Chestionar de screening online

Evaluați-vă riscul de cancer gastro-intestinal cu chestionarul nostru de screening online

Online Screening

Introduction
Sample analysis data
Lifestyle & Family
Gastrict Cancer Screening Questionnaire
Colorectal Screening Questionnaire

What is this questionnaire?

This questionnaire is a screening tool for gastrointestinal cancer in the general population in the Romania-Serbia cross-border area.

What is a screening?

Screening means detecting the disease before serious signs of illness appear. By screening we have the chance that doctors will find the disease earlier and we have a better chance of being cured. A screening is a medical tool and its results should be discussed with a doctor..

How this screening questionnaire can help me?

This screening is useful for people who do not have signs of gastrointestinal cancer to estimate whether you are at risk of developing this type of cancer. This questionnaire allows you to assess your risk of developing gastrointestinal cancer in the future. This risk stems from your lifestyle and health. If the result of this screening questionnaire is abnormal, further tests and investigations are recommended. Answering this questionnaire does not mean that you will be diagnosed with gastrointestinal cancer..

What is gastrointestinal cancer?

The gastrointestinal tract starts from the oral cavity to the anus and includes the oesophagus, stomach, small intestine and large intestine (colon and rectum). Cancer can affect any part of the gastrointestinal tract, although it is less common in the small intestine..

How common is gastrointestinal cancer?

In Romania, colorectal cancer is responsible, along with lung cancer and breast cancer, for the most cases of cancer and ranks second in mortality after lung cancer.

The International Agency for Research on Cancer estimates through GLOBOCAN 2020 that in 2020 there will be almost 13,000 cases of colorectal cancer and 4,000 cases of gastric cancer in Romania.. (Sursa: https://gco.iarc.fr)

How this online screening questionnaire for gastrointestinal and colorectal cancer works?

For each type of cancer there are factors that can be considered protective or risk factors in the development of cancer.
Through your answers to this questionnaire, we analyse these risk factors to which you are exposed and help doctors choose the people to be investigated in more detail.

This questionnaire is based on scientific data validated in high-quality medical studies.

Even though this questionnaire is a medical tool, its results are not a clinical diagnosis but only a medical recommendation. The results of this questionnaire should be discussed and analysed with your family doctor or a specialist gastroenterologist, who can refer you for further investigations and medical tests if necessary and provide a clinical diagnosis..

A copy of your answers together with personalised medical recommendations will automatically be sent to your email address.

This questionnaire is derived from the validated QLQ-CR29 and QLQ-STO22 questionnaire developed by the European Organisation for Research and Treatment of Cancer EORTC (https://www.eortc.org). Further questions or comments on the QLQ-CR29 and QLQ-STO22 screening algorithms can be addressed to the Quality of Life specialists of the European Organisation for Research and Treatment of Cancer EORTC (https://www.eortc.org).

1. Whistance RN, Conroy T, Chie W, et al. Clinical and Psychometric Validation of the EORTC QLQ-CR29 Questionnaire Module to Assess Health-Related Quality of Life in Patients with Colorectal Cancer. Eur J Cancer 45:3017-3026, 2009.

Participation Agreement

By completing this questionnaire I agree to participate in this online screening for gastrointestinal and colorectal cancer, an activity carried out in the framework of the Interreg IPA-CBC Romania-Serbia project "Medical Infrastructure for the Development of Excellence Surgical Services in the Cross-border Area" RORS-467, funded by the European Union..

Also, by completing this questionnaire I agree to have my answers reviewed by health experts and included in the reporting of RORS-467 activities..

Data protection

The data you enter is anonymised and is not associated in any way with your identity. Your email address is used strictly to ensure the transparency of the screening activity. We will not share your email address with any third party for commercial or advertising purposes. A copy of your responses together with personalised recommendations will automatically be sent to your email address..

Your Email

At this email address you will receive a copy of the recommendations generated by this questionnaire.

Address

Country

City

County

Environment

Urban

Rural

Gender

Male

Female

Weight (kg)

Your weight is very important for your health. If you do not know the exact values, estimate based on the last values you remember.

