If You have a Family History of Colorectal Cancer…
If someone in your biological family has or has had colorectal cancer or polyps in the colorectal area, you are at higher risk of experiencing the disease. The closer the relative is to you genetically the more vigilant you should be with your screenings.
Marc I. Brand, MD, an expert in hereditary colorectal cancer and director of the Sandra Rosenberg Registry for Hereditary and Familial Colon Cancer at Rush, explains that a person with a “first-degree” relative (parent, brother, sister, son or daughter) who has had colorectal cancer or polyps is at higher risk for experiencing the disease and should have more frequent screenings. The risk is even greater if one of your first-degree relatives experienced colorectal cancer before age 60.
You are only at a slightly increased risk if a second-degree relative has had the disease. A second-degree relative is anyone related to you by blood that is not a first-degree relative. For example, an aunt, uncle, cousin, etc. would be considered a second-degree relative. People who have experienced inflammatory bowel disorders like ulcerative colitis are also at higher risk for colorectal cancer.
You are at highest risk if you have inherited certain genetic syndromes that are associated with the disease. These “colon cancer syndromes” include familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). “The good news is that there is genetic testing available for these two hereditary syndromes,” according to Brand. “This lets you know if you’ve inherited the condition. We can then watch closely to catch any disease in its earliest stages.”
If you have a family history, screening should include a colonoscopy because it is one of the most sensitive screening methods available. If you have a moderate family history you should have a colonoscopy every five years, either at age 50 or 10 years earlier than your youngest relative that had the disease. For instance, if you have a relative that was diagnosed with colorectal cancer at age 45, you would begin your screenings at age 35.
If you have had an inflammatory bowel disorder such as ulcerative colitis or Crohn’s disease for more than 10 years, you should have a colonoscopy with multiple random biopsies every one to two years.
If genetic testing shows that you have FAP you should have a sigmoidoscopy every year starting around puberty.
If genetic testing shows that you have HNPCC you should have a colonoscopy every one to two years starting between age 20 to 25. Women with HNPCC should be screened annually for ovarian and uterine cancer starting between age 30 to 35.
Familial Adenomatous Polyposis (FAP)
Familial adenomatous polyposis, called FAP for short, is a hereditary condition resulting in the abnormal growth of cells in the colon. The cells most commonly affected are the glandular cells lining the colon, causing growth of multiple adenomatous polyps.
Adenomatous growths have the potential to develop into cancer. It is estimated that about one out of ten polyps will become cancerous. A person with FAP may have hundreds to thousands of polyps in the lining of the colon by age 20, resulting in a nearly 100 percent chance of colon cancer by the age 40 if early treatment is not provided.
Because FAP is hereditary, every cell in the body has the same chance for abnormal growth, with the duodenum, stomach and connective tissue cells being among the most susceptible.
FAP is a complicated condition which is passed from parent to child. It has a high risk for the development of cancer, especially in the colon or duodenum. Special monitoring and genetic testing is available to identify patients with FAP, before the development of cancer. When precancerous growths are found, preventive surgery should be performed to avoid the development of cancer. With modern treatment, FAP can nearly always be controlled and affected persons can live a normal life.
Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
HNPCC is an inherited condition that frequently causes cancer, usually in the colon and rectum. Its presence is often difficult to recognize, since there are few visible changes (such as the formation of many polyps). The result is a high risk for developing cancer with few clues to suggest its presence. Because HNPCC runs in families, each child of an affected person has a 50 percent chance of inheriting the condition. Patients who have inherited HNPCC are at a much higher risk of developing colorectal cancer than those without a family history.
Because HNPCC is hereditary, every cell in the body has the same chance for abnormal growth, with endometrium, ovary, stomach, small intestine, bile duct, brain and the urinary collecting system cells being among the most susceptible.
Cancer of the stomach, small intestine, bile ducts, brain and urinary collecting system develop in HNPCC more often than in the general population. However, these cancers all occur in less than five percent, or one in every 20, of patients with HNPCC.
HNPCC is a complex condition that is passed from parent to child. It has a high risk for the development of cancer, especially in the colon, uterus and ovaries. Special monitoring and genetic testing is available to identify patients with HNPCC, before the development of cancer. When precancerous growths are found, preventive surgery should be performed to avoid the development of cancer. With modern treatment, HNPCC usually can be controlled and affected persons can live a normal life.
Visit the Sandra Rosenberg Registry for Hereditary and Familial Colon Cancer for more information.