Prevention

Gastrointestinal Cancer Prevention Program

Fred Hutchinson Cancer Center, we not only treat patients who have gastrointestinal (GI) cancers — we help prevent people from getting these cancers of the digestive system in the first place.

If genetic testing shows you are at high risk for a GI cancer, our team of gastroenterologists, genetic counselors and medical geneticists at the Gastrointestinal Cancer Prevention Program can expertly assess, screen and monitor you in order to reduce that risk.

Programs for screening and surveillance (monitoring) of GI cancers have been found to detect cancer at an earlier stage, when it is curable. We can help assess your personal risk of cancer and design a personalized prevention plan for you.

Gastrointestinal Refers to the stomach and intestines. Also called GI. Geneticist A scientist who has special training in the study of genes and heredity (the passing of genetic information from parents to their children). A scientist who has special training in the study of genes and heredity (the passing of genetic information from parents to their children). A medical geneticist is a doctor who specializes in diagnosing and treating genetic disorders or conditions. Medical geneticists also counsel individuals and families at risk for certain genetic disorders or cancers. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.

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FAQs about GI cancer prevention

Why is prevention especially important for people with a genetic risk of a GI cancer?

Some cancers show early warning signs; GI cancers do not. In fact, most people with an undiagnosed GI cancer don’t experience health problems until the cancer reaches an advanced stage. That’s why a prevention plan is so important for people with a genetic mutation (change) that puts them at high risk. If a cancer or precancerous growth does begin to develop, it can be caught in an early stage, when it can most easily be treated.

Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant. Precancerous A condition that may (or is likely to) become cancer. Also called premalignant. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Who do we see at the clinic?

If you are referred to the GI Prevention Clinic at Fred Hutch, it means that you have had genetic testing and have already been identified as someone who is at high risk for a GI cancer, either because of a strong family history of GI cancer or because of your test results.

We work with people like you who have been referred to us by their primary care physician or another medical provider, either from within Fred Hutch or another medical system. People who know they have a strong family history of GI cancer can also contact us directly and make an appointment without a referral.

Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.

What does “a strong family history of GI cancer” mean?

A strong family history means that two or more close relatives on the same side of your family have had a GI cancer, especially if the cancer was diagnosed before age 50.
You are also at high risk if you have had:

A precancerous GI polyp before age 40
More than 10 precancerous GI polyps at any age
A GI cancer before age 50
More than one primary cancer, one of which was a GI cancer, at any age
An abnormal result on a genetic test for a hereditary GI cancer syndrome, such as Lynch syndrome (HNPCC) or familial adenomatous polyposis (FAP)

Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited. Lynch syndrome An inherited disorder in which affected individuals have a higher-than-normal chance of developing colorectal cancer and certain other types of cancer, often before the age of 50. Polyp A growth that protrudes from a mucous membrane. Precancerous A condition that may (or is likely to) become cancer. Also called premalignant. Primary cancer The original, or first, tumor in the body. The original, or first, tumor in the body. Cancer cells from a primary cancer may spread to other parts of the body and form new, or secondary, tumors. This is called metastasis. These secondary tumors are the same type of cancer as the primary cancer. Also called primary tumor.

What happens at your first appointment

Before your visit to the Gastrointestinal Cancer Prevention Program at Fred Hutch, our GI experts will review your medical records, your family history of GI and other cancers and the results of any tests you may have had elsewhere.

Once we have this information, we will schedule a time for you to come in to discuss your results and work with you to build your personalized prevention program. Depending on your unique risk profile, you may meet with one or more providers — such as a gastroenterologist, medical geneticist, genetic counselor or nutritionist — during this appointment. Your appointment will last about two hours.

Your plan will be as unique as you are. For instance, if your test results show you are at risk for colon cancer, your plan may include a yearly colonoscopy. If you have a different type of risk, our gastroenterologist might prescribe a medication. You might have surveillance and screening endoscopies done at Fred Hutch or the University of Washington Medical Center. Sometimes, we refer patients to the High-Risk Surveillance Clinic at Fred Hutch for further care.

Colonoscopy An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. An examination of the inside of the colon using a colonoscope, which is inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Gastroenterologist Gastroenterologists are trained to diagnose and treat diseases of the gastrointestinal system, including cancers of the liver, pancreas, esophagus, stomach, colon, rectum and anus. Gastrointestinal Refers to the stomach and intestines. Also called GI. Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group.

What is included in my personalized prevention plan?

Information about hereditary and nonhereditary GI cancer risk factors
Strategies to lower your GI cancer risk
Information about clinical trials you are eligible to participate in through Fred Hutch and our partners at Seattle Children's and UW Medicine
A detailed letter summarizing your visit

Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited.

What are some of the strategies that may be used to reduce my risk?

Screening by physical exam and imaging (colonoscopy, upper endoscopy or endoscopic ultrasound)
Risk-reducing surgery
Medicine to prevent cancer

Endoscopy A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.

