Low risk |
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Moderate risk |
One 1st degree relative affected by colorectal cancer when aged <45 y
Two (one CRC less than 55 y) or 3 affected with colorectal or endometrial cancer who are 1st degree relatives or each other and one a 1st degree relative of consultand
Two affected 1st degree relatives (one less than 55 y)
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30–35 y and again at 55 y |
High risk |
⩾3 family members affected by CRC or ⩾2 with CRC and one with endometrial cancer in ⩾2 generations; one affected relative must be age ⩽50 at diagnosis; one of the relatives must be a first degree relative of the other two
Gene carriers (HNPCC genes)
Untested 1st degree relatives of gene carriers Multiple polyps (3 or more adenomas) in an individual with one of the above criteria for medium and high risk may be regarded as “affected”.
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Colonoscopy every 2 y
Discuss gynaecological screening for endometrial and ovarian cancer
Offer 2 y upper GI endoscopy for gastric cancer
Consideration needs to be given to other screening for other cancers which may occur in specific families and are part of the HNPCC spectrum.
Discuss prophylactic surgery for bowel and hysterectomy with bilateral oophorectomy. For established colorectal and associated cancer discuss extent of surgery
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From 30 y of age or 5 y younger than the youngest affected For stomach cancer from 50 y of age or 5 y younger than the youngest stomach cancer |