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A healthy 32-year-old patient presents to you asking
about screening tests for colon cancer. He reports that his two
older sisters had colon cancers at age 40 and 42 years, his mother
had colon cancer at age 40 years and endometrial cancer at
age 45 years, and a maternal aunt had breast cancer at a young
age. He notes there is no history of colon polyps in any family
member. You recommend he undergo:
a. Annual fecal occult blood testing
b. Colonoscopy now and subsequently every 1 to 2 years
because his risk for colon cancer is very high
c. Colonoscopy with random biopsies to look for inflammatory
bowel disease; if not present, he should follow routine
screening recommendations for average-risk Americans
d. Prophylactic colectomy
e. Reassurance only because no polyps were found in family
b?? it is HNPCC.,,RIGHT?
God is my rock
yes is B
This patient is at very high risk for the development of colon cancer
given his family history. It is unlikely that he would have a hereditary
polyposis syndrome, because no family member had polyps.
His history is highly concerning for the presence of hereditary nonpolyposis
colon cancer, or Lynch syndrome given the multiple firstdegree
relatives affected at an early age and the family history of
breast and endometrial cancer. This syndrome is associated with a
defect in mismatch repair enzymes and leads to microsatellite instability.
Fecal occult blood testing is not adequately sensitive for
screening normal-risk individuals, let alone high-risk persons.
Inflammatory bowel disease does signifcantly increase the risk for
colon cancer, but nothing in this patientâ€™s history suggests this is
present. Prophylactic colectomy is worth considering only if he
tests positive for the defective gene.
Uhm... Extend your narcism as COnrad Fischer says. If there are NO POLYPS but the patient GETS CANCER ANYWAY what good is a bunch of colonoscopies going to be? Run my DNA, if ive got the gene for HNCPP, cut my colon out.
Prophylactic Colectomy for the win.
Poop into a bag or be dead? I'll take poop into a bag, thanks.
reply to the person above. You are mixing up polyps with polyposis. Lets be clear, lynch syndrome can have polyps, and polyps leads to cancer, so you scope for them.
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