• Nurul Nadia Noor Azlan

• Syaza Izzati Zahari

Group 84
 Screening and early detection
• Early detection of cancer greatly increases the chances for successful treatment. The 2
components of early detection of cancer are early diagnosis (or downstaging) and screening.
Early diagnosis focuses on detecting symptomatic patients as early as possible, while screening
consists of testing healthy individuals to identify those having cancers before any symptoms
appear.

Early diagnosis

Early diagnosis programmes aim at reducing the proportion of patients who are diagnosed at a late
stage. They have 2 main components:
• increased awareness of first signs of cancer, among physicians, nurses and other health care
providers as well as among the general public; and
• improved accessibility and affordability of diagnosis and treatment services, and improved
referral from first to secondary and tertiary levels of care.

Early diagnosis is particularly relevant to cancers of the breast, cervix, mouth, larynx, colon and
rectum, and skin.
Screening

• Screening refers to the use of simple tests across a healthy population to identify those
individuals who have a disease, but do not yet have symptoms. Examples include breast
cancer screening using mammography or clinical breast exam, and cervical cancer screening
using pap smears, human papillomavirus test or visual inspection with acetic acid.
• Screening programmes should be undertaken only when their effectiveness has been
demonstrated, when resources (personnel, equipment, etc.) are sufficient to cover nearly all
of the target group, when facilities exist for confirming diagnoses and for treatment and
follow-up of those with abnormal results, and when prevalence of the disease is high
enough to justify the effort and costs of screening.
Even when implemented properly, screening programmes are associated with undesirable
effects which include:
• falsely positive screening tests that result in additional testing, invasive diagnostic
procedures and patient anxiety;
• falsely negative screening tests that provide false reassurance and can result in delayed
presentation/diagnosis when symptoms appear; and
• over diagnosis/treatment of preclinical cancers that could have never cause symptoms nor
pose a serious health threat and which involve unnecessary treatment that injures the
patient.
The importance of these harms varies according to the screening tests, population groups
targeted for screening and quality of screening programmes.
 MAP FOR DISCUSSION
• Breast Cancer Screening
• Lung Cancer Screening
• Thyroid Cancer Screening
• Cervical Cancer Screening
• Stomach Cancer Screening
• Prostate Cancer Screening
• Bowel Cancer Screening
Breast Cancer
Breast cancer is cancer that
develops from breast tissue.
Breast cancer can occur in both
and women, but it’s far more
common in women.
How Breast Cancer Is
Diagnosed
• A breast cancer diagnosis often starts
with a mammogram. If something
suspicious shows up, your doctor will
likely start you down a multi-step
process for diagnosing or ruling out
breast cancer. That involves clinical
evaluation, imaging tests, and biopsy
procedures.
• Breast cancer can be diagnosed long
before symptoms occur. Breast self-
checks, your doctor's clinical
examinations, and yearly mammograms
are diagnostic screening tools that can
detect early-stage disease.
• If you develop symptoms of breast
cancer, you should seek medical
attention. Earlier-stage breast cancer is
typically more easily treated and has a
better outcome than later-stage breast
cancer.
Self-Checks

Breast cancer can produce changes in

the appearance or texture of your
breast. Women (and men) need to pay
attention to any variations, which can
include:

• Discoloration
• A visible or palpable lump
• Nipple discharge
• Bleeding
• Breast pain (rare)
• You may be able to feel lumps and
growths with your fingers even if
they don't produce visible changes in
your breasts. Although self checks
are not recommend as a screen for
breast cancer, regular breast exam by
a health care provider may be
important for women at higher risk
for breast cancer.
Diagnosis

Diagnosing breast cancer

Tests and procedures used to diagnose breast cancer

include:

PHYSICAL EXAMINATION LABS AND TESTS

• Breast exam.
If you have one or more lumps,
Your doctor will check both of your breasts and lymph
your doctor will recommend
nodes in your armpit, feeling for any lumps or other
abnormalities. further testing. In some cases,
your doctor may order
bloodwork, but this is more
common with other types of
cancer. When breast cancer is
suspected, diagnosis is typically
done via imaging and biopsy.
IMAGING

