High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of...
-
Upload
brian-morton -
Category
Documents
-
view
213 -
download
0
Transcript of High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of...
![Page 1: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/1.jpg)
![Page 2: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/2.jpg)
High risk population in GI fieldhow we can find them?
Ahmad Shavakhi MD
Associate professor of gastroenterology
![Page 3: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/3.jpg)
Gastric cancerGastric cancer
• Alarm sign in dyspepsia • Weight loss• Blood in stool• Vomiting• FHx positive for gastric cancer• Dysphagia • Mass in PH/E
![Page 4: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/4.jpg)
![Page 5: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/5.jpg)
• Fist degree relatives of gastric cancer patients?
![Page 6: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/6.jpg)
Colon cancerColon cancer
• Second most commonly diagnosed cancer in women and third most common in men
• 90 percent of cases occurring after age 50
![Page 7: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/7.jpg)
Colon cancer : preventable Colon cancer : preventable
![Page 8: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/8.jpg)
![Page 9: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/9.jpg)
Age over 50 years oldAge over 50 years old
![Page 10: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/10.jpg)
![Page 11: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/11.jpg)
![Page 12: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/12.jpg)
FOBTFOBT
![Page 13: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/13.jpg)
![Page 14: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/14.jpg)
![Page 15: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/15.jpg)
Ct colonograghyCt colonograghy
![Page 16: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/16.jpg)
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?
![Page 17: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/17.jpg)
• Advanced adenoma ≥1 cm, or high-grade dysplasia, or villous elements
![Page 18: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/18.jpg)
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
![Page 19: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/19.jpg)
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
![Page 20: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/20.jpg)
Single first-degree relative was diagnosed at age 60 years or older with CRC or an advanced adenoma
![Page 21: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/21.jpg)
![Page 22: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/22.jpg)
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
![Page 23: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/23.jpg)
• 2 or more first degree relatives with hnpcc cancer
![Page 24: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/24.jpg)
![Page 25: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/25.jpg)
• 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
![Page 26: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/26.jpg)
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
![Page 27: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/27.jpg)
IBDIBD
• left-sided UC• colonoscopy after 12 years of disease;
examinations are then performed every year thereafter
• Proctits • Do not performing surveillance
• Pancolitis •
![Page 28: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/28.jpg)
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
![Page 29: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/29.jpg)
![Page 30: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/30.jpg)
Fap Fap
• Classic FAP is characterized as the presence of 100 or more adenomatous colorectal polyps
![Page 31: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/31.jpg)
![Page 32: High risk population in GI field how we can find them? Ahmad Shavakhi MD Associate professor of gastroenterology.](https://reader035.fdocuments.us/reader035/viewer/2022070407/56649e195503460f94b06b0a/html5/thumbnails/32.jpg)