Table 2.

Indicators for Evaluation of High-Risk Colorectal Cancer Conditions^a

Earlier age of cancer onset than the general population Colorectal or endometrial cancer before age 50 CRC < age 60 and MSI-H histologyb Multiple close family members with CRC or other LS cancersc Individual with multiple primary CRCs or other LS cancersc Multiple cumulative GI polyps >10 colorectal adenomatous polyps >20 colonic serrated polypsd 5 or more serrated polypsd in the proximal colon, two of which are greater than 1 cm 5 or more hamartomatous GI polyps or any histologically distinct Peutz-Jeghers GI polyp Individual from a family with confirmed hereditary CRC syndrome

CRC, colorectal cancer; MSI-H, microsatellite instability high; LS, Lynch syndrome; GI, gastrointestinal

^aSee also NCCN Guidelines for evaluation algorithms of inherited syndromes (www.nccn.org)

^bTumor-infiltrating lymphocytes, Crohn’s-like lymphocytic reaction, mucinous or signet ring cell differentiation, or a medullary growth pattern

^cEndometrial, ovarian, gastric, small bowel, brain, hepatobiliary tract, upper uroepithelial, sebaceous gland, and pancreas cancer

^dserrated polyps include hyperplastic polyps, sessile serrated polyps (also known as sessile serrated adenomas), traditional serrated adenomas and mixed adenomas