• Mammogram.
A mammogram is an X-ray of the breast.
Mammograms are commonly used to screen
for breast cancer. If an abnormality is detected
on a screening mammogram, your doctor may
recommend a diagnostic mammogram to
further evaluate that abnormality

• Breast ultrasound.
Ultrasound uses sound waves to produce
images of structures deep within the body.
Ultrasound may be used to determine whether
a new breast lump is a solid mass or a fluid-
Mammography filled cyst.
The breast is pressed between two plates. X-rays
are used to take pictures of breast tissue
• Breast magnetic resonance
imaging (MRI).

An MRI machine uses a magnet and

radio waves to create pictures of the
interior of your breast. Before a
breast MRI, you receive an injection
of dye. Unlike other types of imaging
tests, an MRI doesn't use radiation to
create the images.

• Other tests and procedures may be

used depending on your situation.
Breast MRI
During a breast MRI, you lie on your stomach on a
padded scanning table. Your breasts fit into a
hollow depression in the table, which contains coils
that detect magnetic signals. The table slides into
the large opening of the MRI machine.
BIOPSY

• Removing a sample of breast cells for

testing (biopsy).

A biopsy is the only definitive way to make a

diagnosis of breast cancer. During a biopsy,
your doctor uses a specialized needle device
guided by X-ray or another imaging test to
extract a core of tissue from the suspicious
area. Often, a small metal marker is left at the
site within your breast so the area can be easily
identified on future imaging tests.
Biopsy samples are sent to a laboratory for
analysis where experts determine whether the Core needle biopsy
cells are cancerous. A biopsy sample is also A core needle biopsy uses a long, hollow
analyzed to determine the type of cells tube to extract a sample of tissue. Here, a
involved in the breast cancer, the biopsy of a suspicious breast lump is being
done. The sample is sent to a laboratory
aggressiveness (grade) of the cancer, and
for testing.
whether the cancer cells have hormone
receptors or other receptors that may influence
your treatment options.
Staging breast cancer

A pathology evaluation will detect the absence or presence of breast cancer in

your biopsy sample.
The pathology report will describe the type of breast cancer and its characteristics,
such as:
• Whether it's invasive or noninvasive
• Size
• Growth rate
• Hormone and genetic status
• Other factors that will influence treatment planning
• When test results are completed and reviewed, your doctor will determine the
grade and stage of your cancer, if present.
• Staging is the process of determining the spread of cancer at the time it is found,
and this relies on imaging tests as well as a pathology report.
• Cancer grade is a way of describing how aggressive the cancer is and how likely it
is to grow and spread.
Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count

• Mammogram of the other breast to look for signs of cancer
• Breast MRI
• Bone scan
• Computerized tomography (CT) scan
• Positron emission tomography (PET) scan
• Not all women will need all of these tests and procedures. Your doctor selects the
appropriate tests based on your specific circumstances and taking into account new
symptoms you may be experiencing.
• Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or
contained within the milk ducts. Stage IV breast cancer, also called metastatic breast
cancer, indicates cancer that has spread to other areas of the body.
• Breast cancer staging also takes into account your cancer's grade; the presence of
tumor markers, such as receptors for estrogen, progesterone and HER2; and
proliferation factors.
 Lung cancer also known as lung
carcinoma is a malignant lung
tumor characterized by
uncontrolled cell growth in tissues
of the lung. This growth can spread
beyond the lung by the process of
metastasis into nearby tissue or
other parts of the body.

