Category: Monitoring

Pinpointing pain: Is it cancer or cancer treatment?

Weird aches and pains abound after cancer treatment, making it hard for patients in remission to figure out whether they’re suffering a treatment side effect or experiencing the first whispers of a cancer recurrence. 

“I see patients with different types of cancer and a lot of the time, they want to know ‘Is this pain related to recurrence or is it something else?’” said Fred Hutchinson Cancer Center’s Medical Director of Cancer Rehabilitation Hanna Hunter MD. “In a lot of cases, it’s something else.”

https://www.fredhutch.org/en/news/center-news/2023/06/pinpointing-pain-cancer-or-treatment-collateral-damage.html

Lynch syndrome: from detection to treatment

Lynch syndrome is encountered by many clinicians at some stage in their practice and yet remains under-diagnosed with historically limited success in risk stratification and management.

The PLSD(http://plsd.eu) international database continues to expand our knowledge of LS-associated cancer risk. However, we have yet to obtain international consensus on the optimal surveillance strategies, which will be essential among a population of patients who are living beyond their index cancer.

The advent of NGS(next generation sequencing) into clinical practice will undoubtably improve detection rates and allow for more effective, precise, and personalised management programmes for patients with LS.

Finally, over the next decade it will be exciting to see improvements in the preventative strategies that can be offered to patients in the form of aspirin, or even anti-cancer vaccines, as we continue to attempt to disrupt the natural history of this prevalent cancer predisposition syndrome.

https://www.frontiersin.org/articles/10.3389/fonc.2023.1166238/full?utm_source=S-TWT&utm_medium=SNET&utm_campaign=ECO_FONC_XXXXXXXX_auto-dlvrit

 National Strategy for Accelerating Genetic and Genomic Medicine in Ireland

The key strategic areas of focus for the development Ireland’s genetics and genomics service are:

  • Coordinating a national approach to genetics and genomics: A national office for genetics and genomics will be established to oversee all aspects of genetic and genomic clinical service and research activities, engage with key stakeholders to address policy and legislative gaps, and drive the implementation of this strategy.
  • Ensuring Patient and Public Involvement (PPI) and Partnerships: In alignment with Sláintecare, this National Strategy outlines our approach for developing a sustainable patient and family centred genetics and genomics service that can be accessed equitably across the country and across the lifespan of patients. The service is to be supported by strong governance, a skilled workforce, pioneering research and innovation, and trusted partnerships.
  • Building the genetics and genomics workforce for the future: A workforce plan will support recruitment, retention, education and career development of the current specialised workforce which includes genetic counsellors and clinical scientists. Staff will be supported and will develop specialised knowledge and skills in genetics and genomics.
  • Enhancing genetic and genomic clinical services: There is a need to continue the transition of genetics and genomics into routine service delivery and support the use of evidence-based genetic and genomic tests. This will enable the development of locally integrated, multidisciplinary, patient and family centred diagnostic and care pathways. 
  • Strengthening infrastructures to drive advances in genetics and genomics: Supporting infrastructure is needed to collect, test, store, process and analyse samples for both patient care and ongoing research applications. To strengthen data infrastructure, existing genetic and genomic data capacity and capability will be reviewed. Continued work on further infrastructure implementation will be carried out to support clinical service delivery.

Click to access national-strategy-for-accelerating-genetic-and-genomic-medicine-in-ireland.pdf

Patients’ satisfaction w/Lynch syndrome providers

This episode is the first in a series featuring former CGA-IGC research grant recipients.Features Dr. Allison Burton-Chase, MD from the Albany College of Pharmacy and Health Sciences. Dr. Burton-Chase was the first recipient of the CGA-IGC research grant in 2014 for her work entitled “Factors Impacting the Decision of an Individual with Lynch Syndrome to Terminate a Health Care Provider Relationship”.

The majority of patients who terminated their patient-provider relationships did so due to negative interactions, such as the provider having a lack of Lynch syndrome-specific knowledge or not being open to improving their knowledge on Lynch syndrome.

https://www.cgaigc.com/post/patients-satisfaction-w-lynch-syndrome-providers-interview-w-2014-cga-igc-research-grant-recipient

Performance of the Fecal Immunochemical Test(FIT) in Detecting Advanced Colorectal Neoplasms and Colorectal Cancers in People Aged 40–49 Years: 

Recently, the cases of colorectal cancers has been rising in younger age (<50) individuals. Although current guidelines recommend colorectal cancer screening should be initiated at age 45 instead of 50, the optimal approach of colorectal cancer screening is not clear.

This article investigates the efficacy of fecal immunochemical test (FIT), which detects occult blood in stool, in predicting advanced colorectal polyps and tumors among people aged 40–49.

