Managing Patients with Lynch Syndrome

Once a diagnosis of Lynch syndrome is confirmed, appropriate treatment and management strategies can begin the process of reducing risk and improving outcomes. If a genetic test result confirms the presence of a known deleterious mutation, the following medical management options may help reduce or even eliminate the risk of certain associated cancers.

Surgical Management of Colorectal Cancer

• Colorectal cancer diagnosed (or more than one advanced adenoma found) in a patient with Lynch Syndrome, total colectomy with ileorectal anastomosis OR hemicolectomy are recommended
• In patients unwilling or unable to undergo periodic colonoscopy screening, prophylactic total colectomy with ileorectal anastomosis may be an option based on carrier status alone

Surgical Management of Endometrial and Ovarian Cancer

• Prophylactic total abdominal hysterectomy and bilateral salpingo-oophorectomy may be considered if colorectal cancer is detected (especially if bleeding or other symptoms of uterine or ovarian disease occur)

- May also be considered after childbearing is concluded

Increased Surveillance for Colorectal Cancer and Endometrial Cancer

• Colonoscopy every 1-2 years beginning between age 20-25, OR 10 years before the earliest age of a diagnosed colorectal cancer in patient’s family, whichever comes first
• Annual colonoscopy after age 40
• Gynecologic exam, transvaginal ultrasound, endometrial aspiration, and CA-125 every 1 to 2 years, beginning between age 25 and 35

Increased Surveillance for Other Lynch Syndrome-Related Cancers (Based on Patient’s Family History)

• Stomach cancer: Gastroscopy every 1 to 2 years, starting between age 30 and 35
• Urinary tract cancer: Ultrasonography or urine cytology every 1 to 2 years, starting between age 30 and 35

** For references and supporting data on risk factors and medical management, visit www.myriadpro.com/references