Lung
How Lung Cancer Is
Diagnosed
• Lung cancer is often suspected after
an abnormal spot is found on a chest
X-ray done to evaluate a cough or
chest pain. But since this test can
miss early cancers, additional testing
is needed to confirm (or rule out) a
lung cancer diagnosis. This can
include a chest computed
tomography (CT) scan and, if a
nodule or mass is found, a biopsy.
• It's helpful to know more about
some of the procedures that may be
recommended to find out if an
abnormality is benign (non-
cancerous) or malignant (cancerous).
If the latter, further studies are done
to see if the cancer has spread
(metastasized) to other areas in the
body and to figure out the stage of
the disease.
Screening

It's important to catch lung cancer as early as possible. Some cases may first be detected during lung cancer
screenings, which are performed on individuals who don't have any symptoms and meet the following
criteria:

• Are between the ages of 55 and 80

• Smoke or smoked for a total of 30 pack-years
• Continue to smoke or quit smoking in the past 15 years

Knowing your risk factors for lung cancer and getting screened when appropriate can lead to earlier
detection, diagnosis, and treatment
Diagnosis

Diagnosing lung cancer

Tests and procedures used to diagnose lung cancer include:

PHYSICAL EXAMINATION

When lung cancer is suspected, a physician will perform a thorough history and physical
exam. This is done to evaluate symptoms and risk factors for lung cancer, and to look for any
physical signs suggestive of the disease.

These can include:

• Abnormal lung sounds
• Enlarged lymph nodes
• Unintentional weight loss
• Clubbing of the fingernails (chubby fingernails)
Tests to diagnose lung cancer

If there's reason to think that you may have lung cancer, your doctor can order a number of tests to look for
cancerous cells and to rule out other conditions.

Tests may include:

IMAGING

• An X-ray image of your lungs may reveal an abnormal mass or nodule.

• A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray.

• For some people, magnetic resonance imaging (MRI) will be used to evaluate the possibility of lung cancer.
This procedure uses magnetism without radiation.Certain individuals, such as those with metal implants
(e.g., pacemakers) should not have MRI scans. The technician will ask questions to make sure these are not
present.

• A positron emission tomography (PET scan) uses radioactive material to create colorful three-dimensional
images of a region of the body. This type of scan differs from the others in that it defines tumors that are
actively growing.A small amount of radioactive sugar is injected into the bloodstream and given time to be
taken up by cells. Cells that are actively growing take up more sugar and light up on films. The test is usually
combined with a CT scan (PET/CT). PET scans are also useful for distinguishing between tumors and scar
tissue in people who have scarring in their lungs for any reason.
LABS AND TESTS

Non-diagnostic tests are frequently performed during the diagnosis of lung cancer as
well. These can include:

• Pulmonary function tests (PFTs): These test lung capacity and can determine how
much a tumor is interfering with breathing and, sometimes, whether it's safe to
perform surgery.

• Blood tests: Certain blood tests can detect biochemical abnormalities caused by
lung cancers and can also suggest spread of the tumor.

• Sputum cytology. If you have a cough and are producing sputum, looking at the
sputum under the microscope can sometimes reveal the presence of lung cancer
cells.
• Tissue sample (biopsy).

A sample of abnormal cells may be removed in a

procedure called a biopsy.
Your doctor can perform a biopsy in a number of
ways, including bronchoscopy, in which your doctor
examines abnormal areas of your lungs using a
lighted tube that's passed down your throat and
into your lungs; mediastinoscopy, in which an
incision is made at the base of your neck and
surgical tools are inserted behind your breastbone
to take tissue samples from lymph nodes; and
needle biopsy, in which your doctor uses X-ray or CT
images to guide a needle through your chest wall
and into the lung tissue to collect suspicious cells.
A biopsy sample may also be taken from lymph
nodes or other areas where cancer has spread, such Bronchoscopy
as your liver. In flexible bronchoscopy, a doctor inserts a thin,
bendable tube through the mouth or nose into the
Careful analysis of your cancer cells in a lab will
lungs. A light and a small camera on the bronchoscope
reveal what type of lung cancer you have. Results of allow the doctor to look inside the lungs' airways.
sophisticated testing can tell your doctor the
specific characteristics of your cells that can help
determine your prognosis and guide your
treatment.
Tests to determine the extent of the cancer

• Once your lung cancer has been diagnosed, your doctor will work to determine the extent
(stage) of your cancer. The cancer's stage helps to decide what treatment is most
appropriate.
• Staging tests may include imaging procedures that allow your doctor to look for evidence
that cancer has spread beyond your lungs.