The findings suggest FIT is useful to identify such people with high risk to have advanced colorectal lesions. Hence, FIT may be considered as the first-line screening tool for these people, and further comparative study between FIT and colonoscopy will be of great value.

The detection rate of ACRN(advanced) and CRC based on FITs in individuals aged 40–49 years is acceptable, and the yield of ACRN might be similar between individuals aged 45–49 and 50–59 years. Further comparative and cost-effective analysis of colonoscopies is mandatory to guide its use in EOCRC screening.

https://www.mdpi.com/2321922

How to detect colon cancer without a colonoscopy

A colonoscopy is the gold standard test in the United States for colon cancer screening, but there are other tests available. Some of these include:

  • Fecal immunochemical test (FIT):
  • Stool FIT/DNA test:
  • Virtual colonoscopy:

Watch out for these colon cancer symptoms

If you experience blood in your stool, abdominal pain or a change in bowel habits, see your doctor right away. These could be the first symptoms of colon cancer.

“The most common symptom of colon cancer is no symptom at all, until late-stage colon cancer,”

https://www.mdanderson.org/cancerwise/how-to-detect-colon-cancer-without-a-colonoscopy.h00-159617856.html

How I Deal With My Lynch Syndrome Diagnosis

“Being proactive with my daily health has been important throughout my Lynch journey. Taking control of my health by exercising, maintaining my weight and eating well is essential and helps me feel like I can control some aspects of my life. “

“Living with Lynch syndrome can be challenging, but prioritising self-care, seeking professional support, connecting with others, and practicing mindfulness and stress reduction techniques have helped me manage the emotional impact of this condition.”

https://www.curetoday.com/view/how-i-deal-with-my-lynch-syndrome-diagnosis

Guidance on faecal immunochemical testing (FIT) to help diagnose colorectal cancer among symptomatic patients in primary care

A new guideline around faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC). NHS England has subsequently written to all GP practices in England recommending they implement this guideline ‘in full’.

Symptoms alone have a poor sensitivity for CRC, meaning a high volume of secondary care investigations are required to detect cases if symptom-based criteria alone guide referrals. Endoscopy services in the UK have been struggling to keep up with referral demands, and waiting times for a colonoscopy lengthened during the COVID-19 pandemic. It is in this context that the role of FIT has been recently evaluated, to determine whether it can safely triage referrals and better identify high-risk patients than symptoms and non-specific blood tests alone.

CONCLUSION

FIT offers a non-invasive, community-based opportunity to help improve triage of the large number of patients seen in primary care with lower GI symptoms. Patients with a negative FIT, particularly in the context of a normal examination and other investigations, are low risk and may be managed in primary care if symptoms resolve. However, CRC pathways must permit the referral of people with a negative FIT and persistent and concerning symptoms or rectal bleeding for urgent assessment.

https://bjgp.org/content/73/731/283

Diagnosis and management of Lynch syndrome

https://fg.bmj.com/content/13/e1/e80

A personalised approach to lifelong gene-specific management for people with LS provides many opportunities for cancer prevention and treatment.

What surveillance should these patients undergo?

  • Colonoscopic surveillance should be performed every 2 years starting at age 25 years for MLH1, or MSH2 pathogenic variant carriers, or age 35 years for MSH6, or PMS2 pathogenic variant carriers.
  • Endoscopic lesions can be difficult to recognise due to a high frequency of flat non-polypoid morphology, and high-quality colonoscopy is essential.
  • Gynaecological surveillance has no proven benefit.
  • Aspirin reduces long-term colorectal cancer (CRC) risk by approximately 50%. Recommended doses include 150 mg ODonce daily or 300 mg ODonce daily for patients with BMIbody mass index >30.

What surgical treatments are recommended?

  • Women should be counselled on prophylactic hysterectomy and bilateral salpingo-oopherectomy from age 40 years (MLH1, MSH2 and MSH6 variant carriers).
  • There is a gene-specific approach to surgical management of CRC which takes in to account other patient factors.

What systemic oncological treatments are recommended?

  • Chemoprophylaxis with daily aspirin for at least 2 years is recommended in patients <70 years old diagnosed with LS to reduce long-term CRC risk.
  • Personalised systemic anticancer therapy is feasible for locally advanced or metastatic disease associated with LS, and may respond very well to relatively novel checkpoint inhibition immunotherapy.

Understanding Lynch Syndrome and Associated Cancer Risk: Epidemiology

https://www.onclive.com/view/understanding-lynch-syndrome-and-associated-cancer-risk-epidemiology?utm_source=twitter&utm_medium=onclive&utm_term=&utm_content=&utm_campaign=

Lynch syndrome is the most commonly inherited colon cancer syndrome, and it accounts for approximately 3% of all newly diagnosed cases of colorectal cancer.

The genetics of both the tumor and the germline have an important role in the development and diagnosis of Lynch syndrome.