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El Halabi J, LaGuardia L, Walsh RM, Kwon CHD, Menon KVN, Liska D, Burke CA. Hepatocellular carcinoma and solid pseudopapillary neoplasm of the pancreas complicating familial adenomatous polyposis: two cases and review of the literature. Fam Cancer 2023; 22:77-82. [PMID: 35896845 DOI: 10.1007/s10689-022-00305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/28/2022] [Indexed: 01/12/2023]
Abstract
Familial adenomatous polyposis (FAP) is characterized by colorectal polyposis and extracolonic tumors. Adenocarcinoma of the pancreas and hepatocellular carcinoma are rare in FAP. In this case series, we describe a mother and daughter with FAP who developed a hepatocellular carcinoma and solid pseudopapillary neoplasm of the pancreas, respectively.
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Affiliation(s)
- Jessica El Halabi
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa LaGuardia
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.,Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.,Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | | | - K V Narayanan Menon
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - David Liska
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.,Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - Carol A Burke
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. .,Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA.
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Yan ML, Pan JY, Bai YN, Lai ZD, Chen Z, Wang YD. Adenomas of the common bile duct in familial adenomatous polyposis. World J Gastroenterol 2015; 21:3150-3153. [PMID: 25780319 PMCID: PMC4356941 DOI: 10.3748/wjg.v21.i10.3150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 09/14/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Familial adenomatous polyposis (FAP) or Gardner’s syndrome is often accompanied by adenomas of the stomach and duodenum. We experienced a case of adenomas of the common bile duct in a 40-year-old woman with FAP presenting with acute cholangitis. Only 8 cases of adenomas or adenocarcinoma of the common bile duct have been reported in the literature in patients with FAP or Gardner’s syndrome. Those patients presented with acute cholangitis or pancreatitis. Local excision or Whipple procedure may be the reasonable surgical option.
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Li M, Gerber DA, Koruda M, O'Neil BH. Hepatocelluar carcinoma associated with attenuated familial adenomatous polyposis: a case report and review of the literature. Clin Colorectal Cancer 2011; 11:77-81. [PMID: 21813337 DOI: 10.1016/j.clcc.2011.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/03/2011] [Accepted: 05/16/2011] [Indexed: 01/28/2023]
Affiliation(s)
- Mingqing Li
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Kim BS, Joo SH, Joo KR. Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report. World J Gastroenterol 2008; 14:4705-8. [PMID: 18698689 PMCID: PMC2738799 DOI: 10.3748/wjg.14.4705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tubulovillous adenomas are common in the colon and rectum, but are rare in the common bile duct. Biliary adenomas may produce obstructive jaundice, which can be easily confused with a malignant neoplasm or stone. We report a case of a carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct causing obstructive jaundice. A 55-year-old male presented with a 10-d history of pruritus and progressive jaundice. Abdominal sonography and computed tomography showed a mass in the distal common bile duct. Endoscopic retrograde cholangiopancreatography showed luminal narrowing of the bile duct due to a polypoid mass. Positron emission tomography demonstrated no abnormal uptake. It was thought that this mass was a malignant tumor, thus a pylorus-preserving panceaticoduodenectomy was performed. The final pathology showed a tubulovillous adenoma with carcinoma in situ of the distal common bile duct. At follow-up 8 mo later, endoscopy showed multiple polyps in the rectum, colon and stomach. The polyps were removed by endoscopic mucosal resection and shown to be tubular adenomas with high grade dysplasia. Biliary adenomas require careful follow-up for early detection of recurrence and malignant transformation.
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Brevet M, Brehant O, Dumont F, Regimbeau JM, Dupas JL, Chatelain D. [Adenomatous polyposis of the gallbladder and Gardner's syndrome. A rare association]. ACTA ACUST UNITED AC 2007; 31:425-7. [PMID: 17483782 DOI: 10.1016/s0399-8320(07)89404-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report one case of adenomatous polyposis of the gallbladder in a 57 year-old woman with Gardner's syndrome presenting with cholangitis. On gross examination the gallbladder contained two calculi and numerous flat or polypoid adenomas less than 1 cm in size. On microscopic examination, the adenomas showed low and high grade intraepithelial neoplasia. Only 10 cases of gallbladder adenomas have been reported in the literature in patients presenting with familial adenomatous polyposis (FAP). Cholecystectomy is usually performed for cholecystitis or cholangitis. These adenomatous gallbladder lesions are discovered late, often when the patient is older than 40. Pathogenesis of gallbladder adenomas is still unclear. It is difficult to assess the risk of malignancy: only 6 cases of gallbladder adenocarcinomas have been reported in patients with FAP.
