| HNPCC |
| Considering Surgery to Lower Cancer Risk in People With HNPCC |
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By
Miriam Komaromy,
MD
Reviewed
by Peggy Conrad,
MS, CGC and Jonathan
Terdiman, MD
Last updated August 9, 2000
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If
you've been diagnosed with hereditary nonpolyposis colon
cancer (HNPCC) your doctor may have brought up the possibility
of surgery to prevent the development of colon cancer.
Much data exists showing a dramatic reduction in colon
cancer in people with the other major hereditary colon
cancer syndrome, FAP, who have had preventive colon
removal. However, preventive surgery is the preferred
option for people with FAP only because it is difficult
to screen for polyps and prevent colon cancer in these
patients if they have intact colons. For people with
HNPCC the benefits of preventive surgery over aggressive
screening are less clear because screening for polpys
is generally more effective in these patients.
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Removing the Colon Before Cancer Develops
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As compared to people with FAP, the risk of colon cancer for people with HNPCC is not quite as high, nor do they experience the rapid and dramatic polyp proliferation that makes colon cancer screening so difficult in FAP patients. For this reason, removing the colon to prevent cancer (prophylactic colectomy) is not as common in people with HNPCC as in people with FAP. However, prophylactic colectomy is still an option for HNPCC patients, because they will need to undergo many colon screening procedures during their lifetime that could still fail to catch a developing cancer. Nevertheless, most HNPCC mutation carriers do not opt for prophylactic colectomy, and most experts do not recommend it for this group.
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Removing the Colon After the Development of
Colon Cancer
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| After an HNPCC patient is diagnosed with his or her first colon cancer, he or she has an elevated risk for developing a second colon cancer. Thus, some doctors will recommend that the patient have his or her entire colon removed rather than just the portion that has developed cancer. |
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| Removing the Ovaries and/or Uterus |
Women with HNPCC are at increased risk of cancer in their ovaries and uterus. For this reason, women may also want to consider surgically removing their uterus and/or ovaries (called prophylactic hysterectomy and oophorectomy)
— primarily because it's so difficult to screen
effectively for ovarian cancer. Keep in mind, however,
that women who undergo this procedure are no longer
able to bear children, and that they will enter into
surgically induced menopause at the time their ovaries
are removed. Furthermore, removal of the ovaries does
not completely eliminate the chance of developing
ovarian cancer, as some remnant ovarian tissue remains
in the body after removal of the ovaries.
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Making
A Choice
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Although
all of the surgical procedures available to FAP and HNPCC
patients involve removal of the colon, they differ in
a number of other ways, including whether or not the rectum
is removed. Surgery is always a permanent decision, therefore
it is important to fully understand your options and the
risks and benefits associated with each choice.
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| References |
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Ambroze,
W. et al. (1995). Surgical options for familial adenomatous
polyposis. Seminars in Surgical Oncology, 11:
423-427.
Rodriguez-Bigas, M. (1996). Prophylactic colectomy for
gene carriers in hereditary nonpolyposis colorectal
cancer. Cancer, 78(2): 199-201.
Syngal, S. et al. (1998). Benefits of colonoscopic surveillance
and prophylactic colectomy in patients with hereditary
nonpolyposis colorectal cancer mutations. Ann Intern
Med, 129(10): 787-96.
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