source: National Comprehensive Cancer Network

year: 1998

Familial Adenomatous Polyposis:

Dr. Gruber stressed the distinction the panel drew between a personal history of Familial Adenomatous Polyposis (FAP) and a family history of the disease, “because it makes a dramatic difference in the way we approach these individuals.”

For patients with a personal history of FAP (ie, the individual who presents with hundreds of polyps lining the colon whether or not there is a family history), treatment is straightforward–colectomy. Genetic testing for the APC gene is irrelevant to the patientÂ’s treatment but is recommended for risk assessment in family members.

The recommended surveillance after colectomy is sigmoidoscopy every 6 months for 3 years–a flexible sigmoid-oscope should be used if the rectum remains in place–plus fecal occult blood testing annually, upper endoscopy every 4 years, and physical exam every 1 to 2 years. Dr. Gruber noted that upper endos-copy need not be performed as often as sigmoidoscopy, since most polyps of the upper colon do not have the same malignant potential as ones in the lower colon unless dysplasia is found.