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Managing Young Colorectal Cancer: A UK and Irish Perspective

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Abstract

Objective

Young patients with familial syndromes have an increased metachronous cancer rate. Effective management is possible by identifying this high-risk group prior to index colectomy. The study surveys the Association of Coloproctology of Great Britain and Ireland (ACPGBI) membership preoperative evaluation and clinical management in young patients with colorectal cancer (CRC).

Method

An electronic survey was sent to the membership of the ACPGBI. The survey polled members on clinical scenarios relating to young-onset CRC patients. We were particularly concerned with preoperative management strategies, the extent of colectomy, and postoperative surveillance. Survey responses were collated and analysed.

Results

A total of 124 members responded to the survey and 74 completed the survey. Of these, 87.8 % would proceed to colectomy without preoperative tumor or genetic testing. Decisions regarding the extent of colectomy depended on family history. A total of 67 (90.6 %) would offer a limited colectomy with no family history, 49 (66.2 %) in a patient with familial CRC type X, 29 (39.2 %) in a young patient with Lynch syndrome. A similar trend was seen with young rectal cancer. Only 16 surgeons (21.6 %) could identify a syndrome of MYH-associated polyposis (MAP).

Conclusion

The majority of ACPGBI members will not offer preoperative risk testing based on a young age alone; however, the majority would alter their surgical strategy based on the results of this testing. MAP is poorly recognized by ACPGBI members and therefore an opportunity exists for education among members.

What is new in this paper?

This study is the first paper to survey the ACPGBI membership on management practices in young-onset CRC. Members are poor in adopting preoperative testing, alter surgical strategy based on a familial syndrome, with a minority recognizing MAP. An opportunity to improve education on young CRC patients exists.

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References

  1. Southey MC, Jenkins MA, Mead L et al (2005) Use of molecular tumour characteristics to prioritise mismatch repair gene testing in early-onset colorectal cancer. J Clin Oncol 23:6524–6532

    Article  CAS  PubMed  Google Scholar 

  2. Farrington SM, Lin-Goerke J, Ling J et al (1998) Systematic analysis of hMSH2 and hMLH1 in young colon cancer patients and controls. Am J Hum Genet 63:749–759

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Warrier SK, Trainer AH, Lynch AC et al (2011) Preoperative diagnosis of Lynch syndrome with DNA mismatch repair immunohistochemistry on a diagnostic biopsy. Dis Colon Rectum 54:1480–1487

    Article  CAS  PubMed  Google Scholar 

  4. Church J (1998) Hereditary colon cancers can be tiny: a cautionary case report of the results of colonoscopic surveillance. Am J Gastroenterol 93:2289–2290

    Article  CAS  PubMed  Google Scholar 

  5. Vasen HF, Fm Nagengast, Khan PM (1995) Interval cancers in hereditary non-polyposis colorectal cancer (Lynch syndrome). Lancet 345:1183–1184

    Article  CAS  PubMed  Google Scholar 

  6. Lynch HT, Smyrk T, Jass JR (1995) Hereditary nonpolyposis colorectal cancer and colonic adenomas? Semin Surg Oncol 11:406–410

    Article  CAS  PubMed  Google Scholar 

  7. Parry S, Win AK, Parry B et al (2011) Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery. Gut 60(7):950–957

    Article  PubMed  Google Scholar 

  8. www.fionnotoole.com/ACPGBI_survey

  9. Lindor N, Rabe K, Petersen G et al (2005) Lower cancer incidence in Amsterdam-I criteria families without mismatch repair deficiency: familial colorectal cancer type X. JAMA 293:1979–1985

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Lichtenstein P, Holm NV, Versalo PK et al (2000) Environmental and heritable factors in the causation of cancer: analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med 343:78–85

    Article  CAS  PubMed  Google Scholar 

  11. Delaney CP, Fazio VW, Remzi FH et al (2003) Prospective, age related analysis of surgical results, functional outcome, and quality of life after ileal pouch-anal anastomosis. Ann Surg 238:221–228

    PubMed Central  PubMed  Google Scholar 

  12. Kalady MF, McGannon E, Vogel JD et al (2010) Risk of colorectal adenoma and carcinoma after colectomy for colorectal cancer in patients meeting Amsterdam criteria. Ann Surg 252(3):507–513

    PubMed  Google Scholar 

  13. http://www.acpgbi.org.uk/members/guidelines/documents-for-themanagementofcolorectal-cancer/

  14. American Society of Colon and Rectal Surgeons. Hereditary colon cancer syndromes and genetic testing. http://www.fascrs.org/physicians/education/core_subjects/2012/hereditary_colon_cancer_syndromes/

  15. Elton C, Makin K, Cohen CRG (2003) Outcome after ileorectal anastamosis. Br J Surg 90:59–65

    Article  CAS  PubMed  Google Scholar 

  16. Church JM, Fazio VW, Lavery IC, Oakley JR, Milsom J, McGannon E (1996) Quality of life after prophylactic colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis. Dis Colon Rectum 39:1404–1408