Height (cm)

Age (in full years)

Income

Less than 400€ / family member

More than 400€ / family member

This information helps us to better stratify your answers about eating habits, risks and recommendations. Think about the total amount of money your family earns in a typical month. Divide this amount by how many members your family has, including children or dependants.

Last Doctor's visit

Last year

Last 5 years

Never, I only go when needed

When was the last time you went to the doctor for a routine check-up without any acute health problem?

I consent to have this website store my submitted information so they can respond to my inquiry

Unhealthy habits

Are you a smoker?

Yes

How many cigarettes a day do you smoke on average?

1-5

6-10

11-20

20-40

How many years have you smoked?

1-5 years

5-10 years

10-20 years

Do you drink alcohol?

Yes

In a typical week, on how many days do you consume alcohol?

1 day

2-3 days

4-6 days

daily

On a typical day when you drink beer, how much do you consume?

1 bottle

2-3 bottles

4-6 bottles

more than 6 bottles

I don't drink beer

On a typical day when you drink wine, how much do you consume?

1 glass

2-3 glasses

4-6 glasses

more than 6 glasses

I don't drink wine

On a typical day when you consume hard alcohol, how much do you consume?

1 glass

2-3 glasses

4-6 glasses

more than 6 glasses

I don't drink hard alcohol

Your Diet

In the past month, about how many servings of leafy greens or salads have you eaten per week? Include leafy green salads and raw, cooked, canned and frozen vegetables (including beans). Do not include fried vegetables such as chips.

None

Less than 1 portion per week

1-2 servings/week

3 -4 servings/week

5-6 servings/week

7-10 servings/week

In the last month, what volume did you usually eat in each serving of vegetables or salad?

half a cup or less (100 ml)

between half a cup and a cup and a half (100 - 300 ml)

between one and a half and 3 cups (300 - 600 ml)

between 3-5 cups (600 - 1000 ml)

more than 5 cups (1000 ml)

Physical Activity

In the past year, in how many months have you done any kind of moderate physical activity? Moderate activities are NOT those that make you sweat or breathe heavily. Some examples include vacuuming, gardening, walking lightly for exercise.

None

1 month

2 months

3 months

4 months

5 months

6 months

7 months

8 months

9 months

10 months

11 months

12 months

During those months, on average, how many hours per week did you do moderate physical activity

Less than 1 hour per week

Between 1-2 hours / week

2-3 hours / week

3-4 hours / week

More than 4 hours/week

In the past year, for how many months have you done any kind of vigorous activity? Vigorous activities ARE those that make you sweat or breathe heavily. Some examples include hard work such as intensive garden digging, intense sports such as running, fast cycling, exercise classes, weight lifting, swimming.

None

1 month

2 months

3 months

4 months

5 months

6 months

7 months

8 months

9 months

10 months

11 months

12 months

During those months, on average, how many hours per week did you do vigorous physical activity?

Less than 1 hour per week

Between 1-2 hours / week

2-3 hours / week

3-4 hours / week

More than 4 hours/week

Medical History

In the last 10 years, have you had a check-up with your gastroenterologist to see if you have polyps in your stomach, colon or rectal polyps?

Yes

In the past 30 days, you have taken aspirin-containing medications at least 3 times a week, such as: - Aspirin (Acetylsalicylic acid), -Aspirin Cardio, - Strong Antipyretic, - Aspenter, -Thrombo ass, - Nevralmed, - Other generic forms (does not include Paracetamol)

Yes

In the past 30 days, have you taken anti-inflammatory drugs that DO NOT CONTAIN aspirin at least 3 times a week, such as: - Ibuprofen, - Brufen, - Ketonal, - Naproxen, - Celebrex, - Advil (not including Paracetamol)

Yes

Family History

Do you have immediate relatives (mother, father, brothers or sisters, sons or daughters) who have ever had gastric or colon/rectal cancer?

