Cancer Screening Q & A

The early diagnosis of any cancer usually results in a better outcome and therefore may not impact a patient's life expectancy. Precancerous conditions can often be diagnosed and treated before they turn malignant. Removing asymptomatic colon polyps during a colonoscopy before they develop into cancer is a perfect example of a screening procedure.

The detection of other precancerous conditions such as dysplasia in patients with longstanding ulcerative colitis or Crohn's disease, Barrett's esophagus and gastric intestinal metaplasia and early imaging of pancreatic lesions can lead to better outcomes through early treatment and enrollment in surveillance programs.

Dr. Audrey Woolrich is an ardent believer in cancer screening, having worked as the medical director of the gastroenterology department at Executive Health Examiners (EHE) International at their Rockefeller Plaza location in New York City. EHE has been at the forefront of colonoscopy screenings for patients over the age of 40. Just recently, the various cancer and gastrointestinal societies have started to contest the need for cancer screenings at age 50, as there has been a significant rise in colon cancer in younger patients.

Upon registering at Dr. Woolrich’s private practice, all patients complete a comprehensive, multigenerational family cancer questionnaire, which she reviews with them in great detail. If appropriate, she orders a blood test for extensive genetic testing at the initial consultation or just prior to your procedure at Carnegie Hill Endoscopy.

Unfortunately, not all cancers are genetically determined. Dr. Woolrich addresses other risk factors during your consultation. Please call  Dr. Woolrich's office or schedule an appointment online to discuss your personal concerns and the tests that could possibly save your life.

Who should be considered for colon cancer screening?

Ultimately, everyone!

The starting age to begin screening depends on whether you are considered average risk or an individual at increased risk. For instance, genetic mutations, longstanding inflammatory bowel disease (IBD) and a family history of colon polyps or colon cancer would make you at increased risk.

If you have been diagnosed with colon polyps or cancer, then your subsequent colonoscopy is considered a surveillance colonoscopy. If you already have symptoms like abdominal pain, a change in bowel habits or rectal bleeding, the exam is no longer considered a preventive screening, but it is essential.

How is colon cancer diagnosed?

At the time of your consultation, Dr. Woolrich determines which of the available screening options are best for your personal situation. Usually a colonoscopy after a vigorous bowel preparation is the appropriate examination and would be performed with sedation at Carnegie Hill Endoscopy. Their website as well as that of the American College of Gastroenterology provides additional information.

If the colon cancer is not completely removed at the time of the colonoscopy, Dr. Woolrich either repeats the exam for complete removal or refers you to a colorectal surgeon and oncologist. She will continue to be involved with your care.

CologuardⓇ is a noninvasive stool test that is advertised on television but not appropriate for many patients. If the test is positive, then a colonoscopy is required.

A virtual colonoscopy is a radiologic examination that also requires a vigorous bowel preparation and is done by a technician and interpreted by a radiologist at their facility. If found to contain any lesions, a colonoscopy is required to remove them and determine if they are cancerous or simply benign, precancerous polyps.

Who should be considered for esophageal cancer screening?

Patients who have any of the following issues should consider an esophageal cancer screening:

• Chronic heartburn or reflux occurring more than three times per week

• Unexplained weight loss

• A prior diagnosis of Barrett's esophagus

• A strong family history of esophageal cancer

• An ethnic/geographic proclivity including Asia and Latin America

You should also consider a screening if you have other high-risk conditions or behaviors.

How is esophageal cancer diagnosed?       

At the time of your consultation, Dr. Woolrich decides if you should undergo a radiologic test, such as a barium swallow or videoesophagram, before ultimately getting an upper endoscopy.

This would be done after a fast of both liquids and solids for a time interval that would be determined by your specific situation. The procedure would be performed with sedation at Carnegie Hill Endoscopy, with biopsies obtained during the procedure.

Dr. Woolrich also discusses certain high-risk behaviors with you besides smoking and excess alcohol consumption that can increase your risk of esophageal cancer. If the diagnosis is confirmed, she refers you to an esophageal surgeon and an oncologist, and continues to be involved with your care.

Who should be considered for stomach cancer screening?

You should consider a stomach cancer screening if you have:

• A strong family history of stomach cancer

• Nonhealing ulcers

• A prior diagnosis of gastric intestinal metaplasia

• Unexplained weight loss

• A genetic mutation that puts you at increased risk, such as Lynch syndrome or hereditary diffuse gastric cancer

• Pernicious anemia

• A long history of untreated Helicobacter pylori (H. pylori) infection

• Other high-risk conditions and high risk behaviors

Certain ethnic/geographic proclivities, including being of Asian or Latin America descent, can also increase your risk of stomach cancer.

How is stomach cancer diagnosed?

During your consultation, Dr. Woolrich discusses an upper endoscopy to test for stomach cancer. She also discusses with you certain high-risk behaviors that are again not just limited to smoking and alcohol consumption.

If the diagnosis is confirmed, depending on the location and severity of the gastric cancer, she may refer you to a surgeon or a gastroenterologist who specializes in endoscopic resection, as well as an oncologist. Even if you are referred to another physician, Dr. Woolrich stays involved in your care.

Who should be considered for pancreatic cancer screening?

You should consider a pancreatic cancer screening if you have:

• A family history of pancreatic cancer

• A genetic mutation that puts you at increased risk such as Lynch syndrome or a defect in the ATM gene

• Pancreatic cysts on sonographic imaging

• A worsening or unexpected onset of your diabetes

• Other high risk conditions

Unexplained abdominal pain or weight loss can also indicate you should get a pancreatic cancer screening.

How is pancreatic cancer diagnosed?

During your consultation, Dr Woolrich might discuss sending you to a radiologist to undergo an MRCP, a magnetic resonance imaging study of your pancreas that visualizes an early pancreatic cancer or potentially premalignant pancreatic cysts.

If a pancreatic lesion is seen, she might obtain a closer in depth view and tissue sampling by endoscopic ultrasound. Dr. Woolrich will refer you to a surgeon and oncologist that specializes in pancreatic cancer if the diagnosis is confirmed.  She will continue to be involved with your care.

To arrange for a consultation about your cancer screening, call Dr. Woolrich or schedule an appointment online today.