Lynch syndrome confers increased risk for various malignancies, including colorectal cancer.Colonoscopic surveillance programs have led to reduced incidence of colorectal cancer andreduced mortality from colorectal cancer. Colonoscopy every 1-2 years beginning at age 20-25, or 10 years earlier than the first diagnosis of colorectal cancer in a family, with annualcolonoscopy after age 40, is the recommended management for mutation carriers.
Screeningprograms have reduced colon cancer mortality, but interval cancers may occur.Case presentationWe describe a 48-year-old woman with Lynch syndrome who was found to have an adenomawith invasive colorectal cancer within one year after a normal colonoscopy.
Conclusion:
Our patient illustrates two current concepts about Lynch syndrome: 1) adenomas are thecancer precursor and 2) such adenomas may be ?aggressive,?in the sense that the adenomaprogresses more readily and more rapidly to carcinoma in this setting compared to usualcolorectal adenomas. Our patient?s resected tumor invaded only into submucosa and alllymph nodes were negative; in that sense, she represents a success for annual colonoscopicsurveillance.
Still, this case does raise the question of whether advanced imaging techniquesare advisable for surveillance colonoscopy in these high-risk patients.
Author: Amy S OxentenkoThomas C Smyrk
Credits/Source: BMC Gastroenterology 2012, 12:50
Published on: 2012-05-24
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