Yes

I don't know

Gastrict Cancer Screening Questionnaire

Please indicate the extent to which you have experienced the symptoms or problems described below during the past four weeks. Please respond by selecting the degree that best fits your situation.

In the last 4 (four) weeks:

Have you had an unpleasant feeling while eating?

Not at all

A little

Pretty much

Very much

Have you had pain in your stomach area?

Not at all

A little

Pretty much

Very much

Have you had an uncomfortable feeling in your stomach area?

Not at all

A little

Pretty much

Very much

Have you experienced bloating of the abdomen?

Not at all

A little

Pretty much

Very much

Have you had problems with stomach or bile acid coming into your mouth?

Not at all

A little

Pretty much

Very much

Have you had heartburn?

Not at all

A little

Pretty much

Very much

Have you had problems with burping?

Not at all

A little

Pretty much

Very much

Have you had difficulty swallowing solid foods?

Not at all

A little

Pretty much

Very much

Have you had difficulty swallowing liquefied or soft foods?

Not at all

A little

Pretty much

Very much

Have you had difficulty swallowing fluids?

Not at all

A little

Pretty much

Very much

Did you feel full too soon after you started eating?

Not at all

A little

Pretty much

Very much

Did you find it hard to enjoy your meals?

Not at all

A little

Pretty much

Very much

Did it take you long to finish your meal?

Not at all

A little

Pretty much

Very much

Have you experienced dry mouth?

Not at all

A little

Pretty much

Very much

Did the food and drink taste different than usual?

Not at all

A little

Pretty much

Very much

Did you find it difficult to eat in front of other people?

Not at all

A little

Pretty much

Very much

Worried about being underweight?

Not at all

A little

Pretty much

Very much

Have you lost weight?

Not at all

A little

Pretty much

Very much

Have you worried about your health in the future?

Not at all

A little

Pretty much

Very much

Has your hair fallen out?

Not at all

A little

Pretty much

Very much

Colorectal Screening Questionnaire

Please indicate the extent to which you have experienced the symptoms or problems described below during the period indicated. Please respond by selecting the degree that best fits your situation.

In the last 4 (four) weeks:

Have you had abdominal pain?

Not at all

A little

Pretty much

Very much

Have you experienced bloating of the abdomen?

Not at all

A little

Pretty much

Very much

Have you had pain in your buttocks/anal area/rectum?

Not at all

A little

Pretty much

Very much

Did you have a bloody stool?

Not at all

A little

Pretty much

Very much

Have you had mucus stools?

Not at all

A little

Pretty much

Very much

Did you have dry mouth?

Not at all

A little

Pretty much

Very much

Have you had problems with your sense of taste?

Not at all

A little

Pretty much

Very much

Have you lost hair?

Not at all

A little

Pretty much

Very much

Have you urinated often during the day?

Not at all

A little

Pretty much

Very much

Have you urinated often during the night?

Not at all

A little

Pretty much

Very much

Have you had unintentional leakage of urine?

Not at all

A little

Pretty much

Very much

Have you had pain during urination?

Not at all

A little

Pretty much

Very much

Have you worried about your health in the future?

Not at all

A little

Pretty much

Very much

Have you worried about your weight?

Not at all

A little

Pretty much

Very much

Have you felt less physically attractive as a result of health problems?

Not at all

A little

Pretty much

Very much

Have you felt less feminine/masculine as a result of health issues?

Not at all

A little

Pretty much

Very much

Have you been dissatisfied with your body?

Not at all

A little

Pretty much

Very much

In the last 7 (seven) days:

Have you experienced involuntary gas/flatulence from your anus?

Not at all

A little

Pretty much

Very much

Have you had stool leak from your anus?

Not at all

A little

Pretty much

Very much

Have you experienced skin pain around the anal area?

Not at all

A little

Pretty much

Very much

Did you happen to have an accelerated bowel movement during the day?

Not at all

A little

Pretty much

Very much

Did you happen overnight to have an accelerated bowel movement?

Not at all

A little

Pretty much

Very much

Have you felt embarrassed because of your bowel movement?

Not at all

A little

Pretty much

Very much