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

From: Genetic testing in a gynaecological oncology care in developing countries—knowledge, attitudes and perception of Nepalese clinicians

Cancer type Recommendations
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
  1. https://www.eviq.org.au Risk Management for Lynch Syndrome
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