___________________________________________________________________________ Colorectal Cancer
SCREENING AND SURVEILLANCE RECOMMENDATIONS FOR COLORECTAL CANCER AND EXTRACOLONIC MALIGNANCIES IN PATIENTS WITH HEREDITARY COLORECTAL CANCER SYNDROMES ( Continued )
Cancer Screening
Recommendations
Colorectal: 21–40 years, small adenoma burden Colorectal: >40 years, small adenoma burden Colorectal: Significant polyposis not manageable with polypectomy
Colectomy with IRA or colonoscopy and polypectomy every one to two years; surgical evaluation and counseling
Colectomy with IRA; surgical evaluation and counseling
Colectomy with IRA (preferred) or proctocolectomy with ileal J-pouch anal anastomosis
Colorectal
If patient had colectomy with IRS, endoscopic exam of rectum every 6 to 12 months depending on polyp burden Annual physical exam; annual thyroid exam NSAID chemoprevention Baseline upper endoscopy every six months to four years starting at 25 to 30 years of age
Family history of AFAP Colorectal: APC positive or not tested Colorectal: APC negative
Colonoscopy starting in late teens, then every two to three years
Average risk screening Diagnosis of MYH -associated polyposis or family history of sibling with MYH polyposis Colorectal: Sibling with MYH polyposis and patient is asymptomatic
Colonoscopy starting at 25 to 30 years of age and every three to five years if negative (shorter intervals with advancing age)
Colorectal: MYH mutation positive or untested
Upper endoscopy and side viewing duodenoscopy starting at 30 to 35 years of age and every three to five years Patients with duodenal adenomas are treated as in FAP Genetic counseling and testing for the familial MYH polyposis mutation(s)
Personal history of MYH -associated polyposis Colorectal: Personal history of positive MYH mutation, polyposis, and negative APC testing
Genetic counseling and testing for MYH polyposis mutation(s); if negative, refer to increased risk colorectal cancer screening guidelines for multiple adenomatous polyps
Colorectal: History of adenomatous polyposis and negative APC testing (>10 at one time or >15 in 10 years)
If adenomas are manageable with colonoscopy and polypectomy: • Colonoscopy and polypectomy every one to two years • Upper endoscopy and side viewing duodenoscopy starting at 30 to 35 years of age every three to five years • Patients with duodenal adenomas treated as in FAP If dense or large polyps are not manageable with colonoscopy and polypectomy: • Subtotal colectomy or proctocolectomy depending on adenoma density and distribution; counseling regarding surgical options • Upper endoscopy and side viewing duodenoscopy starting at 30 to 35 years of age every three to five years • Patients with duodenal adenomas treated as in FAP • Counseling regarding surgical options
AFAP = attenuated familial adenomatous polyposis, CNS = central nervous system, CT = computed tomography, EGD = esophagogastroduodenoscopy, FAP = familial adenomatous polyposis, HNPCC = hereditary nonpolyposis colorectal cancer, IRA = ileorectal anastomosis, MRI = magnetic resonance imaging, NSAID = nonsteroidal anti-inflammatory drug. Source: [112] Table 3
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