Health

What is hereditary nonpolyposis colorectal cancer syndrome (HNPCC)?  HNPCC syndrome is an autosomal dominant disorder distinguished by the early development of CRC (average age is 44). The diagnostic clinical criteria used to help establish the diagnosis of HNPCC include the Amsterdam (modified) and Bethesda classification systems. What are the endoscopic screening and surveillance guidelines for …

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Do patients with PJS require endoscopic screening and surveillance for CRC?  CRC surveillance endoscopy is offered to patients with PJS syndrome because the lifetime risk of CRC for these individuals ranges from 10% to 20%. Several surveillance protocols have been published but the true efficacy of aggressive CRC surveillance for these patients has yet to …

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What is the definition of serrated polyposis syndrome?  The World Health Organization definition requires at least one of the following: At least five serrated polyps proximal to sigmoid, with two or more 10 mm or larger Any serrated polyps proximal to sigmoid with family history of serrated polyposis syndrome More than 20 serrated polyps of any …

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What is a serrated adenoma, and is there any increased risk of malignancy or need for surveillance?  Sessile serrated adenomas are premalignant flat (or sessile), often mucus-covered lesions predominantly seen in the cecum and ascending colon, that are thought to lead to CRC through an (alternate) serrated pathway. This differs from most CRCs, which arise …

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When should screening colonoscopy not be offered or surveillance stopped?  Evidence suggests that the risks of colonoscopy increases with advancing age. Surveillance and screening should not be continued when risks outweigh the benefits. The United States Preventive Services Task Force (USPSTF) determined that screening should not be continued after age 85 years because the risk …

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What are the surveillance recommendations for a patient with a previous history of adenomatous colon polyps?  After the removal of an adenomatous polyp, colonoscopy is the recommended method of surveillance because it has been shown to significantly reduce subsequent CRC incidence. Colonoscopy Surveillance Recommendations Findings on Index Colonoscopy Surveillance Recommendation ≤ 2 small tubular adenomas …

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Do individuals with a first degree relative diagnosed with adenomatous polyps require earlier screening for CRC? Do they have an increased risk for CRC?  Yes. Persons with a first-degree relative diagnosed with advanced (high-risk adenoma [HRA]) adenomas (an adenoma ≥ cm in size, or with HGD, or with villous elements) before the age of 50 …

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