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 Colectomy with IRA or colonoscopy and polypectomy every one to two years; surgical evaluation and counseling Colorectal: >40 years, small adenoma burden Colectomy with IRA; surgical evaluation and counseling Colorectal: Significant polyposis not manageable with polypectomy 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 Colonoscopy starting in late teens, then every two to three years Colorectal: APC negative 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 Colorectal: History of adenomatous polyposis and negative APC testing (>10 at one time or >15 in 10 years)
Genetic counseling and testing for MYH polyposis mutation(s); if negative, refer to increased risk colorectal cancer screening guidelines for multiple adenomatous polyps
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: [111] Table 3
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