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Affiliation(s)
- Marie Brevet
- Service d'Anatomie Pathologique, CHU Amiens, Place Victor Pauchet, Amiens, France.
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Gupta C, Mazzara PF. High-Grade Pancreatic Intraepithelial Neoplasia in a Patient With Familial Adenomatous Polyposis. Arch Pathol Lab Med 2005; 129:1398-400. [PMID: 16253018 DOI: 10.5858/2005-129-1398-hpinia] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Familial adenomatous polyposis (FAP) is caused by mutation of the adenomatous polyposis coli (APC) gene and is characterized by multiple colorectal adenomas and tumors of other organs and sites. A 58-year-old woman with FAP syndrome and previous total colectomy presented for routine follow-up examination. Abdominal ultrasound and subsequent endoscopic evaluation revealed ampullary and duodenal polyps, as well as inhomogeneity of the pancreatic head. A pancreaticoduodenectomy confirmed multiple duodenal adenomas. In addition, high-grade pancreatic intraepithelial neoplasia (PanIN-3) was found in the smaller pancreatic ducts. Pancreatic precancerous lesions have only rarely been described in FAP, including 2 pancreatic duct adenomas and 2 intraductal papillary mucinous neoplasms. A review of the world English literature revealed no reports of PanIN-3 in association with FAP. Further studies are required to determine if patients with FAP are at increased risk for pancreatic premalignant lesions.
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Affiliation(s)
- Chakshu Gupta
- Department of Pathology, St John Hospital and Medical Center, Detroit, Michigan, USA.
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Affiliation(s)
- Anders Merg
- Roswell Park Cancer Center, Buffalo, New York, USA
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Nkondjock A, Krewski D, Johnson KC, Ghadirian P. Dietary patterns and risk of pancreatic cancer. Int J Cancer 2004; 114:817-23. [PMID: 15609315 DOI: 10.1002/ijc.20800] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To investigate associations between broad dietary patterns and pancreatic cancer risk, we conducted a case-control study of 585 histologically confirmed pancreatic cancer cases and 4,779 population-based controls in 8 Canadian provinces between 1994 and 1997. Dietary intake was assessed using a FFQ. Major dietary patterns were identified by factor analysis. Unconditional logistic regression was used to describe associations between dietary pattern scores and risk of pancreatic cancer. Three dietary patterns were identified: Western, characterized by high intake of processed meats, sweets and desserts, refined grains and potatoes; fruits and vegetables, characterized by high intake of fresh fruits and cruciferous vegetables; drinker, characterized by high consumption of liquor, wine and beer. After adjustment for age, BMI, smoking, physical activity, province, educational attainment and total energy intake, the fruits and vegetables pattern was associated with a 49% reduction in pancreatic risk among men (OR = 0.51, 95% CI 0.29-0.90, p = 0.004) when comparing the highest and lowest quartiles of dietary pattern scores. No significant relationship was observed with the Western and drinker patterns. Although the response rate for eligible, recruited subjects was relatively low, our results suggest that the fruits and vegetables dietary pattern reduces pancreatic cancer risk among men.
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Affiliation(s)
- André Nkondjock
- Epidemiology Research Unit, Research Center, Centre hospitalier de l'Université de Montréal (CHUM) Hôtel-Dieu, Montreal, Quebec, Canada
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Ghadirian P, Lynch HT, Krewski D. Epidemiology of pancreatic cancer: an overview. CANCER DETECTION AND PREVENTION 2004; 27:87-93. [PMID: 12670518 DOI: 10.1016/s0361-090x(03)00002-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The incidence of pancreatic cancer worldwide appears to correlate with increasing age, and it is slightly more common among men and Jewish people. There is evidence that the incidence rate is higher among blacks than among whites. METHODS The published literature was reviewed for preparation of an overview on epidemiology of pancreatic cancer. RESULTS A possible role of diabetes in the etiology of pancreatic cancer has been suggested by different epidemiological studies. Several investigations indicate that a history of pancreatitis may increase the risk of pancreas cancer, and it appears that people with a history of pernicious anemia or partial gastrectomy for ulcer as well as cholecystectomy may be at higher risk. Individuals with familial adenomatous polyposis (FAP) also have a high risk of developing this cancer. Pancreatic cancer is seen in some breast cancer families with BRCA1 and BRCA2 mutations. Epidemiological studies have confirmed that relatives of individuals with pancreatic cancer have an increased risk of this malignancy. Affected family members of the familial atypical multiple-mole melanoma (FAMMM) as well as those with a positive family history of ataxia-telangiectasia (AT) have much higher risk of developing pancreatic cancer, compared with the general population. A positive association has been reported between pancreatic cancer risk and dietary intake such as fat and oil, meat, and dairy products, as well as with high intake of energy, fried foods, carbohydrates, cholesterol, and salt. The risk is found to decrease with increased consumption of fresh fruits and vegetables, fiber, natural foods, and Vitamin C. Cigarette smoking has shown the strongest positive association with risk of pancreatic cancer. CONCLUSION Some diseases and medical conditions such as diabetes, chronic pancreatitis, AP, family aggregation of pancreatic cancer, FAMMM, AT, as well as nutrition and lifestyle factors, like smoking may play important role in the etiology of pancreatic cancer.
