HCA Midwest Health - August 14, 2017

With the media pounding the risks of everything from heart disease to norovirus, it's easy to start taking the term “risk” lightly. But when your doctor tells you that you're at high risk for gastrointestinal (GI) cancer—it's a very different situation.

Gastrointestinal (GI) cancers include cancers of the esophagus, stomach, liver, pancreas, appendix, colon and/or rectum. There are two basic reasons you might be at risk:

  • Family medical history—Direct relatives of yours had cancer (parents, grandparents, siblings). The highest risk comes with a family history of gastrointestinal, endometrial or ovarian cancers, especially if multiple family members had cancer. Of course, it's always possible that you have a family history and don't know it, which is why personal medical history is also important.
  • Personal medical history—Conditions you have had at some point in your life combined with lifestyle factors that might impact your risk (e.g., smoking, work environment).

A High Risk GI Cancer Clinic, like the one provided by Sarah Cannon Cancer Institute at HCA Midwest Health, provides patients and their physicians with information and recommendations to make decisions.

What is a high risk GI cancer clinic?

A High Risk GI Cancer Clinic is a team of physicians, nurses and certified genetic counselors that provide patients concerned with a family history of cancer with the information they need to make informed decisions. As part of the clinic, patients receive:

  • A comprehensive risk assessment for hereditary gastrointestinal cancers
  • Genetic counseling and genetic testing
  • Education about the screenings and prevention steps recommended based on the patient's risk level
  • Recommendations for other screenings that may be recommended, such as for breast or gynecological cancers in women.

When is a high risk GI cancer clinic recommended?

Doctors are advised to refer patients to a High Risk GI Cancer Clinic if they meet one or more of the following criteria:

  • More than ten colon polyps in their lifetime.
  • Personal or family history of polyps or GI cancer before age 50.
  • Personal history of more than one GI cancer or GI cancer plus endometrial/ovarian cancer in women.
  • Personal or family history of a genetic mutation associated with increased GI cancer risk.
  • Multiple people in the family with history of GI cancers and/or endometrial/ovarian cancers.
  • Known or suspected hereditary pancreatitis
  • Personal history of colorectal cancer along with abnormal results of at least one of two blood tests for hereditary colorectal cancer—MSI (microsatellite instability) or IHC (immunohistochemistry testing). This puts them at risk for other forms of gastrointestinal cancer.

Some of these criteria are very clinical and not easily understood. That's one of the main benefits of a High Risk GI Cancer Clinic. You'll meet with genetic counselors, doctors and nurses who can help you understand both why you were referred to the program and what happens next.

The high risk GI cancer clinic care team

The patient evaluations involve a spectrum of board-certified or fellowship-trained GI cancer specialists, including:

  • Genetic counselors who specialize in GI cancer
  • Gastrointestinal diagnostic specialist who performs endoscopic ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP), a test that examines the pancreas and bile ducts
  • Colorectal surgical team specializing in minimally invasive and robotic surgery
  • Surgical specialists for liver and pancreas surgeries
  • General surgeons specializing in gastrointestinal cancer surgery
  • Medical oncologist specializing in cutting edge GI clinical trials and targeted therapies
  • Nurse practitioners specializing in GI cancer education

After a high risk GI cancer clinic assessment

After your clinic visit, the team will compile a detailed report with results, recommendations and next steps for the referring physician to go over with you. The clinic team remains a resource for you and your physician as you make decisions to impact your cancer risk.

The Sarah Cannon HCA Midwest Health High Risk GI Cancer Clinic is one of the most comprehensive genetic counseling programs in the region. Talk to your physician if you think you might benefit from visiting a clinic.

If you don't have a physician, our free healthcare referral service, Nurses On-Call, can help. Call 1-800-386-9355 or search and schedule online. You can also take our online colon cancer assessment at any time to see if you may be at an increased risk for GI cancer. Then take the results with you to your next doctor appointment. This can be a great tool to help facilitate an invaluable conversation.