Our Summary

This research paper is about a disease called familial adenomatous polyposis (FAP), which can lead to the development of colorectal cancer if not treated. Even after preventative surgery, there is still a risk of cancer development. The paper aims to understand the long-term rates of cancer and adenoma (a type of benign tumor) development in FAP patients who have undergone preventative surgery.

The authors analyzed data from a large number of studies and found that the cancer rate in the remaining rectum was between 8.8-16.7% in the western population and 37% in the eastern population. Even 30 years after surgery, there was a 24% risk of developing cancer. The survival rate 5 years after diagnosis was 55%.

After one type of surgery (ileal pouch-anal anastomosis or IPAA), the adenoma rate ranged from 9.4-85%, with an 85% risk of developing an adenoma 20 years after surgery. After another type of surgery (ileorectal anastomosis or IRA), the risk of developing an adenoma was 85% after 5 years and 100% after 10 years.

The findings show a significant risk of developing cancer and adenomas in FAP patients after surgery. Therefore, the authors recommend regular check-ups for these patients, even after surgery.

FAQs

  1. What is the risk of developing cancer after preventative surgery for familial adenomatous polyposis (FAP)?
  2. What is the difference in adenoma development between patients who undergo ileal pouch-anal anastomosis (IPAA) and those who have ileorectal anastomosis (IRA)?
  3. Why are regular check-ups recommended for FAP patients even after surgery?

Doctor’s Tip

One helpful tip a doctor might give to a patient who has undergone a colectomy is to make sure to attend regular follow-up appointments with their healthcare provider. These appointments are important for monitoring for any signs of cancer or adenoma development in the remaining rectum or bowel. It is crucial to stay proactive in managing your health and catching any potential issues early on. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can also help reduce the risk of cancer recurrence.

Suitable For

Patients with familial adenomatous polyposis (FAP) are typically recommended colectomy, or surgical removal of the colon, as a preventative measure against the development of colorectal cancer. FAP is a genetic condition that causes numerous polyps to form in the colon, which can eventually lead to cancer if left untreated.

Patients with FAP have a very high risk of developing colorectal cancer, with almost 100% of untreated individuals developing cancer by age 40. As such, colectomy is recommended as a way to remove the source of potential cancer development.

In addition to FAP patients, individuals with inflammatory bowel disease (IBD) such as ulcerative colitis may also be recommended colectomy if their condition is severe and unresponsive to other treatments. In these cases, colectomy is seen as a way to remove the diseased colon and reduce the risk of complications such as colon cancer.

Overall, patients who are at high risk of developing colorectal cancer due to conditions such as FAP or severe IBD are typically recommended colectomy as a preventative measure. This surgery can greatly reduce the risk of cancer development and improve long-term outcomes for these patients.

Timeline

Before colectomy:

  1. Patients are diagnosed with familial adenomatous polyposis (FAP) after experiencing symptoms such as bloody stools, abdominal pain, and changes in bowel habits.
  2. Patients undergo genetic testing to confirm the diagnosis of FAP.
  3. Patients undergo regular colonoscopies to monitor the growth of polyps in the colon.
  4. Patients may opt for preventive measures such as taking medication or undergoing endoscopic procedures to remove polyps.

After colectomy:

  1. Patients undergo colectomy surgery to remove the colon and reduce the risk of developing colorectal cancer.
  2. Patients may choose to have an ileal pouch-anal anastomosis (IPAA) or ileorectal anastomosis (IRA) surgery to create a new way for stool to leave the body.
  3. Patients may experience temporary side effects such as pain, bloating, and changes in bowel habits after surgery.
  4. Patients are advised to follow a specific diet and lifestyle modifications to adjust to life without a colon.
  5. Patients undergo regular follow-up appointments and screenings to monitor for cancer recurrence or the development of adenomas.
  6. Patients may still be at risk for developing cancer or adenomas even after surgery, requiring lifelong monitoring and surveillance.

What to Ask Your Doctor

  1. What is the risk of developing cancer in the remaining rectum after colectomy surgery for FAP?

  2. What is the long-term survival rate for FAP patients after preventative surgery?

  3. What is the risk of developing adenomas in the rectum after different types of colectomy surgeries (IPAA vs IRA)?

  4. How often should FAP patients undergo surveillance colonoscopies after surgery?

  5. Are there any additional preventative measures or treatments that can reduce the risk of cancer or adenoma development after surgery?

  6. What are the signs and symptoms that FAP patients should watch out for that may indicate cancer development?

  7. Are there any lifestyle changes or dietary recommendations that can help reduce the risk of cancer or adenoma development after surgery?

  8. What is the recommended follow-up schedule for FAP patients after surgery to monitor for cancer or adenoma development?

  9. Are there any specific genetic or familial factors that may impact the risk of cancer or adenoma development in FAP patients after surgery?

  10. How can FAP patients best advocate for their own health and ensure they are receiving appropriate follow-up care after surgery?

Reference

Authors: Gavric A, Sanchez LR, Brunori A, Bravo R, Balaguer F, Pellisé M. Journal: Radiol Oncol. 2024 Jun 11;58(2):153-169. doi: 10.2478/raon-2024-0029. eCollection 2024 Jun 1. PMID: 38860690