Friday, October 14, 2016

Optional Rotation: UPMC Hereditary GI Tumor Program

Upon entering the program, I had a strong interest in cancer genetics and wanted to take every opportunity to expand my knowledge in this area. For my optional rotation, I chose to spend three weeks with two wonderful genetic counselors in the UPMC Hereditary GI Tumor Program at Shadyside Hospital. Patients are referred to the clinic for a variety of suspected hereditary cancer predispositions. This may be due to a personal diagnosis or a family history of polyps or gastrointestinal cancers. During my rotation, I was able to see patients whom we counseled regarding Lynch syndrome, Cowden syndrome, and familial pancreatic cancer – all of which I had not yet had the opportunity to see as part of my rotations.

Before coming into this optional rotation, I had completed two general cancer rotations, so I had a solid understanding of how a general cancer genetic counseling session went. I was comfortable counseling patients regarding Hereditary Breast and Ovarian Cancer, and I was familiar with ordering gene panels for patients. I was able to take these skills and continue to build on them - addressing psychosocial issues in session, learning the nuances of cancer counseling, and crafting my own counseling style. Most importantly to me, I became intimately familiar with the numerous hereditary colon cancer syndrome criteria and guidelines that had initially felt overwhelming when I learned about them in class.

Another terrific experience I gained during this rotation was observing the same surveillance procedures I had discussed as management recommendations with patients throughout my rotations. Individuals at an increased risk for colon cancer and polyps have more frequent colonoscopies than the general population. Some of the cancer predispositions confer an increased risk for gastric, small bowel, and pancreatic cancer. The first two can be screened for with upper endoscopy and pancreatic cancer surveillance can include endoscopic ultrasound. Having observed these procedures, I feel that I can speak about them more confidently when describing them to the patients.

As a MS Genetic Counseling/MPH Public Health Genetics dual degree student, I felt that this rotation was extremely valuable as it gave me the chance to learn more about Lynch syndrome, which is one of the CDC’s Tier 1 conditions. The information that I learned in clinic has allowed me to participate more fully in my Public Health classes, especially those in which these Tier 1 conditions are discussed, which in turn allows me to help educate my peers who do not have a genetic background. The education of other healthcare providers and policy makers is going to be part of the multifaceted role I have as a practicing genetic counselor, which makes the education of my peers a valuable learning experience.

I am very grateful that I had this rotation experience. I think it was a perfect one for me as it allowed me to gain more experience in cancer genetic counseling sessions, get the opportunity to interact with patients with a variety of syndromes not seen as frequently in the general cancer rotations, and acquire knowledge that dovetailed with my Public Health classes.

- Emily Griffenkranz, Class of 2017

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