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Sánchez A, Bujanda L, Cuatrecasas M, Bofill A, Alvarez-Urturi C, Hernandez G, Aguilera L, Carballal S, Llach J, Herrera-Pariente C, Iglesias M, Rivero-Sánchez L, Jung G, Moreno L, Ocaña T, Bayarri C, Pellise M, Castells A, Castellví-Bel S, Balaguer F, Moreira L. Identification of Lynch Syndrome Carriers among Patients with Small Bowel Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13246378. [PMID: 34944998 PMCID: PMC8699558 DOI: 10.3390/cancers13246378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Small bowel adenocarcinoma (SBA) is associated with Lynch syndrome (LS). This is the first study to evaluate the identification of LS patients based on mismatch repair deficiency (MMRd) tumor among SBA. The authors found a 21.3% prevalence of MMRd tumors and a 10.1% prevalence of LS. A germline mutation was identified in 60% of patients with a MMRd tumor. This data suggests that universal tumor MMR testing among SBA patients should be implemented for the identification of LS. Abstract Background: Small bowel adenocarcinoma (SBA) is a rare disease which can be associated with Lynch syndrome (LS). LS tumors are characterized by the presence of microsatellite instability (MSI) and/or the loss of mismatch repair (MMR) protein expression. In SBA, the frequency of MMR deficient (MMRd) tumors varies from 5% to 35%. This study aims to describe the prevalence of LS carriers among patients with MMRd small bowel adenocarcinomas. Methods: A multicenter retrospective study with identification and MMR testing of all consecutive SBA between 2004 and 2020 in a multicenter Spanish study. Demographical data, tumor characteristics, follow-up and survival information were collected. Germline testing was driven by identification of MMRd tumors. Results: A total of 94 individuals diagnosed with SBA were recruited. We observed 20 (21.3%) MMRd tumors. In 9/15 (60%) patients with MMRd tumors, a pathogenic variant was identified (three MLH1, four MSH2, one MSH6 and one PMS2). Accordingly, the prevalence of LS among all SBA cases was 10.1%. Conclusions: More than one-fifth of SBA display MMRd and in more than a half is due to LS. Our data supports the implementation of universal MMR tumor testing among SBA for the identification of LS families.
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Affiliation(s)
- Ariadna Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain;
| | - Miriam Cuatrecasas
- Department of Pathology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain;
| | - Alex Bofill
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Cristina Alvarez-Urturi
- Department of Gastroenterology, IMIM (Hospital del Mar Medical Research Institute), Barcelona Hospital del Mar, 08003 Barcelona, Spain;
| | - Goretti Hernandez
- Department of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Lara Aguilera
- Department of Gastroenterology, Vall d’Hebron Research Institute, 08035 Barcelona, Spain;
| | - Sabela Carballal
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Joan Llach
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Cristina Herrera-Pariente
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Mar Iglesias
- Department of Pathology, IMIM (Hospital del Mar Medical Research Institute), Barcelona Hospital del Mar, 08003 Barcelona, Spain;
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Gerhard Jung
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Lorena Moreno
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Carolina Bayarri
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Maria Pellise
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Sergi Castellví-Bel
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036 Barcelona, Spain; (A.S.); (A.B.); (S.C.); (J.L.); (C.H.-P.); (L.R.-S.); (G.J.); (L.M.); (T.O.); (C.B.); (M.P.); (A.C.); (S.C.-B.); (F.B.)
- Correspondence: ; Tel.: +34-93-227-5739; Fax: +34-93-227-5589
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Vasen HFA. Progress Report: New insights into the prevention of CRC by colonoscopic surveillance in Lynch syndrome. Fam Cancer 2021; 21:49-56. [PMID: 33464460 DOI: 10.1007/s10689-020-00225-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022]
Abstract
Lynch syndrome is the most frequent hereditary colorectal cancer (CRC) syndrome, affecting approximately 1 in 300 in the Western population. It is caused by pathogenic variants in the mismatch repair (MMR) genes including MLH1, MSH2 (EPCAM), MSH6 and PMS2, and is associated with high risks of CRC, endometrial cancer and other cancers. In view of these risks, carriers of such variants are encouraged to participate in colonoscopic surveillance programs that are known to substantially improve their prognosis. In the last decade several important studies have been published that provide detailed cancer risk estimates and prognoses based on large numbers of patients. These studies also provided new insights regarding the pathways of carcinogenesis in CRC, which appear to differ depending on the specific MMR gene defect. In this report, we will discuss the implications of these new findings for the development of new surveillance protocols.
