Table 2 Lynch Syndrome risk management guidelines. All patients should be entered on a local hereditary cancer registry for information and surveillance reminders

Colorectal

Surgical

▪ consider subtotal colectomy in selected individuals

Surveillance MSH6/PMS2

▪ annual colonoscopy from age 30 years or 5 years younger than youngest affected if <35 years

▪ review frequency of colonoscopy at age 60 years with a view to reduced frequency

Surveillance MLH1/MSH2

▪ annual colonoscopy from age 25 years or 5 years younger than youngest affected if <30 years

▪ review frequency of colonoscopy at age 60 years with a view to 2nd yearly frequency

Risk-reducing medication

▪ there may be a reduction of risk in taking aspirin however the appropriate dose is not yet defined (preliminary data)

Endometrial

Surgical

▪ recommend hysterectomy after childbearing complete or from age 40 years, or 5 years younger than the youngest affected, whichever comes first

Surveillance

▪ there is no evidence for transvaginal ultrasound (TVU) and/or aspiration biopsy

Ovarian

Surgical

▪ recommend risk reducing salpingo-oophorectomy (RRSO) at time of hysterectomy

▪ recommend HRT at the time of RRSO and continue until the usual time of menopause

Surveillance

▪ do not offer serum CA125 and/or transvaginal ultrasound (TVU). See Cancer Australia for further information

Gastric

Surveillance

▪ consider second yearly gastroscopy from age 30 years in families with gastric cancer or those at high ethnic risk - e.g. Chinese, Korean, Chilean and Japanese

Urothelial

Surveillance

▪ no evidence of benefit but patients encouraged to report symptoms e.g. haematuria