Do you have a significant Family history of bowel cancer (CRC) in

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Transcript Do you have a significant Family history of bowel cancer (CRC) in

Do you have 3 or more affected
relatives?
(2 or less)
SEEK REFERRAL
Risk Assessment: High/High-Moderate
Advice: Seek genetic counselling
Possible Genetic Testing: Tumour block analysis
(TBA) for HNPCC
What is this?
If tests normal; may require 2 yearly screening from age
25 if there has been a relative diagnosed under 50.
HNPCC: A condition in which the tendency to develop colorectal cancer
is inherited. families with HNPCC, cancer usually occurs on the right
side of the colon. It often occurs at a younger age than colon cancer that
is not inherited. Other cancers can occur in these families including
cancer of the uterus, ovaries, stomach, urinary tract, small bowel, and
bile ducts. MORE INFO
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Do you have any family history of
womb (endometrial) cancer?
SEEK REFERRAL
Risk Assessment: High
Advice: Seek genetic counselling
Possible Genetic Testing: Tumour block analysis(TBA)
What is this?
If HNPCC is confirmed; recommended bowel screening
every 18 months from age 25 and gynaecological review at
35.
HNPCC: A condition in which the tendency to develop colorectal cancer
is inherited. families with HNPCC, cancer usually occurs on the right
side of the colon. It often occurs at a younger age than colon cancer that
is not inherited. Other cancers can occur in these families including
cancer of the uterus, ovaries, stomach, urinary tract, small bowel, and
bile ducts. MORE INFO
NEXT
Did any affected patients in your
family have multiple bowel polyps
or tumours?
SEEK
REFERRAL
Risk Assessment: High
Advice: Seek genetic counselling
Possible Genetic Testing: Tumour block analysis
TBA / APC / MYH /
What is this?
FAP (familial polyposis)
If tests FAP; may require annual screening from age 12.
MYH polyposis has autosomal recessive inheritance
APC = Adenomatous polyposis coli is a protein that in humans is encoded
by the APC gene. Mutations in the APC gene may result in colorectal cancer
as APC is classified as a tumour suppressor gene; prevents the uncontrolled
growth of cells that may result in cancerous tumours. MORE INFO
MYH =MYH-associated polyposis (MAP) is a hereditary condition. MAP
sufferers’ develop multiple adenomatous colon polyps (normal cells that line
the inside of the colon can begin to make mucous and form a mass) during
their lifetime and will have an increased risk of colorectal cancer.
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Were any relatives diagnosed with
Bowel Cancer under 50 years of
age?
SEEK REFERRAL
Risk Assessment: High - moderate
Advice: Seek genetic counselling
Possible Genetic Testing: Tumour block analysis (TBA)
Risk of CRC (Bowel Cancer) in the UK:
Men = 1 in 14
Women = 1 in 19
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Single case, diagnosed under the
age of 50?
(2+ cases)
REFERRAL UNLIKEY TO BE HELPFUL
Risk Assessment: Low (Population)
Advice: Discuss with your GP, likely that no further
investigations needed
Possible Genetic Testing: NONE
Further information:
Right sided bowel cancers presents symptoms such as
anaemia, left sided tumours show signs of altered
bowel habit or rectal bleeding
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Average age of diagnosed is less
than 60?
Example: ages are 54 and 62.
(54+62)÷2 = 58 = less than 60
SEEK REFERRAL
Risk Assessment: High - Moderate
Advice: Seek Genetic Advice
Possible Genetic Testing: Tumour Block Analysis (TBA)
If tests normal, consider 5 yearly bowel screening from age
50.
NEXT
REFERRAL UNLIKEY TO BE HELPFUL
Risk Assessment: Low - Moderate
Advice: Discuss with your GP, may require specialist
advice if wider family history show: gastric/renal
/gynaecological tumours/Right sided bowel tumours
Possible Genetic Testing: Tumour Block Analysis (TBA)
may be indicated
If tests normal consider a 1 off colonoscopy at 55.
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Do you have 3 or more
affected relatives?
“YES”
High
Risk
Seek genetic counselling and a
Tumour Block Analysis (TBA)
Do you have a family history of
womb cancer?
“YES”
High
Risk
Seek genetic counselling and a
Tumour Block Analysis (TBA)
Did any affected patients in your
family have multiple bowel
polyps and/or tumours?
“YES”
High
Risk
Seek genetic counselling and
TBA/APC/MYH/FAR
Were any relatives diagnosed with
Bowel Cancer before the age of
50?
“YES”
Medium
Risk
Seek genetic counselling and a
Tumour Block Analysis
Single case, diagnosed
after the age of 50?
“YES”
Low
Risk
Discuss with GP
Average age of diagnosed is less
than 60?
“YES”
Medium
Risk
Seek genetic counselling and a
Tumour Block Analysis
All Questions
“NO”
Low
Risk
Discuss with GP