These tests include:

• CT scan of the abdomen to check for spread to the liver or adrenal glands.
• MRI of the brain to look for metastases to the brain
• Bone scan to test for metastases to bones, especially the back, hips, and ribs.
• PET scan to look for metastases essentially anywhere in the body: This can sometimes
replace other tests for metastasis listed above.

The stages of lung cancer are indicated by Roman numerals that range from 0 to IV, with the
lowest stages indicating cancer that is limited to the lung. By stage IV, the cancer is
considered advanced and has spread to other areas of the body.
 Thyroid Cancer

Thyroid cancer is a cancer that

affects the thyroid gland, a
small gland at the base of the
neck that produces hormones.
How Thyroid Cancer Is
Diagnosed
Comprehensive and thorough
diagnosis of thyroid cancer involves a
number of procedures and tests.
Usually, the process of evaluating for
thyroid cancer starts with finding a
lump or nodule in your gland. You may
find it or see it yourself, or, in some
cases, your doctor may detect it during
an exam. It's also fairly common for
thyroid nodules to be discovered when
you have X-rays of your head or neck
for other purposes.
Self-Checks

• Examining your neck can sometimes help you find lumps or enlargements that may point
to thyroid conditions, including nodules, goiter, and thyroid cancer. You can do a test at
home to help detect nodules, which—if noticed—should be brought to your doctor's
attention for further evaluation.

Thyroid Neck Check

To detect a thyroid abnormality early or lumps that may indicate potential thyroid cancer,
follow these steps:

• Stand in front of a mirror.

• Take a sip of water and hold it in your mouth.
• Stretch your neck back and swallow the water.
• Look for an enlargement in your neck below your Adam's apple, above your collarbone.
• Feel the area to confirm an enlargement or bump.
• If any bump or enlargement is detected, see your doctor as soon as possible.
• Again, this self-check does not replace an exam by a medical professional. A thorough
examination by a physician is needed to diagnose or rule out thyroid cancer.
Diagnosis

Tests and procedures used to diagnose thyroid cancer include:

• Physical exam. Your doctor will examine your neck to feel for physical changes in your thyroid, such as thyroid
nodules. He or she may also ask about your risk factors, such as past exposure to radiation and a family history of
thyroid tumors.

• Blood tests. Blood tests help determine if the thyroid gland is functioning normally.

1. Thyroid-stimulating hormone (TSH): Your doctor may check the TSH level in your blood to evaluate your thyroid's
activity and test for hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid). This test's
results can help your doctor determine which imaging tests to do to visualize your nodule, depending on the
result. That said, with thyroid cancer, your TSH level is typically normal.

2. T3 and T4: These are the main hormones that your thyroid makes. Your doctor may test your levels to check how
your thyroid is functioning. Like TSH, these hormone levels are usually normal when you have thyroid cancer. 

3. Calcium: When medullary thyroid cancer is suspected, your doctor will typically test for high levels of calcium, as
this can be an indicator of the disease.