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Affiliation(s)
- Hans F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Piombino C, Cortesi L, Lambertini M, Punie K, Grandi G, Toss A. Secondary Prevention in Hereditary Breast and/or Ovarian Cancer Syndromes Other Than BRCA. JOURNAL OF ONCOLOGY 2020; 2020:6384190. [PMID: 32733558 PMCID: PMC7376433 DOI: 10.1155/2020/6384190] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022]
Abstract
BRCA1- and BRCA2-associated hereditary breast and ovarian cancer syndromes are among the best-known and most extensively studied hereditary cancer syndromes. Nevertheless, many patients who proved negative at BRCA genetic testing bring pathogenic mutations in other suppressor genes and oncogenes associated with hereditary breast and/or ovarian cancers. These genes include TP53 in Li-Fraumeni syndrome, PTEN in Cowden syndrome, mismatch repair (MMR) genes in Lynch syndrome, CDH1 in diffuse gastric cancer syndrome, STK11 in Peutz-Jeghers syndrome, and NF1 in neurofibromatosis type 1 syndrome. To these, several other genes can be added that act jointly with BRCA1 and BRCA2 in the double-strand break repair system, such as PALB2, ATM, CHEK2, NBN, BRIP1, RAD51C, and RAD51D. Management of primary and secondary cancer prevention in these hereditary cancer syndromes is crucial. In particular, secondary prevention by screening aims to discover precancerous lesions or cancers at their initial stages because early detection could allow for effective treatment and a full recovery. The present review aims to summarize the available literature and suggest proper screening strategies for hereditary breast and/or ovarian cancer syndromes other than BRCA.
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Affiliation(s)
- Claudia Piombino
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Laura Cortesi
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Kevin Punie
- Department of General Medical Oncology, Multidisciplinary Breast Center, Leuven Kanker Instituut, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Grandi
- Department of Obstetrics and Ginecology, University Hospital of Modena, Modena, Italy
| | - Angela Toss
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
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Haanstra JF, Dekker E, Cats A, Nagengast FM, Hardwick JC, Vanhoutvin SA, de Vos Tot Nederveen Cappel WH, Vasen HF, Kleibeuker JH, Koornstra JJ. Effect of chromoendoscopy in the proximal colon on colorectal neoplasia detection in Lynch syndrome: a multicenter randomized controlled trial. Gastrointest Endosc 2019; 90:624-632. [PMID: 31028782 DOI: 10.1016/j.gie.2019.04.227] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Patients with Lynch syndrome (LS) undergo regular surveillance by colonoscopy because of an increased risk of colorectal neoplasia, particularly in the proximal colon. Chromoendoscopy (CE) has been reported to improve neoplasia detection compared with conventional white-light endoscopy (WLE), but evidence is limited. Our aim was to investigate the effect of CE in the proximal colon on detection of neoplastic lesions during surveillance in LS. METHODS This was a multicenter prospective randomized controlled trial of 246 patients with LS who were randomly assigned (1:1) to conventional WLE (n = 123) or colonoscopy with CE in the proximal colon (n = 123), stratified for previous colorectal adenomas and enrolling center. Two years after baseline colonoscopy, patients underwent colonoscopy with CE in the proximal colon. The primary outcome was the proportion of patients with at least one neoplastic lesion at baseline and after 2 years. RESULTS Neoplasia detection rates at baseline colonoscopy were 27% for WLE versus 30% for CE (odds ratio [OR], 1.23; 95% confidence interval [CI], 0.69-2.2; P = .56). In the proximal colon, neoplasia detection rates were 16% for WLE versus 24% for CE (OR, 1.6; 95% CI, 0.9-3.1; P = .13). Total procedure time was 9 minutes longer in the CE group. At follow-up after 2 years, neoplasia detection rates were similar in both groups: 26% for the original WLE group versus 28% for the CE group (OR, 1.1; P = .81). CONCLUSIONS CE in the proximal colon for LS surveillance was not superior to WLE with respect to the initial detection of neoplasia, and not associated with reduced neoplasia detection rates after 2 years. The value of CE remains to be established. (Clinical trial registration number: NCT00905710.).
