andrew latchford bsc, mbbs, md, frcp consultant gastroenterologist

ANDREW LATCHFORD BSc, MBBS, MD, FRCP

CONSULTANT GASTROENTEROLOGIST

www.bowelcancerwest.org.uk


BACKGROUND COLORECTAL BACKGROUND COLORECTAL CANCERCANCER

Interaction between genotype and Interaction between genotype and the environment the environment

The UK lifetime risk of CRC is ≈5% The UK lifetime risk of CRC is ≈5% Many people by chance alone have Many people by chance alone have

at least one affected relativeat least one affected relative number of affected relatives, risk number of affected relatives, risk

of developing CRCof developing CRC


GENETIC RISKGENETIC RISK

Spectrum of riskSpectrum of risk High-risk, overwhelming contribution High-risk, overwhelming contribution

of genotype of genotype – ≤≤5% CRC, at risk of ‘inherited bowel 5% CRC, at risk of ‘inherited bowel

cancer’cancer’ Low- and moderate-risk, genotype Low- and moderate-risk, genotype

contributes to risk, role in ≈30%contributes to risk, role in ≈30%


ASSESSMENT OF RISKASSESSMENT OF RISK

Accurate family history Accurate family history – site and age at diagnosis of ALL cancers in site and age at diagnosis of ALL cancers in

family members, family members,

– presence of colorectal adenomas/other polypspresence of colorectal adenomas/other polyps The family history has limitationsThe family history has limitations

– small familiessmall families– incorrect information, early death of individuals incorrect information, early death of individuals

before they develop cancersbefore they develop cancers. .


ASSESSMENT OF RISKASSESSMENT OF RISK

A full personal history A full personal history – symptomssymptoms– previous large bowel polypsprevious large bowel polyps– previous large bowel cancersprevious large bowel cancers– cancers at other sitescancers at other sites– other risk factors for colorectal cancer other risk factors for colorectal cancer

(IBD, acromegaly)(IBD, acromegaly)


LOW RISK GROUPLOW RISK GROUP

Individuals in this group have:Individuals in this group have:– no personal history of bowel cancer; no confirmed family no personal history of bowel cancer; no confirmed family

history of bowel cancer; orhistory of bowel cancer; or– no first-degree relative (i.e. parent, sibling or child) with no first-degree relative (i.e. parent, sibling or child) with

bowel cancer; orbowel cancer; or– one first-degree relative with bowel cancer diagnosed at one first-degree relative with bowel cancer diagnosed at

age 50 years or olderage 50 years or older

No evidence to support invasive No evidence to support invasive surveillancesurveillance


MODERATE RISK GROUPMODERATE RISK GROUP

Low-moderate riskLow-moderate risk– those with one affected relative those with one affected relative

diagnosed under 50 years; ordiagnosed under 50 years; or– two affected first-degreetwo affected first-degree relatives relatives

diagnosed at at age 60 years or olderdiagnosed at at age 60 years or older

ONE OFF COLONOSCOPY AGE 55 YEARSONE OFF COLONOSCOPY AGE 55 YEARS

MODERATE RISK GROUPMODERATE RISK GROUP

High-moderate riskHigh-moderate risk– three or more affected relatives in a first three or more affected relatives in a first

degree kinship (none under 50 years)degree kinship (none under 50 years)– two affected relatives diagnosed under 60 two affected relatives diagnosed under 60

years (or with a mean age at diagnosis years (or with a mean age at diagnosis under 60 years) in a first degree kinshipunder 60 years) in a first degree kinship

5 YEARLY COLONOSCOPY FROM AGE 5 YEARLY COLONOSCOPY FROM AGE 50 YEARS50 YEARS


HIGH RISK GROUPHIGH RISK GROUP Criteria includeCriteria include

– member of family with polyposis syndromemember of family with polyposis syndrome– member of family with Lynch syndromemember of family with Lynch syndrome– pedigree suggestive of autosomal dominantly pedigree suggestive of autosomal dominantly

inherited colorectal (or other Lynch syndrome-inherited colorectal (or other Lynch syndrome-associated) cancerassociated) cancer

– pedigree indicative of autosomal recessive pedigree indicative of autosomal recessive inheritance, MYH associated polyposis (MAP)inheritance, MYH associated polyposis (MAP)

Condition specific managementCondition specific management


PEARLS AND PITFALLSPEARLS AND PITFALLS Family history assessment of risk but Family history assessment of risk but

difficult to do welldifficult to do well If between risk groups, manage the If between risk groups, manage the

family as if in the higher risk groupfamily as if in the higher risk group Family histories evolve, risk group Family histories evolve, risk group

change if cancers develop/excludedchange if cancers develop/excluded ASPIRIN THE FUTURE?ASPIRIN THE FUTURE?


ANY QUESTIONS?ANY QUESTIONS?


andrew latchford bsc, mbbs, md, frcp consultant gastroenterologist

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