4. Thyroglobulin: The thyroid makes a protein called thyroglobulin that's then converted into T3 and T4. If you've
already been treated for thyroid cancer and you've had a thyroidectomy, your doctor may check to make sure your
cancer is gone or to see if it has come back by looking at your thyroglobulin level. Though this test can't diagnose
cancer, it can be a marker for it. Since you no longer have a thyroid to make thyroglobulin, if there's more than a
very low level in your blood, or if it rises after having been low, this may indicate cancer. In this case, your doctor
• Ultrasound imaging.
Ultrasound uses high-
frequency sound
waves to create
pictures of body
structures. To create
an image of the
thyroid, the
ultrasound transducer
is placed on your
lower neck. The
appearance of your
thyroid on the
ultrasound helps your
doctor determine • Removing a sample of thyroid tissue.
whether a thyroid During a fine-needle aspiration biopsy, your doctor
nodule is likely to be inserts a long, thin needle through your skin and into
noncancerous the thyroid nodule. Ultrasound imaging is typically
(benign) or whether used to precisely guide the needle into the nodule.
there's a risk that it Your doctor uses the needle to remove samples of
might be cancerous. suspicious thyroid tissue. The sample is analyzed in
the laboratory to look for cancer cells.
• Other imaging tests. You may have one or more imaging tests to help your
doctor determine whether your cancer has spread beyond the thyroid.
Imaging tests may include CT, MRI and nuclear imaging tests that use a
radioactive form of iodine.
• Genetic testing. Some people with medullary thyroid cancer may have
genetic changes that can be associated with other endocrine cancers. Your
family history may prompt your doctor to recommend genetic testing to
look for genes that increase your risk of cancer.
Cervical
Cancer
Cervical cancer is a type of
cancer that occurs in the cells of
the cervix – the lower part of
the uterus that connects to the
vagina. Various strains of HPV a
sexually transmitted infection
play a role in causing most
cervical cancer.
How Cervical
Cancer Is Diagnosed

Screening

• Screening tests can help detect

cervical cancer and precancerous
cells that may one day develop into
cervical cancer. Most guidelines
suggest that women ages 21 to 29
should have a Pap test every three
years, and women between ages
30 and 65 should have one every
five years. There are other tests
that can also identify cervical
cancer, particularly in the more
advanced stages.
Self-Checks

• Cervical cancer symptoms do not usually appear until cancer has progressed to a fairly
advanced stage. And HPV, the most common cause of cervical cancer, does not usually
cause symptoms—which is why it's so important to have your regularly scheduled Pap
smears. 

What to Watch For:

Nevertheless, there are a few things you can look for. Noting these will not enable you to
diagnose cervical cancer. Rather, they are simply signs you should see a doctor:

• Genital warts, which may be raised, painless, and skin-colored

• Vaginal discharge
• Abnormal uterine bleeding
• Increased urinary frequency
• Pelvic pain, especially during intercourse
LABS AND TESTS

Screening tests include:

• Pap test. During a Pap test,

your doctor scrapes and
brushes cells from your
cervix, which are then
examined in a lab for
abnormalities. A Pap test can
detect abnormal cells in the
cervix, including cancer cells
and cells that show changes
that increase the risk of
Pap test
cervical cancer. The In a Pap test, your doctor uses a vaginal speculum to hold your
abnormal cells are referred vaginal walls apart and to see the cervix. Next, a sample of cells
from your cervix is collected using a small cone-shaped brush and
to as cervical dysplasia. a tiny plastic spatula (1 and 2). Your doctor then rinses the brush
and spatula in a liquid-filled vial (3) and sends the vial to a
laboratory for testing.
• HPV DNA test.
The HPV DNA test involves testing cells collected from the cervix for
infection with any of the types of HPV that are most likely to lead to
cervical cancer.
Diagnosis

If cervical cancer is suspected, your doctor is likely to

start with a thorough examination of your cervix. A
special magnifying instrument (colposcope) is used to
check for abnormal cells.

During the colposcopic examination, your doctor is likely

to take a sample of cervical cells (biopsy) for laboratory
testing. To obtain tissue, your doctor may use:

• Punch biopsy, which involves using a sharp tool to

pinch off small samples of cervical tissue. • Endocervical curettage, which uses a
small, spoon-shaped instrument (curet)
or a thin brush to scrape a tissue sample
from the cervix.
If the punch biopsy or endocervical • Cone biopsy (conization), which is a
curettage is worrisome, your procedure that allows your doctor to obtain
doctor may perform one of the deeper layers of cervical cells for laboratory
following tests: testing. A cone biopsy may be done in a
hospital under general anesthesia
• Electrical wire loop, which uses
a thin, low-voltage electrified
wire to obtain a small tissue
sample. Generally this is done
under local anesthesia in the
office.

