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Zorluk: KolayClinical Preventive Services and Screening

A 55-year-old man with average risk for colorectal cancer opts for noninvasive screening at his annual wellness visit. Arrange the following clinical steps in the correct chronological order for his preventive care and subsequent management, assuming his initial screening test is positive and reveals advanced adenomas.

  1. 1Perform a fecal immunochemical test (FIT)
  2. 2Perform a diagnostic colonoscopy
  3. 3Perform an endoscopic polypectomy
  4. 4Schedule a surveillance colonoscopy in 3 years

Cevap

The correct chronological sequence is: 1) Perform a fecal immunochemical test (FIT), 2) Perform a diagnostic colonoscopy, 3) Perform an endoscopic polypectomy, and 4) Schedule a surveillance colonoscopy in 3 years.
The clinical pathway begins with the initial noninvasive screening test (FIT). When this yields a positive result, the mandatory next step is a diagnostic colonoscopy. During this procedure, any identified polyps are removed via polypectomy. Finally, the pathological confirmation of advanced adenomas dictates a shortened surveillance colonoscopy interval (typically 3 years) to prevent future malignancies, rather than returning to routine screening.

Adım Adım Çözüm

1
Identify the initial screening modality.
Perform a fecal immunochemical test (FIT).
For an average-risk patient opting for noninvasive colorectal cancer screening, FIT is the first step in the clinical pathway.
2
Determine the next step after a positive screening test.
Perform a diagnostic colonoscopy.
Any positive noninvasive colorectal screening test (like FIT) requires direct visualization of the colon to identify the source of bleeding.
3
Identify the necessary intervention during the diagnostic procedure.
Perform an endoscopic polypectomy.
If polyps are found during the colonoscopy, they must be removed therapeutically and sent for pathology to determine the histology.
4
Determine the appropriate follow-up interval based on findings.
Schedule a surveillance colonoscopy in 3 years.
Finding advanced adenomas changes the patient's status from routine screening to surveillance, requiring a shorter follow-up interval (e.g., 3 years instead of returning to annual FIT or 10-year colonoscopy).

Anahtar Kavram

The clinical pathway for colorectal cancer screening follows a stepwise progression: initial noninvasive testing, diagnostic visualization if positive, therapeutic intervention during the procedure, and risk-stratified surveillance based on pathology results.
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