    Article  CAS  PubMed  Google Scholar 

  17. Van Duijvendijik P, Slors JFM, Tatt CW, Oosterveld P, Vasen HFA (1999) Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis with familial adenomatous polyposis. Ann Surg 230:648–654

    Article  Google Scholar 

  18. Ko CY, Rusin LC, Schoetz DJ Jr, Moreau L, Coller JA, Murray JJ et al (2000) Does better functional result equate with better quality of life? Implications for surgical treatment in familial adenomatous polyposis. Dis Colon Rectum 43:829–837

    Article  CAS  PubMed  Google Scholar 

  19. Lynch AC, Chruch JM, Lavery IC (2003) QOL following partial colectomy: relevance to hereditary non-polyposis colorectal cancer. Dis Colon Rectum 46:A55

    Google Scholar 

  20. Haanstra JF, de Vos tot Nederveen Cappel WH, Gopie JP et al (2012) Quality of life after surgery for colon cancer in patients with Lynch syndrome: partial versus subtotal colectomy. Dis Colon Rectum 55:653–659

    Article  PubMed  Google Scholar 

  21. You N, Chua H (2008) Segmental vs extended colectomy: measurable differences in morbidity, function, and quality of life. Dis Colon Rectum 51:1036–1043

    Article  PubMed  Google Scholar 

  22. Win AK, Parry S, Parry B et al (2013) Risk of metachonous colon cancer following surgery for rectal cancer in mismatch repair gene mutation carriers. Ann Surg Oncol 20(6):1829–1836

    Article  PubMed Central  PubMed  Google Scholar 

  23. Kalady MF, Lipman J, McGannon E, Church JM (2012) Risk of colonic neoplasia after proctectomy for rectal cancer in hereditary nonpolyposis colorectal cancer. Ann Surg 255:1121–1125

    Article  PubMed  Google Scholar 

  24. Lovegrove RE, Tilney HS, Heriot AG et al (2006) A comparison of adverse events and functional outcomes after restorative proctocolectomy for familial adenomatous polyposis and ulcerative colitis. Dis Colon Rectum 49:1293–1306

    Article  PubMed  Google Scholar 

  25. Church J, Heald B, Burke C, Kalady M (2012) Understanding MYH-associated neoplasia. Dis Colon Rectum 55:359–362

    Article  PubMed  Google Scholar 

  26. Hendriks YM, Wagner A, Morreau H et al (2004) Cancer risk in hereditary nonpolyposis colorectal cancer due to MSH6 mutations: impact on counselling and surveillance. Gastroenterology 127:17–25

    Article  CAS  PubMed  Google Scholar 

  27. Schmeler KM, Lynch HT, Chen LM et al (2006) Prophylactic surgery to reduce the risk of gynaecological cancers in the Lynch Syndrome. N Eng J Med 354:261–269

    Article  CAS  Google Scholar 

  28. Shia J, Stadler Z, Weiser MR et al (2011) Immunohistochemical staining for DNA mismatch repair proteins in intestinal tract carcinoma: how reliable are biopsy samples? Am J Surg Pathol 35(3):447–453

    Article  PubMed  Google Scholar 

  29. Maeda T, Cannom R, Beart RW Jr, Etzioni D (2010) Decision model of segmental compared with total abdominal colectomy for colon cancer in hereditary nonpolyposis colorectal cancer. J Clin Oncol 28(7):1175–1180

    Article  PubMed  Google Scholar 

  30. Burn J, Gerdes AM, Macrae F et al (2011) Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet 378:2081–2087

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors thank the ACPGBI members for answering the survey and thank the society secretariat, Anne O Mara for allowing us to distribute the survey via email to the respondents.

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Authors and Affiliations

  1. Department of Surgery, Epworth Healthcare, Richmond, VIC, Australia

    Satish K. Warrier, A. Craig Lynch & Alexander G. Heriot

  2. Division of Cancer Surgery, Peter MacCallum Cancer Institute, Melbourne, VIC, Australia

    Satish K. Warrier, A. Craig Lynch & Alexander G. Heriot

  3. Division of Colorectal Surgery, Leicester Royal Infirmary, Leicester, UK

    Justin M. Yeung

  4. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett St, Melbourne, VIC, 8006, Australia

    Satish K. Warrier

Authors
  1. Satish K. Warrier
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  2. Justin M. Yeung
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  3. A. Craig Lynch
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  4. Alexander G. Heriot
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Corresponding author

Correspondence to Satish K. Warrier.

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Warrier, S.K., Yeung, J.M., Lynch, A.C. et al. Managing Young Colorectal Cancer: A UK and Irish Perspective. World J Surg 38, 1827–1833 (2014). https://doi.org/10.1007/s00268-014-2470-x

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  • DOI: https://doi.org/10.1007/s00268-014-2470-x

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