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Basic concepts for genetic testing in common hereditary colorectal cancer syndromes

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Abstract

Approximately 5% of colorectal cancers are associated with one of the autosomal dominant hereditary cancer syndromes. The two most common familial colon cancer syndromes are familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). The causative mutation can be identified in many families with these syndromes by genetic testing of an affected individual. If an affected individual tests positive for a disease-causing mutation, genetic testing of unaffected, at-risk family members can be performed to determine whether they have inherited the cancer-susceptibility mutation, and a personalized cancer surveillance strategy can be devised. Genetic testing significantly enhances cancer risk assessment in these families. However, the complicated nature of result interpretation and the emotional impact of the result necessitate that testing be carried out in conjunction with patient education and informed consent by a physician who has a keen appreciation for the inherent challenges. This article describes the genetic testing strategy in HNPCC and FAP.

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References and Recommended Reading

  1. Katballe N, Juul S, Christensen M, et al.: Patient accuracy of reporting on hereditary non-polyposis colorectal cancer-related malignancy in family members. Br J Surg 2001, 88:1228–1233.

    Article  PubMed  CAS  Google Scholar 

  2. American Gastroenterological Association: American Gastroenterological Association medical position statement: hereditary colorectal cancer and genetic testing. Gastroenterology 2001, 121:195–197.

    Google Scholar 

  3. American Society of Clinical Oncology: Statement of the American Society of Clinical Oncology: genetic testing for cancer susceptibility. J Clin Oncol 1996, 14:1730–1736.

    Google Scholar 

  4. Joint Test and Technology Transfer Committee Working Group: Genetic testing for colon cancer: joint statement of the American College of Medical Genetics and American Society of Human Genetics. Genet Med 2000, 2:362–366.

    Google Scholar 

  5. Geller G, Botkin JR, Green MJ, et al.: Genetic testing for susceptibility to adult-onset cancer: the process and content of informed consent. JAMA 1997, 277:1467–1474.

    Article  PubMed  CAS  Google Scholar 

  6. Lynch HT, de la Chapelle A: Genetic susceptibility to nonpolyposis colorectal cancer. J Med Genet 1999, 36:801–818.

    PubMed  CAS  Google Scholar 

  7. Vasen HFA, Wijnen JT, Menko FH, et al.: Cancer risk in families with hereditary nonpolyposis colorectal cancer diagnosed by mutation analysis. Gastroenterol 1996, 110:1020–1027.

    Article  CAS  Google Scholar 

  8. Aarnio M, Sankila R, Pukkala E, et al.: Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer 1999, 81:214–218.

    Article  PubMed  CAS  Google Scholar 

  9. Mecklin JP, Jarvinen HJ: Clinical features of colorectal carcinoma in cancer family syndrome. Dis Colon Rectum 1986, 29:160–164.

    Article  PubMed  CAS  Google Scholar 

  10. Lin KM, Shashidharan M, Thorson AG, et al.: Cumulative incidence of colorectal and extracolonic cancers in MLH1 and MSH2 mutation carriers of hereditary nonpolyposis colorectal cancer. J Gastrointest Surg 1998, 2:67–71.

    Article  PubMed  CAS  Google Scholar 

  11. Scott RJ, McPhillips M, Meldrum CJ, and Hunter Family Cancer Service: Hereditary nonpolyposis colorectal cancer in 95 families: differences and similarities between mutation-positive and mutation-negative kindreds. Am J Hum Genet 2001, 68:118–127.

    Article  PubMed  CAS  Google Scholar 

  12. Watson P, Butzoz R, Lynch HT, and International Collaborative Group on HNPCC: The clinical features of ovarian cancer in hereditary nonpolyposis colorectal cancer. Gynecol Oncol 2001, 82:223–228.