Cone biopsy
During a cone biopsy (conization), a doctor surgically
removes a cone-shaped piece of tissue from the cervix.
Typically, the cone-shaped piece includes tissue from both
the upper and lower part of the cervix.
Staging

If your doctor determines that you have cervical cancer, you'll have further
tests to determine the extent (stage) of your cancer. Your cancer's stage is
a key factor in deciding on your treatment.
Staging exams include:

• Imaging tests. Tests such as X-ray, CT, MRI and positron emission
tomography (PET) help your doctor determine whether your cancer has
spread beyond your cervix.
• Visual examination of your bladder and rectum. Your doctor may use
special scopes to see inside your bladder and rectum.
GASTRIC CANCER
Gastric cancer is a disease in which malignant
(cancer) cells form in the lining of the
stomach.

Age, diet, and stomach disease can affect the

risk of developing gastric cancer.

Symptoms of gastric cancer include

indigestion and stomach discomfort or pain.
 METHODS FOR GASTRIC CANCER
Physical exam and health history: An exam of the body to
check general signs of health, including checking for signs of
disease, such as lumps or anything else that seems unusual. A
history of the patient’s health habits and past illnesses and
treatments will also be taken.

Blood chemistry studies: to measure the amounts of certain

substances released into the blood by organs and tissues in the
body. An unusual (higher or lower than normal) amount of a
substance can be a sign of disease.

Complete blood count (CBC): A procedure in which a sample

of blood is drawn and checked for the following:
i. The number of RBC, WBC, and platelets.
ii. The amount of hemoglobin in the RBC.

Upper endoscopy: A procedure to look inside the esophagus,

stomach, and duodenum (first part of the small intestine) to
check for abnormal areas.
An endoscope (a thin, lighted tube) is passed through the
mouth and down the throat into the esophagus.
Barium swallow: A series of x-rays of the esophagus and
stomach.
The patient drinks a liquid that contains barium (a silver-white
metallic compound). The liquid coats the esophagus and
stomach, and x-rays are taken.

CT scan (CAT scan): A procedure that makes a series of detailed

pictures of areas inside the body, taken from different angles.
A dye may be injected into a vein or swallowed to help the
organs or tissues show up more clearly.

Biopsy: The removal of cells or tissues so they can be viewed

under a microscope to check for signs of cancer. A biopsy of the
stomach is usually done during the endoscopy.
The sample of tissue may be checked to measure how many
HER2 genes there are and how much HER2 protein is being
made. If there are more HER2 genes or higher levels of HER2
protein than normal, the cancer is called HER2 positive. HER2-
positive gastric cancer may be treated with a monoclonal
antibody that targets the HER2 protein.
The sample of tissue may also be checked for Helicobacter pylori
(H. pylori) infection.
 OTHER METHODS

Endoscopy US

MRI PET Scan

PROSTATE CANCER

common type of cancer in males, but it

is highly treatable in the early stages.
 PROSTATE SPECIFIC ANTIGEN

Prostate specific antigen (PSA) is a protein made by both

normal prostate cells and cancerous prostate cells.

If the PSA result is > than the typical range for your age (e.g.
above 3 ng/mL for people aged 50–59) or is rising quickly, this
may indicate the possibility of prostate cancer.
However, the amount of PSA in the blood can be raised even
when you do not have cancer.

There are some other blood tests that may suggest:

● Free PSA or free-to-total test – This measures the PSA
molecules in the blood that are not attached to other
blood proteins (free PSA). This test may be suggested if
the PSA score is above 3 ng/mL and the doctor is not
sure whether you need a biopsy. The free PSA test
measures the ratio of free PSA to total PSA. A low level
of free PSA compared to total PSA may be a sign of
prostate cancer.
● Prostate health index (PHI) – This measures
three different forms of the PSA protein.
 • To palpate the • If a TRUS is
prostate gland and abnormal, a biopsy is
check for lumps, still needed to
hardness, or determine if any
tenderness. regions that appear
abnormal are actually
cancer.

