Master the board step 3

Gastroenterology
When is a “virtual colonoscopy” by CT scan the answer?
Answer: This is the answer when you are asked what colon cancer screening test NOT to do.
It lacks both sensitivity and specificity, because you cannot biopsy and it misses small lesions.
One Family Member with Colon Cancer
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Colonoscopy starting at age 40 or 10 years before the age of the family
member who had cancer
Three Family Members, Two Generations, One Premature (< 50)
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Colonoscopy every 1–2 years starting at age 25. This is a “Lynch syndrome,”
or hereditary nonpolyposis colon cancer syndrome.
Familial Adenomatous Polyposis (FAP)
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Start screening sigmoidoscopies at age 12.
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Perform a colectomy once polyps are found.
On routine x-ray, a man is found to have several osteomas. What do you recommend?
Answer: Perform a colonoscopy to screen for cancer. This is Gardner’s syndrome.
Gardner’s Syndrome
This presents with benign bone tumors known as osteomas, as well as other
soft tissue tumors.
Peutz-Jeghers Syndrome
This presents with melanotic spots on the lips. There are hamartomatous polyps
throughout the small bowel and colon. The lifetime risk of colon cancer is
about 10 percent, only slightly higher than the 6–8 percent risk of colon cancer
in the general population. There is no extra screening recommended.
Juvenile Polyposis
There are multiple extra hamartomas in the bowel. Hamartomas do not bring
a significant increase in the risk of colon cancer. There is no extra screening
recommended. This is markedly different from FAP.
Dysplastic Polyp Found
Repeat colonoscopy 3–5 years after the polyp was found.
Carcinoembryonic antigen
(CEA) is never a screening
test. CEA is used to follow
response to therapy.
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