Continuing Medical Education Questions: June 2022

Abstract

Article Title: Diagnosis and Management of Cancer Risk in the Gastrointestinal Hamartomatous Polyposis Syndromes: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

LEARNING OBJECTIVE

Explain preventive medicine tools for patients with gastrointestinal hamartomatous polyposis syndromes at increased risk for gastrointestinal cancers

QUESTION 1

A 20-year-old man presents for screening colonoscopy due to a family history of colorectal cancer in his mother at age 30 years. The colonoscopy reveals multiple polyps with pathology confirming 4 of the 6 are hamartomatous polyps less than 1 cm. What is the next step in management for this patient?

1. CT abdomen/pelvis with contrast
2. CEA now and at 6 months
3. Genetic testing
4. Repeat colonoscopy at 5 years

QUESTION 2

A 45- year-old patient undergoes colonoscopy with polypectomy of an 8 mm polyp. Pathology is reported as “characteristic hypercellularity with glandular crowding, enlarged nuclei, increased mitotic activity and reduced goblet cells” (Figure 1). What is the most likely diagnosis?

1. Peutz-Jeghers polyp
2. Juvenile polyp
3. Ganglioneuroma
4. Adenomatous polyp

Figure 1.: Cumulative incidence plot for esophageal second primary tumors with death as competing risk in patients with head and neck squamous cell carcinoma. CI, confidence interval.

QUESTION 3

A 42-year-old patient with a history of Peutz-Jeghers Syndrome (PJS) and gastroesophageal reflux disease presents to a clinic for follow-up of results from a recent upper endoscopy and colonoscopy. Clinically, the patient denies abdominal pain, nausea or vomiting. The patient is currently taking omeprazole 20 mg twice daily. On physical examination, vitals are stable. Fasting comprehensive metabolic panel and complete blood count are normal. What additional diagnostic study should be performed?

1. Fasting glucose
2. No further studies at this time: return to clinic at 1 year
3. Magnetic resonance cholangiopancreatography (MRCP)
4. CT abdomen with contrast