently been diagnosed with colon cancer and the family physician sugested "an inheritable form of cancer".
She wants to know wether she needs to be studied for cancer or not.
What should we recommend?
What study we order for screeningn this patient?
At what intervals?
Should we recomend regular screening for primary cancer other than colorrectal?
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Guillermo Ballarino
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| zaki
Forum Guru
Topics: 92
Posts: 398
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1.she must have screening test.
2.for this pt i should recommend colonoscopy.
3. i am not sure at this age what to do, but high risk pt should have early colonscopy as compare to 3-5early for other peoples,but i am not sure at what age this should be started.
4. as you describe and have the name of the syndrome in your subject area that is lynch syndrome also know as hereditary nonpolyposis syndrome(HNPCC), Pt affected with this syndrom are also at high risk of ovarian and endometrial cancer, so screening for these cancer also recommended.
do we have any screenig test for ovarian cancer??
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Maverick
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| Moozy
Forum Guru
Topics: 46
Posts: 820
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I agree with Zaki.
I guess i would do a fecal occult blood test at this age.
Colonoscopy after 40 yrs of age at 5 year intervals.
And yes ovarian and endometrial cancer should be checked for also.. but i am not sure abt any screening tests.. we can run the diagnostice tests though. ( but not sure of age again).
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Inability is a disaster; patience is bravery; abstinence is a treasure, self-restrain is a shield; and the best companion is submission to Divine Will
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| gballarino
Forum Senior
Topics: 12
Posts: 96
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Looking for blood in stools is no longer an acceptable screening method for GI cancer. Suppose you got yourself a positive result.... you´re too late!!! It´s not sensitive nor specific enough. So, if you think screening is indicated, you have to go for visualization of the colon. The options are sigmoidoscopy or complete colonoscopy.
In general population, with no aditional risk factors (universal), screening should begin at age 45 for men and 55 for woman, and repeated at 5 year intervals.
Now... for people family history of colon cancer, the screening should begin 10 years before the age at which the diagnosis was made on the relative.
Screening for "genetic" forms of colon cancer (polyposis coli, lynch's) begins even earlier. Around adolescence for familial polyposis coli, and at 25 years old for lynch's. Moreover, the screening for colon cancer in polyposis coli can be done with sigmoidoscpy, but the screening for cancer in lynch's syndrome have to be done by complete colonoscopy, because the finding of a "clean" distal bowel does not allow you to asume that proximal colon is free of cancer. In polyposis coli, adenomas occur throughout the colon, and by sampling only the sigmoid, you can rule out the blown up syndrome. About the intervals, I am not sure, but i think is every 3 years for both.
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Guillermo Ballarino
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