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Treatments and drugs
By Mayo Clinic staff
Colon cancer associated with Lynch syndrome is treated similarly to other types of colon cancer. However, surgery for Lynch syndrome colon cancer is more likely to involve the removal of more of the colon, since people with Lynch syndrome have a high risk of developing additional colon cancer in the future. Your treatment options will depend on the stage and location of your cancer, as well as your own health and personal preferences. Treatments for colon cancer may include surgery, chemotherapy and radiation therapy.
Cancer screening for people with Lynch syndrome
If you have Lynch syndrome, but haven't been diagnosed with an associated cancer, your doctor can develop a cancer-screening plan for you. Stick to your doctor's recommended plan. Screening for cancer may help your doctor find tumors at their earliest stages — when they're more likely to be cured.
As part of your cancer-screening plan, your doctor may recommend you undergo:
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Colon cancer screening. A colonoscopy exam allows your doctor to see inside your entire colon and look for areas of abnormal growth that may indicate cancer. Removing precancerous growths called polyps can reduce the risk of colon cancer. People with Lynch syndrome typically begin colonoscopy screening every year or two starting in their 20s.
People with Lynch syndrome tend to develop colon polyps that are more difficult to detect. For this reason, newer colonoscopy techniques may be recommended. High-definition colonoscopy creates more-detailed images and narrow band colonoscopy uses special light to create clearer images of the colon. Chromoendoscopy uses dyes to color colon tissue, which may make it more likely that the flat polyps that tend to occur more often in people with Lynch syndrome are detected.
- Endometrial cancer screening. Women with Lynch syndrome may undergo annual endometrial biopsy to screen for cancer beginning in their 30s. During an endometrial biopsy, your doctor removes a small piece of tissue from your uterus. The tissue is examined to look for changes in the cells that may indicate cancer.
- Ovarian cancer screening. Your doctor may recommend an annual ultrasound examination of your ovaries if you have Lynch syndrome. By comparing annual ultrasound images, your doctor may be able to see changes to your ovaries that may indicate cancer. Talk to your doctor about when to begin ovarian cancer screening.
- Urinary system cancer screening. If your family has a history of urinary system cancers related to Lynch syndrome, such as kidney cancer, your doctor may recommend periodic screening for these cancers. Analysis of a urine sample may reveal cancerous cells.
- Gastrointestinal cancer screening. If your family has a history of gastrointestinal cancers associated with Lynch syndrome, such as stomach cancer and small intestine cancer, your doctor may recommend endoscopy screening for these cancers. An endoscopy procedure allows your doctor to see your stomach and other parts of your gastrointestinal system.
- Skin cancer screening. Your doctor may encourage you to occasionally inspect your skin for signs of skin cancer. Lynch syndrome increase your risk of a certain type of skin cancer that affects the sweat glands (sebaceous glands). If you notice any skin changes, make an appointment with your doctor.
Your doctor may recommend other cancer-screening tests if your family has a history of other cancers. Ask your doctor about what screening tests are best for you.
Surgery to prevent cancers caused by Lynch syndrome
In certain situations, you and your doctor may opt for surgery to prevent cancer. If your increased risk of cancer is unacceptable to you, surgery to remove most or all of your colon may put you at ease. Or if you're unable to comply with the need for frequent cancer screenings, you may opt to have your colon removed. But all operations carry risks. Discuss the benefits and risks of preventive surgery with your doctor.
Surgical options for preventing cancer may include:
- Surgery to remove your colon (colectomy). Surgery to remove most or all of your colon will reduce or eliminate the chance that you'll develop colon cancer. Little evidence exists to show that removing your colon has any advantage over frequent cancer screening, in terms of helping you live longer. Yet, some people prefer the peace of mind. These procedures can be done in a way that allows you to expel waste normally without the need to wear a bag outside of your body to collect waste.
- Surgery to remove your ovaries and uterus (oophorectomy and hysterectomy). Preventive surgery to remove your uterus eliminates the possibility that you'll develop endometrial cancer in the future. Removing your ovaries can reduce your risk of ovarian cancer. But these procedures also make it impossible to become pregnant. Women considering this surgery can wait until they're done having children.
- Genetics of colorectal cancer (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/genetics/colorectal/healthprofessional. Accessed Jan. 24, 2012.
- Lindor NM, et al. Concise handbook of familial cancer susceptibility syndromes. Journal of the National Cancer Institute Monographs. 2008;38:1.
- Colorectal cancer screening. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Jan. 31, 2012.
- Lindor NM, et al. Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: A systematic review. Journal of the American Medical Association. 2006;296:1507.
- Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008:180.
- Backes FJ, et al. Lynch syndrome. Clinical Obstetrics and Gynecology. 2011;54:199.
- Making sense of your genes: A guide to genetic counseling. National Society of Genetic Counselors. http://www.nsgc.org/client_files/GuidetoGeneticCounseling.pdf. Accessed Jan. 24, 2012.
- Kaltenbach T, et al. Image-enhanced endoscopy is critical in the detection, diagnosis and treatment of non-polypoid colorectal neoplasms. Gastrointestinal Endoscopy Clinics of North America. 2010;20:471.
- Pande M, et al. Smoking and colorectal cancer in Lynch syndrome: Results from the Colon Cancer Family Registry and the University of Texas M.D. Anderson Cancer Center. 2010;16:1331.
- Burn J, et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: An analysis from the CAPP2 randomised controlled trial. Lancet. 2011;378:2081.
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