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Kim HM, Kim TI. Screening and surveillance for hereditary colorectal cancer. Intest Res 2024; 22:119-130. [PMID: 38311713 PMCID: PMC11079514 DOI: 10.5217/ir.2023.00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024] Open
Abstract
Hereditary colorectal cancer is a type of cancer that is caused by a genetic mutation. Individuals with a family history of colorectal cancer, or who have a known hereditary syndrome, are at an increased risk of developing the disease. Screening and surveillance are important tools for managing the risk of hereditary colorectal cancer. Screening involves a combination of tests that can detect precancerous or cancerous changes in the colon and rectum. Surveillance involves regular follow-up examinations to monitor disease progression and to identify new developments. The frequency and type of screening and surveillance tests may vary depending on an individual's risk factors, genetic profile, and medical history. However, early detection and treatment of hereditary colorectal cancer can significantly improve patient outcomes and reduce mortality rates. By implementing comprehensive screening and surveillance strategies, healthcare providers can help individuals at risk of hereditary colorectal cancer to receive timely interventions and make informed decisions about their health. Specific examples of screening and surveillance tests for hereditary colorectal cancer include colonoscopy, genetic testing, and imaging tests. In this review article, we will discuss detailed screening and surveillance of hereditary colorectal cancer.
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Affiliation(s)
- Hee Man Kim
- Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Mogere E, Mwaura E, Waithaka M, Mutua V, Mugao M, von Csefalvay C, Mukamati D. Juvenile polyposis syndrome: A case report. Clin Case Rep 2023; 11:e6798. [PMID: 36619487 PMCID: PMC9810833 DOI: 10.1002/ccr3.6798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Juvenile polyposis syndrome (JPS) is an autosomal dominant disease that is characterized by multiple hamartomatous polyps. Patients with JPS are at increased risk for developing colorectal and gastric cancer. JPS was diagnosed by endoscopy and histology, and the patient underwent surgery, total proctocolectomy and ileal pouch-anal anastomosis.
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Affiliation(s)
| | | | | | - Victor Mutua
- P.C.E.A Chogoria Mission HospitalTharaka NithiKenya
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Sninsky JA, Shore BM, Lupu GV, Crockett SD. Risk Factors for Colorectal Polyps and Cancer. Gastrointest Endosc Clin N Am 2022; 32:195-213. [PMID: 35361331 DOI: 10.1016/j.giec.2021.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colorectal cancer (CRC) is a common malignancy in the U.S. and worldwide. Most CRC cases arise from precancerous adenomatous and serrated polyps. Established risk factors for conventional adenomas and CRC include age, male sex, family history, obesity and physical inactivity, and red meat intake. White race and tobacco and alcohol use are important risk factors for serrated polyps, which have a distinct risk factor profile compared to conventional adenomas. A history of abdominopelvic radiation, acromegaly, hereditary hemochromatosis, or prior ureterosigmoidostomy also increases CRC risk. Understanding these risk factors allows for targeted screening of high-risk groups to reduce CRC incidence.
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Affiliation(s)
- Jared A Sninsky
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, CB 7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7555, USA
| | - Brandon M Shore
- Department of Medicine, University of North Carolina School of Medicine, CB 7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7555, USA
| | - Gabriel V Lupu
- Department of Medicine, University of North Carolina School of Medicine, CB 7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7555, USA
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, CB 7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7555, USA.
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Khongcharoen N, Laochareonsuk W, Choochuen P, Maneechay W, Sangkhathat S. Sequencing for novel mutation screening in juvenile polyposis syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mismatch repair proteins immunohistochemical null phenotype in colon medullary carcinoma. Clin J Gastroenterol 2021; 14:1448-1452. [PMID: 34279804 DOI: 10.1007/s12328-021-01484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In mismatch repair (MMR) immunohistochemistry, four MMR proteins' staining pattern reveals which particular gene may be defective. However, in the null phenotype, four MMR proteins are lost; consequently, it will be challenging to assume the target gene by immunohistochemistry and to determine whether deficient MMR was sporadic or germline. CASE REPORT A 70-year-old man underwent right hemicolectomy with the diagnosis of ascending colon cancer. The postoperative histopathology revealed the diagnosis of medullary carcinoma and the loss of all four MMR expressions in immunohistochemistry. The mutation analysis using a peripheral blood sample showed no germline mutations in the four genes. DISCUSSION This clinical case presents an unusual colon carcinoma that showed a MMR protein immunohistochemistry null phenotype. The cause of expression loss of MMR proteins can be explained by the loss of MLH1 and MSH2 functions associated with somatic loss of function mutations, functional loss in all four MMR proteins associated with somatic loss of function mutations, or Lynch-like syndrome. Correct interpretation and accumulation of relevant cases are necessary to unveil unusual cases in the era of universal screening.
