Übersichtsarbeit · Review Article
Resektionsausmaß und Therapiekonzept bei Verdacht auf hereditäres, nichtpolypöses kolorektales Karzinom – Sicht des GastroenterologenAndus T.
Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und internistische Onkologie, Krankenhaus Bad-Cannstatt, Klinikum Stuttgart, Deutschland
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In patients with hereditary non-polypous colorectal carcinoma (HNPCC) the lifetime risk for colorectal cancer amounts to approximately 60-80%. HNPCC patients very rarely develop colorectal cancer before the age of 25 years. Therefore, surveillance should start in this age. In a controlled study continuous surveillance colonoscopies every 3 years significantly reduced the colorectal cancer risk and mortality and proved to be an effective and safe method of cancer prevention in HNPCC patients. Preventive colectomy or proctocolectomy, theoretically would be an alternative option, similarly as in the case the of familial adenomatous polyposis (FAP). However, in contrast to FAP where the risk for intestine cancer is 100% approximately 20-40% of the HNPCC patients would be operated who will never develop colorectal cancer. Therefore, according to German guidelines preventive colectomy and/or proctocolectomy cannot be recommended since nearly all colorectal cancers are discovered by regular surveillance colonoscopies in the stage UICC I/II or even as premalignant adenomas, showing only incomplete penetrance. If colorectal cancer is diagnosed, patients are operated on the basis of surgical criteria. However, the risk of colorectal cancer in the remaining large intestine and the risk of extracolonic neoplasias remain clearly increased. Therefore, an intensive postoperative surveillance program must be supplied to these patients.
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