    Article  PubMed  CAS  Google Scholar 

  13. Peltomaki P: Deficient DNA mismatch repair: a common etiologic factor for colon cancer. Hum Molec Genet 2001, 10:735–740. This paper briefly reviews the biochemical process of DNA mismatch repair and how loss of this function is related to both HNPCC and sporadic colorectal cancer. The authors describe the full spectrum of mutations in DNA mismatch repair genes that have been found in HNPCC families, the importance of epigenetic mechanisms (methylation of MLH1) of defective mismatch repair in sporadic colorectal cancers, and the links between defective mismatch repair and high mutation rates in important growth regulatory genes. This paper is useful for readers who want to learn more about how mismatch repair deficiency leads to an increased cancer risk in both hereditary and sporadic colon cancer.

    Article  PubMed  CAS  Google Scholar 

  14. Miyaki M, Konishi M, Tanaka K, et al.: Germ line mutation of MSH6 as the cause of hereditary nonpolyposis colorectal cancer. Nat Genet 1997, 17:271–272.

    Article  PubMed  CAS  Google Scholar 

  15. Vasen HFA, Watson P, Mecklinn JP, Lynch HT, and the ICGHNPCC: New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the international collaborative group on HNPCC. Gastroenterology 1999, 116:1453–1456. This important paper describes the Amsterdam II criteria,which include the extracolonic tumors that are found in HNPCC. These criteria recommend that many HNPCC families who do not meet the original strict Amsterdam criteria should be referred for genetic counseling and offered DNA testing or targeted surveillance. The article describes the extracolonic cancers and their incidence in HNPCC families.

    Article  PubMed  CAS  Google Scholar 

  16. Syngal S, Fox EA, Eng C, et al.: Sensitivity and specificity of clinical criteria for hereditary non-polyposis colorectal cancer associated mutations in MSH2 and MLH1. J Med Genet 2000, 37:641–645. This is a key validation paper for genetic testing in HNPCC. The authors examined the value of the Amsterdam and Bethesda criteria in identifying subjects with mutations in their mismatch repair genes and found that the first three Bethesda criteria were the most sensitive for finding mutations. The paper provides an approach to more streamlined Bethesda criteria that would be easier to use in a clinical setting and makes recommendations about which patients should proceed directly to sequencing and which should have MSI screening prior to sequencing.

    Article  PubMed  CAS  Google Scholar 

  17. American Medical Association: Identifying and Managing Risk for Hereditary Nonpolyposis Colorectal Cancer and Endometrial Cancer. Chicago, IL: American Medical Association; 2001. This review of HNPCC includes easy-to-follow guidelines that explain how to approach genetic testing in families at risk for HNPCC. It discusses clinical criteria, interpretation of genetic test results, and counseling before and after testing.

    Google Scholar 

  18. Wahlberg S, Liu T, Lindblom P, Lindblom A: Various mutation screening techniques in the DNA mismatch repair genes hMSH2 and hMLH1. Genet Test 1999, 3:259–264.

    Article  PubMed  CAS  Google Scholar 

  19. Marcus VA, Madlensky L, Gryfe R, et al.: Immunohistochemistry for hMLH1 and hMSH2: a practical test for DNA mismatch repair deficient tumors. Am J Surg Pathol 1999, 23:1248–1255.

    Article  PubMed  CAS  Google Scholar 

  20. Evans DG, Guy SP, Thakker N, et al.: Non-penetrance and late appearance of polyps in families with familial adenomatous polyposis. Gut 1993, 34:1389–1393.

    PubMed  CAS  Google Scholar 

  21. Gardner EJ, Richards RC: Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 1953, 5:139–147.

    PubMed  CAS  Google Scholar 

  22. Houlston R, Crabtree M, Phillips R, Tomlinson I: Explaining differences in the severity of familial adenomatous polyposis and the search for modifier genes. Gut 2001, 48:1–5.

