CME Questions: colorectal cancer screening: today and tomorrow.

1. A 38-year-old patient comes to you for advice about colon cancer screening. He reports that his father was diagnosed with colon cancer at age 58. Which of the following would you recommend?

a. Colonoscopy starting at age 40 years.

b. Colonoscopy starting at age 48 years.

c. Colonoscopy starting at age 50 years.

d. Flexible sigmoidoscopy now.

e. Fecal occult blood testing at age 40.

2. All of the following are Amsterdam criteria for the diagnosis of the Hereditary Nonpolyposis Colorectal Cancer (HNPCC) syndrome except:

a. There are 3 cases of colon cancer within the family.

b. Two cases of colon cancer must be in 1st degree relatives of the 3rd case.

c. The cases must span at least 2 generations.

d. One colon cancer case must be diagnosed before age 50 years.

e. There must be a diagnosis of endometrial cancer within the kindred.

3. Which of the following statements about fecal occult blood testing (FOBT) is correct?

a. Rehydration should be routinely performed.

b. Large randomized controlled trials have demonstrated a 23% reduction in mortality from colorectal cancer in those who have undergone screening with FOBT.

c. A single FOBT test performed in the office is equivalent to a 6-sample test performed at home.

d. FOBT should be performed every other year in average risk individuals.

e. The FOBT is not influenced by dietary factors.

4. All of the following should prompt a referral to a genetics specialist except:

a. Colon cancer diagnosed before age 50.

b. Colon cancer in three 1st degree relatives.

c. Colon cancer and endometrial cancer in two 1st degree relatives.

d. >50 adenomatous polyps seen on a screening colonoscopy.

e. Colon cancer in a 1st degree relative diagnosed at age 65.

5. Which of these options is not a reasonable screening approach for an average risk individual?

a. Colonoscopy every 10 years

b. Flexible sigmoidoscopy every 5 years

c. Annual fecal occult blood testing (FOBT)

d. Flexible sigmoidoscopy every 5 years and annual FOBT

e. Barium enema every 10 years

6. Patients with a personal history of one or two small (<1 cm) tubular adenomas should have a follow-up colonoscopy in:

a. 6 months

b. 1 year

c. 3 years

d. 5 years

e. 10 years

7. Patients with a personal history of one villous adenoma should have a follow-up colonoscopy in:

a. 6 months

b. 1 year

c. 3 years

d. 5 years

e. 10 years

8. Patients with inflammatory bowel disease affecting the entire colon should have four-quadrant biopsies taken every 10 cm during colonoscopy after how many years of disease activity?

a. 1 year

b. 5 years

c. 8 years

d. 10 years

e. Surveillance is not necessary. These patients are not at increased risk for colon cancer.

9. All of the following statements about genetic testing for colon cancer risk are true except:

a. It is a blood test.

b. Genetic counseling is recommended before performing a genetic test.

c. The ideal family member to test first is the individual who developed colon cancer at the youngest age.

d. Genetic test results can help to determine who in the family requires aggressive cancer screening and who does not.

e. Genetic tests are available for all hereditary colon cancer syndromes.

10. A 35-year-old patient comes to your office and informs you that his mother was diagnosed with colon cancer at 45-years-old. There are no other known cancers in the family. The patient undergoes colonoscopy that reveals no lesions. When should he next undergo another colonoscopy?

a. 6 months

b. 1 year

c. 5 years

d. 10 years

e. The patient is not at increased risk and can have their next colonoscopy at age 50.

Answers to CME Questions

1. A, 2. E, 3. B, 4. E, 5. E, 6. D, 7. C, 8. C, 9. E, 10. C

Faith consists in believing when it is beyond the power of reason to
believe.
--Voltaire