• If a PSA is • In men over 50, if a

persistently PSA is persistently
abnormal/abnormali elevated but a biopsy
ties are felt on a does not reveal cancer,
DRE /TRUS. In this the genetic test gene 3
procedure, samples (PCA3) RNA may be
are taken from 12 recommended. This
random areas in the test measures the ratio
prostate gland and of PCA3 RNA to PSA
are looked at under RNA in the urine. If
the microscope to the test is elevated, a
determine if repeat biopsy may be
prostate cancer cells recommended.
are present.
BOWEL CANCER
A cancer in any part of the large bowel (colon
or rectum). It is sometimes known as
colorectal cancer and might also be called
colon cancer or rectal cancer, depending on
where it starts.
Cancer of the small bowel is very rare – it is
called small bowel cancer or small intestine
cancer.
 GENERAL EXAMINATIONS

• Physical • CT
• Blood Test
Examination Colonography
Full blood count Not often used
Liver Function Test because it is not as
Urea & Electrolytes accurate as a
Tumours Markers colonoscopy and
exposes you to
radiation.
 iFOBT
Immunochemical faecal occult blood test (iFOBT)
Depending on your symptoms, you may have an iFOBT.
This test is generally not recommended for people who are
bleeding from the rectum, but may be used for people with
unexplained weight loss, abdominal pain, changes to their
bowel habits or anaemia.

The iFOBT involves taking a sample of your stools at home.

The stool sample is examined for microscopic traces of blood,
which may be a sign of polyps, cancer or another bowel
condition. An iFOBT does not diagnose cancer, but if it finds
blood, your doctor will recommend you have a colonoscopy
(see opposite page) as soon as possible, but no later than 120
days after getting the result.
 FLEXIBLE SIGMOIDOSCOPY
You'll lie on a bed on your left side, with your knees tucked up to your
chest. You don't normally need medication to make you relax while you
have the test.

The endoscopist will first check your back passage for any abnormalities.
They then gently put the colonoscope into your back passage and up into
the large bowel. This is uncomfortable but is not usually painful. They put
gel on the colonoscope to make it more comfortable. The gel usually feels
cold.

The doctor or nurse puts a small amount of gas and water through the
colonoscope into your bowel. This opens the bowel so they can see the
lining of the bowel clearly. This can make you feel bloated and like you
want to go to the toilet. Don't worry you won't as your bowel will be
empty. You may pass wind during the procedure, this is expected so don't
be embarrassed.

If you find it too uncomfortable at any stage tell the endoscopist and they
will stop.

You might have pain relief using gas and air (Entonox). This is a fast
acting pain relief breathed in through a mouth piece.
 FURTHER TESTS

CEA blood test: tested for a protein called carcinoembryonic antigen (CEA). This protein is
produced by some cancer cells. If the results of the blood test show that you have a high CEA
level, your doctor may organise more tests. This is because other factors, such as smoking or
pregnancy, may also increase the level of CEA. Your CEA level may be retested after treatment to
see if the cancer has come back.

CT scan : (computerised tomography) scan to check if the cancer has spread to other areas. The
scan takes 5–10 minutes and is painless.

MRI scan: An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves
to create detailed, cross-sectional pictures of the inside of your body.

PET-CT scan: most commonly used after surgery to help find out where the cancer has spread to
in the body or if the cancer has come back after treatment.
PATIENT CASE

Primary
 Answers :
Risk Factors of cancer in this patient

• Gender
• Alcohol
• Obesity
• Diet
• GERD
• Barrett’s esophageous

Precancerous condition and changes detected in this patient

Barrett’s Esophageous
• Massive sliding hernia of the esophageal orifice of the diaphragm.
• Cylindrical cell metaplasia with 2.5 x 2.0 M on the background erosive esophagitis stage II

Primary and secondary prevention of esophageal cancer in a polyclinic

Lifestyle changes may reduce the risk of developing esophageal cancer :

• Quit smoking
• Quit drinking alcohol
• Maintain a healthy weight and incorporate exercise into a lifestyle
• Eating a healthy diet
• Getting treated for barrett’s esophagus
THANK YOU !