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Results from an American Society of Colon and Rectal Surgeons survey on the management of young-onset colorectal cancer

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Abstract

Background

Young patients with colorectal cancer (CRC) present a diagnostic and clinical challenge. The aim of our study was to survey the approaches to preoperative evaluation and clinical management of young patients with CRC by colorectal surgeons in North America.

Methods

A standard electronic survey was sent to the members of the American Society of Colon and Rectal Surgeons. The survey polled management decisions in various clinical scenarios for CRC patients less than 50 years old. Survey responses were collated and analyzed.

Results

One hundred ninety surgeons responded and 140 completed the entire survey (response rate 10 %). Eighty percent of surgeons would offer preoperative genetic testing if the patient’s family met the Amsterdam criteria compared to only 67 % if the criteria were not met. Of those offering preoperative tumor testing, 48 % test microsatellite instability, 19 % mismatch repair protein expression by immunohistochemistry, and 24 % offer both. Decisions regarding the extent of the resection for cancer were dependent on family history: Most members (86 %) would perform a segmental colectomy for CRC in a patient without family history. Eighty-four percent of respondents would offer a total abdominal colectomy if preoperative tests indicated Lynch syndrome. When questioned about MYH-associated polyposis, only 27 % recognized the appropriate diagnosis.

Conclusions

Among the American Society of Colon and Rectal Surgeons, family history influences preoperative testing and surgical management decisions. A significant portion of surgeons do not offer preoperative genetic testing, despite implications on operative management, postoperative surveillance, and screening of family members.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  2. Edwards BK, Ward E, Kohler BA et al (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, an treatment) to reduce future rates. Cancer 116:544–573

    Article  PubMed Central  PubMed  Google Scholar 

  3. You NY, Xing Y, Feig BW, Chang GJ, Cormier JN (2012) Young onset colorectal cancer: is it time to pay attention? Arch Intern Med 13:287–289

    Article  Google Scholar 

  4. Aaltonen LA, Salovaara R, Kristo P et al (1998) Incidence of hereditary nonpolyposis colorectal cancer and the feasibility of molecular screening for the disease. N Engl J Med 21:1481–1487

    Article  Google Scholar 

  5. 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 

  6. Lynch HT, Riley BD, Weismann S et al (2004) Hereditary non-polyposis colorectal carcinoma (HNPCC) and HNPCC-like families; problems in diagnosis, surveillance and management. Cancer 100:53–64

    Article  PubMed  Google Scholar 

  7. 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 

  8. Online reference www.fionnotoole.com/ASCRS_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. Polamaki GE, McCalin MR, Melilo S, Hampell H, Thibodeau SN (2009) EGAPP supplementary evidence review: DNA testing strategies aimed at reducing morbidity and mortality from Lynch syndrome. Genet Med 11:42–65

    Article  Google Scholar 

  11. Shia J (2008) Immunohistochemistry versus microsatellite testing for screening colorectal cancer at risk for hereditary nonpolyposis colorectal cancer syndrome. Part 1. The utility of immunohistochemistry. J Mol Diagn 10:293–300

    Article  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 252:507–513

    PubMed  Google Scholar 

  13. Lindor NM (2009) Hereditary colorectal cancer: MYH-associated polyposis and other newly identified disorders. Best Pract Res Clin Gastroenterol 23:75–87

    Article  CAS  PubMed  Google Scholar 

  14. 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 

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

    Article  PubMed  Google Scholar 

  16. 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 

  17. 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 

  18. Ringland CL, Arkenau HT, O’Connell DL, Ward RL (2010) Second primary colorectal cancers (SPCRs): experiences from a large Australian cancer registry. Ann Oncol 21:92–97

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Church J, Simmang C (2003) Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer). Dis Colon Rectum 46:1001–1012

    Article  PubMed  Google Scholar 

  21. Winawer S, Fletcher R, Rex D et al (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 124:544–560

    Article  PubMed  Google Scholar 

  22. Bellizzi AM, Frankel WL (2009) Colorectal cancer due to deficiency in DNA mismatch repair function: a review. Adv Anat Pathol 16:405–417

    Article  CAS  PubMed  Google Scholar 

  23. Vasen HF, Watson P, Khan PM (1991) The international collaborative group on hereditary non-polyposis colorectal cancer (ICG-HNPCC). Dis Colon Rectum 34:424–425

    Article  CAS  PubMed  Google Scholar 

  24. 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 60:950–957

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  26. Nielson M, Morreau H, Vasen HF, Hes HF (2010) MUTYH- associated polyposis (MAP). Crit rev Oncol/Haematol 2010

  27. Warrier SK, Lynch AC, Heriot AG (2013) A binational perspective on the management of young patients with colorectal cancer. ANZ J Surg. doi:10.1111/ans.12071

    Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA

    S. K. Warrier, M. F. Kalady, R. P. Kiran & J. M. Church

  2. Department of Colorectal Surgery, Epworth Healthcare, Victoria, Australia

    S. K. Warrier

  3. Division of Surgical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia

    S. K. Warrier

  4. Center for Hereditary Colorectal Neoplasia, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    M. F. Kalady & J. M. Church

Authors
  1. S. K. Warrier
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  2. M. F. Kalady
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  3. R. P. Kiran
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  4. J. M. Church
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Corresponding author

Correspondence to S. K. Warrier.

Additional information

This work was presented as a poster at the American Society Colorectal Rectal Surgeons meeting at San Antonio, 2012.

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Warrier, S.K., Kalady, M.F., Kiran, R.P. et al. Results from an American Society of Colon and Rectal Surgeons survey on the management of young-onset colorectal cancer. Tech Coloproctol 18, 265–272 (2014). https://doi.org/10.1007/s10151-013-1052-5

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  • DOI: https://doi.org/10.1007/s10151-013-1052-5

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