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Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2020 for the Clinical Practice of Hereditary Colorectal Cancer. Int J Clin Oncol 2021; 26:1353-1419. [PMID: 34185173 PMCID: PMC8286959 DOI: 10.1007/s10147-021-01881-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 12/14/2022]
Abstract
Hereditary colorectal cancer (HCRC) accounts for < 5% of all colorectal cancer cases. Some of the unique characteristics commonly encountered in HCRC cases include early age of onset, synchronous/metachronous cancer occurrence, and multiple cancers in other organs. These characteristics necessitate different management approaches, including diagnosis, treatment or surveillance, from sporadic colorectal cancer management. There are two representative HCRC, named familial adenomatous polyposis and Lynch syndrome. Other than these two HCRC syndromes, related disorders have also been reported. Several guidelines for hereditary disorders have already been published worldwide. In Japan, the first guideline for HCRC was prepared by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), published in 2012 and revised in 2016. This revised version of the guideline was immediately translated into English and published in 2017. Since then, several new findings and novel disease concepts related to HCRC have been discovered. The currently diagnosed HCRC rate in daily clinical practice is relatively low; however, this is predicted to increase in the era of cancer genomic medicine, with the advancement of cancer multi-gene panel testing or whole genome testing, among others. Under these circumstances, the JSCCR guidelines 2020 for HCRC were prepared by consensus among members of the JSCCR HCRC Guideline Committee, based on a careful review of the evidence retrieved from literature searches, and considering the medical health insurance system and actual clinical practice settings in Japan. Herein, we present the English version of the JSCCR guidelines 2020 for HCRC.
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Early gastric cancer with three gastric gastrointestinal stromal tumors combined with synchronous colon cancer: a case report. World J Surg Oncol 2020; 18:231. [PMID: 32862828 PMCID: PMC7457498 DOI: 10.1186/s12957-020-02013-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There have been very few reports of patients with early gastric cancer (EGC) and colorectal cancer combined with gastric gastrointestinal stromal tumors (GISTs). CASE PRESENTATION We report the case of a patient with multiple tumors that were found at the same time in the abdomen. The patient was a 77-year-old man who was referred for a gastric GIST. Esophagogastroduodenoscopy showed the known lesion (a gastric GIST) on the lesser curvature of the upper body and a new lesion on the lesser curvature of the lower body of the stomach with suspicion of EGC. Computed tomography findings confirmed the presence of a GIST in the stomach and revealed two new lesions. One of these lesions was suspected to be a 4-cm submucosal tumor on the anterior wall of the upper body of the stomach. The other was a wall thickening of the descending colon that demonstrated the possibility of malignancy. Synchronous colon cancer was confirmed on colonoscopy. Laparoscopic near-total gastrectomy with D1+ lymph node dissection and left hemicolectomy were performed sequentially without significant events. The patient was discharged without any postoperative complications. CONCLUSIONS We reported a rare case of EGC with multiple gastric GISTs combined with synchronous colon cancer.
