What are NCCN criteria for the evaluation of high-risk syndromes in colorectal cancer screening?

Updated: Mar 18, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The NCCN guidelines provide screening recommendations for patients at increased risk due to any of the following [8] :

  • Personal history of adenoma or sessile serrated polyp
  • Personal history of colorectal cancer
  • Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
  • Positive family history

The guidelines also specify recommendations for patients with the following high-risk syndromes [9] :

  • Lynch syndrome (hereditary nonpolyposis colorectal cancer)
  • Classic familial adenomatous polyposis (FAP)
  • Attenuated familial adenomatous polyposis (AFAP)
  • MUTHYH-associated polyposis (MAP)
  • Peutz-Jeghers syndrome (PJS)
  • Juvenile polyposis syndrome (JPS)
  • Serrated polyposis syndrome (SPS)
  • Colonic adenomatous polyposis of unknown etiology
  • Cowden syndrome/PTEN hamartoma tumor syndrome
  • Li-Fraumeni syndrome

Individuals meeting one or more of the following criteria should receive further evaluation for polyposis syndromes [9] :

  • Individuals with more than 10 adenomas detected (FAP, AFAP, MAP, and other rare genetic causes of multiple adenomatous polyps)
  • Individuals with more than 2 hamartomatous polyps (PJS, JPS and Cowden/PTEN hamartoma tumor syndrome)
  • Individuals with 5 or more serrated polyps proximal to the rectum
  • Family members with a known high-risk syndrome associated with colorectal cancer, with or without a known mutation
  • Individuals with a desmoid tumor, hepatoblastoma, cribriformmorular variant of papillary thyroid tumor (FAP, AFAP, MAP)

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