New guideline recommends genetic testing of tumors in patients with colorectal cancer -
Task Force US Multi-Society published a consensus statement on the assessment and management of genetics Lynch syndrome
about 143,000 patients diagnosed with colorectal cancer each year in the United States, 25 percent have a familial risk of colorectal cancer. A new guideline multi-company American Task Force on Colorectal Cancer recommends genetic testing of tumors in all patients with newly diagnosed colorectal cancer. The working group is monitoring and specific recommendations management for people affected by a genetic condition called Lynch syndrome, the most common cause of inherited colorectal cancer, representing about 3 per cent, over 4000, new cases diagnosed in the US each year.
tumor Universal Testing
Universal genetic testing of tumors repair evidence mismatches (MMR) deficiency in patients with newly diagnosed colorectal cancer is recommended for several reasons:
1. the use of clinical criteria and predictive models to identify patients with Lynch syndrome are less than optimal sensitivity and specificity.
2. It has been shown to be cost effective for diagnosing Lynch syndrome.
3. It has greater sensitivity for the identification of Lynch syndrome compared to other strategies, including Bethesda guidelines, or a test strategy of selective tumor.
Genetic counseling and genetic testing germ confirmatory
those whose tumors MMR deficiency signs, a mutation of MMR gene known in the family, meet clinical criteria for Lynch syndrome, or have a higher personal risk or equal to 5 percent of Lynch syndrome probability based forecasting models should undergo genetic evaluation for Lynch syndrome. the germline genetic testing has the following advantages:
1. It can confirm a diagnosis of Lynch syndrome in the patient.
2. It can determine the status of family members at risk in families where the mutation of the disease has been found.
3. It can direct the management of individuals affected and unaffected.
Lynch management Syndrome
Patients Lynch syndrome are at increased risk of developing colorectal cancer, as well as outside of colon cancer . The US Multi-Society Task Force on Colorectal Cancer recommends that the annual history, physical examination, and patient and family education regarding the risk of cancer should begin between the ages of 20 and 25 years. In addition, the following recommendations are made for patients with or at risk for Lynch syndrome
- Colorectal cancer
- colonoscopy screening every one to two years from age 20 to 25, or two to five years younger than the youngest age of CRC diagnosis in the family, if the diagnosis was before the age of 25
- endometrial cancer
- conduct pelvic exams and screening endometrial sampling each year from between the ages of 30 and 35.
- ovarian cancer
- Start an annual screening transvaginal ultrasound at an age of 30 to 35.
- hysterectomy and salpingo-oophorectomy bilaterial is recommended for women Lynch syndrome at age 40 or after the pregnancy is over.
- gastric cancer
- screen via endoscopy with gastric biopsies from 30 to 35. Continue every two to three years function of the patient's risk factors.
- urinary cancer
- conduct urinalysis annually from age 30 to 35.
routine screening of the small intestine, pancreas, prostate and breasts are not. recommended
treatment
There are two recommended treatments for patients with Lynch syndrome
1. The removal of the large intestine: colectomy with ileal anastomosis, which eliminates the large intestine and attaches the small intestine to the rectum, is the main treatment for patients with Lynch syndrome who have colon cancer or precancerous colon polyps that can not be removed by colonoscopy. Less extensive surgery may be considered in patients over the age of 60 to 65.
2. Aspirin Therapy: There is growing evidence that the use of aspirin is beneficial in preventing cancer in patients with Lynch syndrome. Although the evidence is inconclusive, the treatment of an individual patient with aspirin is a consideration after discussing patient-specific risks, benefits and uncertainties of treatment
United States colorectal cancer is a major health problem -. It is the second leading cause of cancer deaths, causing nearly 51,000 deaths each year. Environmental causes and the play of the inheritance of roles in different patients with varying colorectal cancer. About 20 to 30 percent of colorectal cancer patients appear to have a familial risk and a minority has a genetic mutation that contributed to the development of the disease.
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