Managing Patients with Adenomatous Polyposis Syndromes

It is possible to change the outcome for patients who have adenomatous polyposis syndromes. If a COLARIS AP® test result confirms the presence of adenomatous polyposis syndromes, the following medical management options may help reduce or even eliminate the risk of cancer.

Familial Adenomatous Polyposis (FAP)

Increase Surveillance:

  • Annual flexible sigmoidoscopy beginning between ages 10 and 1287
  • Following a prophylactic subtotal colectomy, flexible sigmoidoscopy of remaining ileal pouch and rectal epithelium every 6 months to 3 years, depending on number of polyps found on previous exam88,89
  • Esophagogastroduodenoscopy (EGD) every 1 to 4 years (depending on polyp burden), beginning between age 20 and 2590
  • Annual physical exam, including palpation of the thyroid, beginning between age 10 and 1290

Chemoprevention:

  • Research to determine the effectiveness of NSAIDS in colorectal polyp development is currently being conducted
  • The FDA has approved some NSAIDS to help prevent polyp formation in the rectum after a total colectomy, but none of these drugs are proven to reduce or prevent polyps prior to surgery

Surgical Management

  • Prophylactic total colectomy is advised following development of adenomatous polyps91

Note: Screening for other FAP/AFAP-associated cancers may be considered, depending on family history.

Attenuated FAP (AFAP)

Increased Surveillance:

  • Colonoscopy every 1 to 3 years, beginning in late teens or mid-twenties92
  • Esophagogastroduodenoscopy (EGD) every 1 to 4 years (depending on polyp burden), beginning between age 20 and 2590

Surgical Management:

  • Prophylactic colectomy, though it may not be necessary for an APC-positive patient, should be considered on an individual basis87

Note: Screening for other FAP/AFAP-associated cancers may be considered, depending on family history.

MYH-Associated Polyposis (MAP):

  • For patients who have MAP, medical society management recommendations include colonoscopies every 1-2 years starting at age 25-30, upper endoscopies every 3-5 years starting at age 30-35, and surgical considerations. The most appropriate medical management will vary based upon your patient’s clinical presentation.282
  • For MYH mutation carriers (1 mutation), medical management should be determined by clinical findings and personal and family history of colorectal polyps and/or cancer. Current data are limited but suggest that any increase in risk, if present, is likely to be small.283

Screening Recommendations for Extracolonic Manifestations of FAP and AFAP

screening

*Any discussion of medical management options is for general information purposes only and does not constitute a recommendation. While genetic testing and medical society guidelines provide important and useful information, medical management decisions should be made based on consultation between each patient and his or her healthcare provider.