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Affiliation(s)
- Jasmijn F Haanstra
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Gastroenterology, Isala Clinics, Zwolle, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke Cats
- Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Fokko M Nagengast
- Department of Gastroenterology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - James C Hardwick
- Department of Gastroenterology, Leiden University Medical Center, Leiden, the Netherlands
| | - Steven A Vanhoutvin
- Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Hans F Vasen
- Department of Gastroenterology, Leiden University Medical Center, Leiden, the Netherlands; The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, the Netherlands
| | - Jan H Kleibeuker
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan J Koornstra
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
Lynch syndrome is the hereditary disorder that most frequently predisposes to colorectal cancer as well as predisposing to a number of extracolonic cancers, most prominently endometrial cancer. It is caused by germline mutations in the mismatch repair genes. Both its phenotype and genotype show marked heterogeneity. This review gives a historical overview of the syndrome, its heterogeneity, its genomic landscape, and its implications for complex diagnosis, genetic counseling and putative implications for immunotherapy.
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Vangala DB, Cauchin E, Balmaña J, Wyrwicz L, van Cutsem E, Güller U, Castells A, Carneiro F, Hammel P, Ducreux M, van Laethem JL, Matysiak-Budnik T, Schmiegel W. Screening and surveillance in hereditary gastrointestinal cancers: Recommendations from the European Society of Digestive Oncology (ESDO) expert discussion at the 20th European Society for Medical Oncology (ESMO)/World Congress on Gastrointestinal Cancer, Barcelona, June 2018. Eur J Cancer 2018; 104:91-103. [PMID: 30342310 DOI: 10.1016/j.ejca.2018.09.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
Patients with hereditary gastrointestinal (GI) cancers represent a substantial fraction of the overall affected population. Although awareness for hereditary GI cancer syndromes is on the rise, identification of patients and measures of surveillance are often unclear in everyday clinical routine. Therefore, the European Society of Digestive Oncology expert discussion 2018 at the World Congress on Gastrointestinal Cancer focussed on screening and surveillance of hereditary colorectal, gastric and pancreatic cancers. An international panel of experts and opinion leaders developed the here presented recommendations based on published evidence and on profound clinical expertise to facilitate clinical routine in identification and caretaking of patients with familial GI cancers.
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Affiliation(s)
- Deepak B Vangala
- Department of Internal Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Germany.
| | - Estelle Cauchin
- Institut des Maladies de L'Appareil Digestif, Hepato-Gastroenterology and Digestive Oncology, Nantes University Hospital, Nantes, France
| | - Judith Balmaña
- Vall D'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Lucian Wyrwicz
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Eric van Cutsem
- Digestive Oncology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Ulrich Güller
- Division of Medical Oncology and Hematology, Kantonsspital St Gallen, Switzerland
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Catalonia, Spain
| | - Fatima Carneiro
- Faculty of Medicine of the University of Porto (FMUP), Centro Hospitalar de Sao Joao (CHSJ) and Ipatimup/i3S, Porto, Portugal
| | - Pascal Hammel
- Department of Digestive Oncology, Hôpital Beaujon, Clichy, University Paris VII Denis Diderot, France
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Villejuif and Université Paris-Saclay, Saint Aubain, France
| | - Jean-Luc van Laethem
- Department of Gastroenterology and Digestive Oncology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Tamara Matysiak-Budnik
- Institut des Maladies de L'Appareil Digestif, Hepato-Gastroenterology and Digestive Oncology, Nantes University Hospital, Nantes, France
| | - Wolff Schmiegel
- Department of Internal Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Germany
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Update on the role of chromoendoscopy in colonoscopic surveillance of patients with Lynch syndrome. Eur J Gastroenterol Hepatol 2018; 30:1116-1124. [PMID: 30044237 DOI: 10.1097/meg.0000000000001214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
(Virtual) chromoendoscopy (CE) improves the detection of small or flat colorectal polyps; however, the evidence in high-risk groups, such as patients of Lynch syndrome (LS), is low. Our aim was to identify and update the evidence for the recommendations regarding surveillance of LS patients, for which the current underlying evidence for use of (virtual) CE was explored. A systematic literature search in PubMed, EMBASE, and Cochrane library was conducted, for all studies comparing (virtual) CE with white-light endoscopy in LS patients. Studies are explained in detail, with special attention to study design, type of (virtual) CE, and timing of polypectomy. Eight studies (409 patients) were included. Five were nonrandomized back-to-back studies and three were randomized back-to-back studies (one parallel and two cross-over design). In six studies the polyps were directly removed, while in two studies polyps were removed only during the second caecal withdrawal. Five studies researched CE with indigo carmine and three studies investigated virtual CE. Due to the heterogeneity between studies, no statistical analysis could be performed. There was a large variety in study design, timing of polypectomy, different (virtual) CE techniques and the patients that were included. Based on current literature, no firm conclusions can be drawn with respect to the additional value of (virtual) CE in the surveillance of patients with LS. However, training of endoscopists in detection and removal of nonpolypoid colorectal neoplasms is crucial, as well as stricter adherence to LS surveillance guidelines in daily clinical practice. For future research, standardization in study designs is needed.