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Affiliation(s)
- P Ghadirian
- Epidemiology Research Unit, Centre hospitalier de l'Université de Montréal (CHUM), Pav. Masson, Hôtel-Dieu, Faculty of Medicine, Université de Montréal, 3850 St. Urbain Street, Montreal, Que., Canada H2W 1T7.
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Su LK, Abdalla EK, Law CH, Kohlmann W, Rashid A, Vauthey JN. Biallelic inactivation of the APC gene is associated with hepatocellular carcinoma in familial adenomatous polyposis coli. Cancer 2001; 92:332-9. [PMID: 11466687 DOI: 10.1002/1097-0142(20010715)92:2<332::aid-cncr1327>3.0.co;2-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Certain primary hepatic tumors have been associated with familial adenomatous polyposis (FAP), a condition caused by germline mutations of the adenomatous polyposis coli (APC) gene. However, a genetic association between FAP and hepatocellular carcinoma (HCC) has not been shown. This study tested the hypothesis that biallelic inactivation of the APC gene contributed to the development of HCC in a patient with FAP and a known germline mutation of the APC gene at codon 208, but no other risk factors for HCC. METHODS Total RNA and genomic DNA were isolated from the tumor, and in vitro synthesized protein assay and DNA sequencing analysis were used to screen for a somatic mutation in the APC gene. RESULTS A somatic one-base pair deletion at codon 568 was identified in the wild-type allele of the APC gene. CONCLUSIONS To the authors' knowledge, this study provides the first evidence that biallelic inactivation of the APC gene may contribute to the development of HCC in patients with FAP.
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Affiliation(s)
- L K Su
- Department of Molecular and Cellular Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
OBJECTIVE Cancers of the biliary tract, including cancers of the gallbladder and bile duct, generally carry a very poor prognosis. Little is known about their etiology. The pattern of co-occurrence of two cancers may give clues to shared etiological risk factors. We therefore investigated the association of biliary tract cancer with other cancers, especially with estrogen- and tobacco-related cancers. METHODS We used data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Associations between biliary tract cancer and other cancers were evaluated using the standardized incidence ratio as an estimate of the relative risk of a second primary malignancy. RESULTS Estrogen-related cancers of the breast and uterine corpus and smoking-related upper aerodigestive tract cancers were not associated with biliary tract cancer. The risk of gallbladder cancer was inversely related to the risk of prostate cancer in men, but positively related to the risk of cervical cancer in women. CONCLUSIONS This study suggests that smoking and estrogen exposure have minimal roles in the pathogenesis of biliary tract cancer. Our finding of an inverse relationship between prostate cancer and gallbladder cancer requires confirmation by further studies.
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Affiliation(s)
- Y Su
- Division of Epidemiology, Joseph L. Mailman School of Public Health, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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Gruner BA, DeNapoli TS, Andrews W, Tomlinson G, Bowman L, Weitman SD. Hepatocellular carcinoma in children associated with Gardner syndrome or familial adenomatous polyposis. J Pediatr Hematol Oncol 1998; 20:274-8. [PMID: 9628444 DOI: 10.1097/00043426-199805000-00018] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Gardner syndrome, a variant of familial adenomatous polyposis, is characterized by colonic polyps that undergo malignant change and benign and malignant extracolonic lesions. Tumors frequently associated with Gardner syndrome include carcinoma of the ampulla of Vater, papillary carcinoma of the thyroid, and, in children, hepatoblastoma. The childhood malignancies often precede the appearance of other manifestations by several years. PATIENTS AND METHODS Two patients are described. Gardner syndrome was diagnosed in a 15-year-old girl with fibrolamellar hepatocellular carcinoma after desmoid tumors and colonic polyposis developed. Classic hepatocellular carcinoma was also diagnosed in a 9 1/2-year-old boy with familial adenomatous polyposis. RESULTS In patient 1, the diagnosis of fibrolamellar hepatocellular carcinoma preceded the diagnosis of Gardner syndrome by almost 2 years. The diagnosis was confirmed by identifying a germline mutation of the adenomatous polyposis coli (APC) gene. This is the first patient reported with fibrolamellar hepatocellular carcinoma associated with Gardner syndrome. Patient 2 had a strong family history of familial adenomatous polyposis but no manifestations of Gardner syndrome. He was not tested for the APC mutation. The current literature and previously reported cases of hepatocellular carcinoma in patients with Gardner syndrome or familial adenomatous polyposis are reviewed. CONCLUSIONS Because hepatocellular carcinoma is uncommon in the pediatric and adolescent population, it is important to consider the possibility of Gardner syndrome or familial adenomatous polyposis in these patients.
