Colon cancer screening recommendation presentation from Dr. Tracy d'Entremont, Director of Oncology Services at the Abramson Cancer Center at Valley Forge.

1. COLORECTAL CANCER
SCREENING
RECOMMENDATIONS
Tracy S. d’Entremont, MD
Clinical Assistant Professor
Hematology-Oncology Division
Hospital of the University of Pennsylvania

2. COLORECTAL CANCER
 CRC is the second leading cause of cancer death in the US
 An estimated 134,000 new cases will be diagnosed in 2016.
 Anticipated 49,000 deaths annually from this disease.
 The goal of any screening program
 Prevention
 Early detection
 Increased survival
JAMA June 21, 2016.

3. BENEFITS OF SCREENING
Gastroenterology November 2012 143 (5): 1227-1236

4. TYPES OF TESTS
 Tests that mainly find Cancer
 High- Sensitivity fecal occult blood test (FOBT)
 Fecal Immunochemical test (FIT)
 Stool DNA Test
 Tests that find Polyps and Cancer
 Flexible Sigmoidoscopy
 CT Colonography (virtual colonoscopy)
 Colonoscopy

5. DEFINE YOUR RISK
 Average Risk
 Age 50-75 years
 High Risk
 Personal History of Colorectal Cancer or Adenomatous Polyps
 Personal History of Inflammatory Bowel Disease
 Family History of Hereditary Colon Cancer Syndrome
 Strong Family History of Colorectal Cancer or polyps

6. AVERAGE RISK PATIENTS
 Colonoscopy every 10 years
 Flex Sigmoidoscopy every 5 years
 Plus stool test annually
 CT colonography every 5 years
 Plus stool test annually
USPTF, ACS, CDC

7. HIGH RISK PATIENTS
 First Colonoscopy
 At age 40, or 10 years before the youngest case
of cancer in the family
 At age 10-12, for patients in FAP families
 At age 20, for Lynch syndrome families
 8 years after the onset of colitis for inflammatory
bowel patients

8. POLYPS
Hyperplastic
Adenomatous
If more than 3
any larger than a cm
or any dysplasia
close interval colonoscopy is recommended
Sessile
Unless whole polyp was removed,
follow up in 2-6 months

10. DETECTION
VS.
PREVENTION

11. MELANOMA

12. The American Cancer Society estimates there will be 76,380
cases of invasive melanoma diagnosed in 2016
And 10,100 deaths from the disease
Incidence since 1975 has been increasing annually
3.2% for men
2.4 % for women
Without any end in site
American Cancer Society

13. PREVENTION
Avoidance of UV Exposure
Sunscreen
Limiting sun exposure during peak hours
Sunglasses
Wide brimmed hats
Long sleeves
No tanning beds

14. Self Skin Examination
Assymetry
Border Irregularity
Color

15. Diameter
Evolving