What is the High-Risk Prevention Program?

The Northwestern Medicine Digestive Health Center High-Risk Prevention Program is dedicated to early detection, prevention, treatment and counseling for people who are at a higher risk for gastrointestinal cancers (colon, small intestine, stomach, pancreas and esophagus). Services include:

• Genetic testing
• Screening using blood tests and X-rays
• Therapeutic endoscopy
• Psychological counseling
• Nutritional counseling

Genetic testing

People who develop cancer in the colon, stomach, pancreas and small intestine often have a family history of the disease or a history of pre-cancerous conditions. Genetic testing can help in developing an individual risk assessment and treatment plan.

Northwestern Medicine tests for genetic markers for:

• Lynch syndrome (hereditary non-polyposis colorectal cancer): The tendency to develop colon and uterine cancer
• Familial adenomatous polyposis: Development of polyps in the large intestine, stomach and small intestine
• Hereditary gastric cancer
• Hereditary pancreatitis
• Peutz-Jeghers syndrome: A genetic change that increases the risk for developing cancer and causes the growth of polyps
• Juvenile polyposis: The growth of non-cancerous polyps in the digestive tract

Psychological counseling

People who learn they have a higher genetic risk for developing cancer may want help understanding their risk, available treatments, and management and probable course of the disease. Northwestern Medicine clinical psychologists can help patients learn about a genetic disease, manage stress, and make informed decisions about treatment and how the disease may affect other family members.

Screening

Although most people start screening for colon cancer at age 50, people with a higher genetic risk should start screening earlier. Your physician may recommend tests such as:

• High-sensitivity fecal occult blood tests (FOBT): To check for blood in the stool that cannot be seen
• Sigmoidoscopy: A procedure that uses a flexible lighted instrument to check for abnormal growths in the rectum and sigmoid colon
• Colonoscopy: A procedure that uses a flexible lighted instrument to check for and remove any abnormal growths in the colon lining

Therapeutic endoscopy

Treatment for bleeding and removal of polyps can be carried out endoscopically. Sometimes a therapeutic endoscopy is performed to remove polyps found during a diagnostic endoscopy, or therapeutic treatments can be performed during a diagnostic endoscopy. Using a flexible tube with an instrument at the end, physicians can treat a variety of disorders of the digestive tract:

• Bleeding peptic ulcers with adrenaline injections or by clamping the bleeding vessels
• Gastric varices (dilated veins that often bleed) with injections of alcohol
• Gastrointestinal bleeding from tumors and ulcers using an electric current
• Achalasia and esophageal strictures (narrowing) by dilating parts of the esophagus
• Polyp removal

Nutritional counseling

Patients at a high risk for developing gastrointestinal cancer can make dietary changes to reduce their risk, such as eating fruits and vegetables, limiting alcohol consumption, stopping smoking, exercising and maintaining a healthy weight. Patients with inflammatory bowel disorders that increase their chances of cancer can also work with their physicians and nutritionists to develop a diet plan.