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Abstract
Conducting randomized controlled trials (RCTs) in patients with germline mutations in genes that predispose to adult-onset cancer is hampered by the rarity of these mutations, barriers to their identification, and challenges inherent to randomizing high-risk individuals as part of a clinical trial. Most of the clinically relevant RCTs have been conducted in 3 syndromes in only some of the high-risk genes for which clinical testing is currently available. This article reviews the surgical, screening, and chemoprevention RCTs in each of the syndromes in clinically relevant studies conducted in the past 10 years.
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Razvi MA, Giardiello FM, Law JK. DNA Mismatch Repair and Lynch Syndrome. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0366-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Macaron C, Heald B, Burke CA. Using Genetics to Identify Hereditary Colorectal Polyposis and Cancer Syndromes in Your Patient. Curr Gastroenterol Rep 2016; 17:463. [PMID: 26292665 DOI: 10.1007/s11894-015-0463-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The majority of patients with colorectal polyps and cancer do not have a Mendelian cause of the disease. Age, lifestyle, and environmental factors interact with complex genetic traits to contribute to the etiology. However, approximately 5-10 % of patients with colorectal cancer (CRC) and more than 40 % of patients meeting specific clinical features of the hereditary polyposis syndromes have a discoverable, actionable genetic cause which will significantly alter their medical management.
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Affiliation(s)
- Carole Macaron
- Section of Gastroenterology, Department of Veterans Affairs, Louis Stokes Cleveland Medical Center, Cleveland, 44106, OH, USA
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Hereditary Non-polyposis Colorectal Cancer: Prevention and Therapeutic Options. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bikhchandani J, Lynch HT. Commentary on 'Colonoscopy screening compliance and outcomes in patients with Lynch syndrome'. Colorectal Dis 2015; 17:46-9. [PMID: 25536883 DOI: 10.1111/codi.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Jai Bikhchandani
- Creighton University, 2500 California Plaza, Omaha, Nebraska, 68102, USA
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Carballal S, Leoz ML, Moreira L, Ocaña T, Balaguer F. Hereditary colorectal cancer syndromes. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.13.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
SUMMARY Colorectal cancer (CRC) is one of the most common malignancies and the second-leading cause of cancer death in both sexes in developed countries. Over the last 25 years, highly penetrant monogenic germline mutations that predispose to CRC and other digestive tumors have been identified, accounting for up to 5% of all CRC cases. Identification and characterization of these disorders have allowed modification of their natural history, with a substantial decrease in morbidity and mortality among high-risk patients. Recognizing hereditary CRC has also impacted predictive genetic testing and personalized medicine based on genomic information. This review summarizes the current knowledge on hereditary CRC regarding pathogenesis, clinical features, diagnostic evaluation and management recommendations.
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Affiliation(s)
- Sabela Carballal
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas & Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria Liz Leoz
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas & Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas & Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas & Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas & Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
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Abstract
PURPOSE Despite colonoscopic surveillance, Lynch syndrome patients develop colorectal cancer (CRC). Identification of modifiable factors has the potential to improve outcome of surveillance. The aims of this study were to determine (1) characteristics of patients with CRC, (2) endoscopic and histological features of these cancers, and (3) quality of the previous colonoscopy. METHODS Approximately 2,200 medical reports from proven and obligate mutation carriers identified at the Dutch Lynch Syndrome Registry and two large hospitals were retrospectively analyzed for the presence of an interval cancer defined as CRC diagnosed within 24 months of previous colonoscopy. RESULTS Thirty-one interval cancers were detected in 29 patients (median age of 52 [range 35-73]), after a median time of 17 months. All were MLH1 or MSH2 mutation carriers, and 39 % had a previous CRC. In patients without previous surgery for CRC, 84 % was proximally located. Of all interval cancers, 77 % were at local stage (T1-3N0Mx). In three patients (9 %) with an incomplete previous colonoscopy, CRC was located in the unexamined colon. In six of the nine patients with an adenoma during previous colonoscopy, the cancer was detected in the same colonic segment as the previously removed adenoma. CONCLUSIONS Interval cancers were detected in MLH1 and MSH2 mutation carriers, especially in those with a history of previous CRC and between 40 and 60 years. Interval cancer could be related to incompleteness of previous endoscopy and possibly residual adenomatous tissue. Further reduction of the interval cancer risk may be achieved by optimizing endoscopy quality and individualization of surveillance guidelines.
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