“Just because you have a genetic susceptibility to a GI cancer doesn’t mean you have to get it. Our whole program is built around preventing cancer through surveillance.”

— Teri Brentnall, MD, Gastroenterologist

Care team

The Gastrointestinal Cancer Prevention Program team is made up of experts from a variety of specialties within Fred Hutch.

Gastrointestinal Refers to the stomach and intestines. Also called GI.

Gastroenterologist

Gastroenterologists are trained to diagnose and treat diseases of the gastrointestinal system, including cancers of the liver, pancreas, esophagus, stomach, colon, rectum and anus. At the GI Cancer Prevention Program at Fred Hutch, our gastroenterologists educate patients and help them understand how their genetic risk affects the treatment of their blood cancer.

Gastrointestinal Refers to the stomach and intestines. Also called GI.

Medical geneticist

A medical geneticist is a physician who is specially trained to know what types of genetic tests to order for patients, as well as how to interpret the results. Testing for genetic disorders is complex and includes many different types of tests. Interpreting the results also requires specialized knowledge, because results are typically not simple or straightforward.

Genetic counselor

This specially trained health care provider helps you understand your risk of a genetic disorder. A genetic counselor can also determine if genetic testing could be helpful for you, based on your personal and family medical and health history. After you have had genetic testing, a genetic counselor can offer information and resources for prevention; connect you with prevention programs, such as those available at Fred Hutch; and help with testing your family members, based on your results. Fred Hutch Genetic Counseling Service providers are all licensed, board-certified genetic counselors.

Genetic counselor A health care professional with special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. A health professional who has special training in medical genetics and counseling. Genetic counselors help patients and families who have, or who may be at risk of, a genetic condition. They help patients find out their chances of having a genetic condition or of having a child or other family member with a genetic condition. They also help patients understand their options for genetic testing, including its risks and benefits. After genetic testing is done, genetic counselors help patients understand their test results, including how the results can affect other family members. They also provide counseling and support. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk.

Registered dietitian

Registered dietitians are credentialed food and nutrition experts. To earn this designation, they must undergo extensive training and formal education, including completing an internship and passing a national registration exam. Registered dietitians provide medical nutrition therapy which means they use an evidence-based approach to treat and help patients manage medical conditions through diet and nutrition.

Registered nurse

Your nurse manages your care alongside your physician. They also assist with procedures and treatments. Nurses are resources for you and your caregiver. They answer questions and help with a wide range of topics, like how to cope with side effects or get other services you need at Fred Hutch.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Patient care coordinator

Your patient care coordinator will likely be one of the first people you meet when you come to Fred Hutch. They will gather your medical records and family health history and help guide you to the appropriate genetics or prevention care services within Fred Hutch.

Find care team profiles

Meet the caring, dedicated people who take care of you and your family at Fred Hutch.

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Genetic counselors

Fred Hutch Genetic Counseling Service providers are all licensed, board-certified genetic counselors.

Lauren Brown, MS, CGC

Lauren Brown provides counseling for a variety of hereditary cancer syndromes. She enjoys coming alongside patients to share meaningful and relevant genetic health information. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health. In her free time, Lauren enjoys biking and overlanding (a fusion of camping and off-roading).

Lauren Facchini, MS, CGC

Lauren Facchini provides counseling for a variety of hereditary cancer syndromes. She has a special interest in genitourinary malignancies and focuses on helping patients understand how genetic test results can impact their personal and family’s risk for disease. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health.

Cynthia Handford, MSc, CGC, CCGC

Cynthia Handford has been a genetic counselor since 2007 and has worked in both clinical and laboratory settings. She has a special interest in hereditary cancer and enjoys helping patients and their families use genetic information to be proactive with their health. Cynthia is certified by the American Board of Genetic Counseling as well as the Canadian Association of Genetic Counsellors and licensed by the Washington State Department of Health.

Everett Lally, MS, CGC

Everett Lally provides counseling for a variety of hereditary cancer syndromes. He has a special interest in cancer genetics with a focus on gastrointestinal diseases and prostate cancer. He is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health.

Mercy Laurino, MS, CGC, PhD

Mercy Laurino is a certified genetic counselor. She manages Fred Hutch’s Breast and Ovarian Cancer Prevention Program, Gastrointestinal Cancer Prevention Program, Lung Cancer and Early Detection Program, as well as the Tobacco Cessation Counseling and the Genetic Counseling services. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health. She is the recent recipient of the International Leader award from the National Society of Genetic Counselors.

Lorraine Naylor, MS, CGC

Lorraine Naylor provides counseling to patients referred for a variety of inherited conditions. She has a special interest in cancer genetics, with a focus on gastrointestinal malignancies. She is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health.

Britta Sjoding, MS, CGC

Britta Sjoding is a certified genetic counselor and primarily provides cancer genetic counseling service to our Fred Hutch community sites. Counseling patients regarding hereditary cancer syndromes since 2009, she is certified by the American Board of Genetic Counseling and licensed by the Washington State Department of Health.

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