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Moradi A, Pourseif MM, Jafari B, Parvizpour S, Omidi Y. Nanobody-based therapeutics against colorectal cancer: Precision therapies based on the personal mutanome profile and tumor neoantigens. Pharmacol Res 2020; 156:104790. [DOI: 10.1016/j.phrs.2020.104790] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/07/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022]
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Gao XH, Li J, Zhao ZY, Xu XD, Du YQ, Yan HL, Liu LJ, Bai CG, Zhang W. Juvenile polyposis syndrome might be misdiagnosed as familial adenomatous polyposis: a case report and literature review. BMC Gastroenterol 2020; 20:167. [PMID: 32487124 PMCID: PMC7268223 DOI: 10.1186/s12876-020-01238-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/26/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Juvenile polyposis syndrome (JPS) is a rare disorder characterized by the presence of multiple juvenile polyps in the gastrointestinal tract, and germline mutations in SMAD4 or BMPR1A. Due to its rarity and complex clinical manifestation, misdiagnosis often occurs in clinical practice. CASE PRESENTATION A 42-year-old man with multiple pedunculated colorectal polyps and concomitant rectal adenocarcinoma was admitted to our hospital. His mother had died of colon cancer. He was diagnosed with familial adenomatous polyposis (FAP) and underwent total proctocolectomy and ileal pouch anal anastomosis. Two polyps were selected for pathological examination. One polyp had cystically dilated glands with slight dysplasia. The other polyp displayed severe dysplasia and was diagnosed as adenoma. Three years later, his 21-year-old son underwent a colonoscopy that revealed more than 50 pedunculated colorectal juvenile polyps. Both patients harbored a germline pathogenic mutation in BMPR1A. Endoscopic resection of all polyps was attempted but failed. Finally, the son received endoscopic resection of polyps in the rectum and sigmoid colon, and laparoscopic subtotal colectomy. Ten polyps were selected for pathological examination. All were revealed to be typical juvenile polyps, with cystically dilated glands filled with mucus. Thus, the diagnosis of JPS was confirmed in the son. A review of the literatures revealed that patients with JPS can sometimes have adenomatous change. Most polyps in patients with JPS are benign hamartomatous polyps with no dysplasia. A review of 767 colorectal JPS polyps demonstrated that 8.5% of the polyps contained mild to moderate dysplasia, and only 0.3% had severe dysplasia or cancer. It is difficult to differentiate juvenile polyps with dysplasia from adenoma, which could explain why juvenile polyps have been reported to have adenomatous changes in patients with JPS. Therefore, patients with JPS, especially those with concomitant dysplasia and adenocarcinoma, might be easily diagnosed as FAP in clinical practice. CONCLUSIONS Juvenile polyp with dysplasia is often diagnosed as adenoma, which might lead to the misdiagnosis of JPS as FAP. The differential diagnosis of JPS versus FAP, should be based on comprehensive evaluation of clinical presentation, endoscopic appearance and genetic investigations; not on the presence or absence of adenoma.
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Affiliation(s)
- Xian Hua Gao
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.,Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Juan Li
- Department of Nephrology, Changhai Hospital, Shanghai, China
| | - Zi Ye Zhao
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.,Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Xiao Dong Xu
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.,Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Yi Qi Du
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, Shanghai, China
| | - Hong Li Yan
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China.,Reproductive Medicine Center, Changhai Hospital, Shanghai, China
| | - Lian Jie Liu
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
| | - Chen Guang Bai
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China. .,Department of Pathology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China. .,Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China.
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Macaron C, Heald B, Burke CA. Using Genetics to Identify Hereditary Colorectal Polyposis and Cancer Syndromes in Your Patient. Curr Gastroenterol Rep 2016; 17:463. [PMID: 26292665 DOI: 10.1007/s11894-015-0463-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The majority of patients with colorectal polyps and cancer do not have a Mendelian cause of the disease. Age, lifestyle, and environmental factors interact with complex genetic traits to contribute to the etiology. However, approximately 5-10 % of patients with colorectal cancer (CRC) and more than 40 % of patients meeting specific clinical features of the hereditary polyposis syndromes have a discoverable, actionable genetic cause which will significantly alter their medical management.
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Affiliation(s)
- Carole Macaron
- Section of Gastroenterology, Department of Veterans Affairs, Louis Stokes Cleveland Medical Center, Cleveland, 44106, OH, USA
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Tan RY, Met-Domestici M, Zhou K, Guzman AB, Lim ST, Soo KC, Feeley TW, Ngeow J. Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic. J Oncol Pract 2016; 12:e320-31. [DOI: 10.1200/jop.2015.007765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Methods: Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Results: Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. Conclusion: This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.
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Affiliation(s)
- Ryan Y.C. Tan
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Marie Met-Domestici
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Ke Zhou
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Alexis B. Guzman
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Soon Thye Lim
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Khee Chee Soo
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Thomas W. Feeley
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
| | - Joanne Ngeow
- National Cancer Centre Singapore; Duke-National University of Singapore Graduate Medical School, Singapore; The University of Texas MD Anderson Cancer Center, Houston, TX; and Harvard Business School, Boston, MA
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