Fast Five Quiz: Colorectal Cancer Screening

Ali Alqahtani, MD

Disclosures

June 14, 2022

Recommendations published in 2017 by the American Society of Colon and Rectal Surgeons indicate that patients with familial adenomatous polyposis or with personal or family risk factors for it should be referred to center registries and genetic counselors with experience in the multidisciplinary management of these individuals. Additionally, the society recommends:

  • Treating clinically inert tumors with sulindac (a nonsteroidal anti-inflammatory drug) or not treating them at all

  • Routinely performing prophylactic colectomy and proctocolectomy

  • Small tubular adenomas with mild dysplasia can be kept under surveillance, but adenomas with high-grade dysplasia must be removed

  • Duodenectomy or pancreaticoduodenectomy for persistent or recurrent severe dysplasia in the papilla or duodenal adenomas

  • Treatment of slowly growing or mildly symptomatic tumors with a less toxic regimen such as sulindac and tamoxifen can be considered

  • Aggressive therapy with anti-sarcoma type chemotherapy can be considered for rapidly growing tumors

Chemoprevention is not recommended as primary therapy. Additionally, it is controversial whether chemopreventive agents effectively prevent cancer in patients with familial adenomatous polyposis. Although sulindac can cause regression of colorectal adenomas in familial adenomatous polyposis, it does not completely prevent the development of CRC, per Matsumoto and colleagues. However, in cases where unresectable desmoid tumors arise in patients with familial adenomatous polyposis, treatment with a tyrosine kinase inhibitor, tamoxifen, and cytotoxic chemotherapy can be considered.

Learn more about CRC screening.

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