    Article  PubMed  CAS  Google Scholar 

  23. Hernegger GS, Moore HG, Guillem JG: Attenuated familial adenomatous polyposis: an evolving and poorly understood entity. Dis Colon Rectum 2002, 45:127–136.

    Article  PubMed  Google Scholar 

  24. Muto T, Kamiya J, Sawada T, et al.: Small ’flat adenoma’ of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 1985, 28:847–851.

    Article  PubMed  CAS  Google Scholar 

  25. Matsumoto T, Iida M, Kobori Y, et al.: Serrated adenoma in familial adenomatous polyposis: relation to germline APC mutation. Gut 2002, 50:402–404.

    Article  PubMed  CAS  Google Scholar 

  26. Spiroio L, Olschwang S, Groden J, et al.: Alleles of the APC gene: an attenuated form of familial polyposis. Cell 1993, 75:951–957.

    Article  Google Scholar 

  27. Lamlum H, Al Tassan N, Jaeger E, et al.: Germline APC variants in patients with multiple colorectal adenomas, with evidence for the particular importance of E1317Q. Hum Mol Genet 2000, 9:2215–2221.

    PubMed  CAS  Google Scholar 

  28. Leblanc R: Familial adenomatous polyposis and benign intracranial tumors: a new variant of Gardner’s syndrome. Can J Neurol Sci 2000, 27:341–346.

    PubMed  CAS  Google Scholar 

  29. Bisgaard ML, Fenger K, Bulow S, et al.: Familial adenomatous polyposis (FAP): frequency, penetrance, and mutation rate. Hum Mutat 1994, 3:121–125.

    Article  PubMed  CAS  Google Scholar 

  30. Fearnhead NS, Britton MP, Bodmer WF: The ABC of APC. Hum Mol Genet 2001, 10:721–733. This is a comprehensive and very readable review of the structure and function of the APC gene. The paper briefly describes the clinical features of FAP and then focuses on the APC gene and protein. It describes the types of mutations that occur in the APC gene, the functional domains of the gene APC protein, and the biochemical and biologic functions of the normal APC protein. This review is valuable for the reader who desires a more detailed genetic, biochemical, and biologic understanding of FAP.

    Article  PubMed  CAS  Google Scholar 

  31. Sieber OM, Lamlum H, Crabtree MD, et al.: Whole-gene APC deletions cause classical familial adenomatous polyposis, but not attenuated polyposis or ’multiple’ colorectal adenomas. Proc Natl Acad Sci U S A 2002, 99:2954–2958.

    Article  PubMed  CAS  Google Scholar 

  32. Laken SJ, Papadopoulos N, Petersen GM, et al.: Analysis of masked mutations in familial adenomatous polyposis. Proc Natl Acad Sci U S A 1999, 96:2322–2326.

    Article  PubMed  CAS  Google Scholar 

  33. Giardiello FM, Brensinger JD, Petersen GM: AGA technical review on hereditary colorectal cancer and genetic testing. Gastroenterology 2001, 121:198–213.

    Article  PubMed  CAS  Google Scholar 

  34. Bala S, Kraus C, Wijnen J, et al.: Multiple products in the protein truncation test due to alternative splicing in the adenomatous polyposis coli (APC) gene. Hum Genet 1996, 98:528–33.

    Article  PubMed  CAS  Google Scholar 

  35. Ballhausen WG: Genetic testing for familial adenomatous polyposis. Ann N Y Acad Sci 2000, 910:36–47.

    Article  PubMed  Google Scholar 

  36. Salovaara R, Loukola A, Kristo P, et al.: Population-based molecular detection of hereditary nonpolyposis colorectal cancer. J Clin Oncol 2000, 18:2193–2200.

    PubMed  CAS  Google Scholar 

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Markey, K., Axel, L. & Ahnen, D. Basic concepts for genetic testing in common hereditary colorectal cancer syndromes. Curr Gastroenterol Rep 4, 404–413 (2002). https://doi.org/10.1007/s11894-002-0011-5

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