In addition to genetic counseling, what are the recommendations for surveillance and treatment of patients with familial adenomatous polyposis (FAP) and risk for rectal cancer?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Additional recommendations include:

  • Prophylactic colectomy or proctocolectomy should be routine; the frequency and type of surgery should depend on the severity of the polyposis phenotype
  • Use of chemoprevention as primary therapy is not recommended
  • Small tubular adenomas with mild dysplasia can be kept under surveillance, but adenomas with severe dysplasia must be removed
  • Duodenectomy or pancreaticoduodenectomy is recommended for persistent or recurrent severe dysplasia in the papilla or duodenal adenomas
  • Clinically inert tumors should be treated with sulindac or not treated at all
  • Slowly growing or mildly symptomatic tumors may be treated with less toxic regimens such as sulindac and tamoxifen or with vinblastine and methotrexate
  • Rapidly growing tumors need aggressive therapy with either very-high-dose tamoxifen or antisarcoma-type chemotherapy
  • Radiation is an option if collateral damage is not a major concern

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