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Affiliation(s)
- B A Gruner
- Department of Pediatrics, University of Texas Health Science Center, San Antonio 78284-7810, USA
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Futami H, Furuta T, Hanai H, Nakamura S, Baba S, Kaneko E. Adenoma of the common human bile duct in Gardner's syndrome may cause relapsing acute pancreatitis. J Gastroenterol 1997; 32:558-61. [PMID: 9250908 DOI: 10.1007/bf02934100] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Familial adenomatous polyposis of the colon, or Gardner's syndrome, is often accompanied by adenomas of the stomach and duodenum. We experienced a rare case of Gardner's syndrome, with adenomas of the common bile duct, in a patient who presented with relapsing acute pancreatitis. Our findings indicate that adenoma in the common bile duct or pancreatic duct should be considered as a possible etiology when patients with familial polyposis or Gardner's syndrome present with pancreatitis, particularly relapsing acute pancreatitis.
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Affiliation(s)
- H Futami
- First Department of Medicine, Hammamatsu University School of Medicine, Japan
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Abbasakoor F, Manson JM, Carr ND. Pancreatitis in childhood associated with villous adenoma of the ampulla of Vater. Br J Surg 1997; 84:581. [PMID: 9112928 DOI: 10.1002/bjs.1800840446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Lynch HT, Fusaro L, Smyrk TC, Watson P, Lanspa S, Lynch JF. Medical genetic study of eight pancreatic cancer-prone families. Cancer Invest 1995; 13:141-9. [PMID: 7874567 DOI: 10.3109/07357909509011683] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- H T Lynch
- Department of Preventive Medicine/Public Health, Creighton University School of Medicine, Omaha, Nebraska 68178
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Stewart CJ, Imrie CW, Foulis AK. Pancreatic islet cell tumour in a patient with familial adenomatous polyposis. J Clin Pathol 1994; 47:860-1. [PMID: 7962661 PMCID: PMC494949 DOI: 10.1136/jcp.47.9.860] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of familial adenomatous polyposis is reported in a 39 year old patient who underwent a Whipple's resection for adenoma of the duodenum. He subsequently developed a pancreatic glucagonoma. Endocrine neoplasia other than papillary carcinoma of thyroid has seldom been reported in association with FAP. The true incidence of islet cell tumours in FAP may be underestimated.
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Affiliation(s)
- C J Stewart
- Department of Pathology, Glasgow Royal Infirmary
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Nugent KP, Spigelman AD, Talbot IC, Phillips RK. Gallbladder dysplasia in patients with familial adenomatous polyposis. Br J Surg 1994; 81:291-2. [PMID: 8156364 DOI: 10.1002/bjs.1800810248] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Spigelman AD, Hodgson SV, Thomson JP. Management of familial adenomatous polyposis. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1992; 6:75-94. [PMID: 1316794 DOI: 10.1016/0950-3528(92)90019-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The management of FAP involves treatment of affected individuals and their families. Such an approach is best coordinated by registrars working in dedicated registries, in close collaboration with nurses, physicians, surgeons, clinical geneticists and others who become involved in the care of these patients. The large bowel of patients with FAP should be removed (totally or subtotally) by the third decade of life. Screening of other areas at risk is recommended to document the natural history of extracolonic manifestations and to allow study of the effects of intervention. Despite these other, sometimes life-threatening manifestations, a near to normal life span is possible in the majority of patients with FAP. The aims of management of the individual and of the family are to ensure that their quality of life is optimal, that support is provided in times of emotional need, that anxiety is minimized and that relatives are adequately screened and treated.
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