Gastrointestinal surveillance and management in Lynch syndrome

Cancer of the large bowel is one of the most common cancers. About one in 20 patients with such cancer have a hereditary predisposition for such cancer, called Lynch syndrome (LS). By regularly performing an examination of the inside of the large bowel (colonoscopy) with removal of polyps with malignant potential, chance of developing cancer is strongly reduced. We examined if the colonoscopy could be optimized by spraying a dye on the wall of the large bowel to improve visualization of polyps. This technique did not prove more effective in detecting polyps compared to a standard colonoscopy.When cancer is detected in a LS-patient, most of the large bowel is usually removed, because of the substantial risk of developing cancer in the remaining bowel. The effect of this extended resection on quality of life in comparison with removing only a small part of bowel, as is usual in non-hereditary cancer, was unknown. We found that the extensive surgery did not have a more negative impact on general quality of life of patients with LS.People with LS also have an increased risk of small bowel cancer. We therefore looked if an examination of the small bowel using a video capsule, a pill-sized camera that can be swallowed, could prove useful. We found that cancer of the small bowel is less common than previously expected. Hence we do not recommend the use of this videocapsule in LS.

Dissertation: https://hdl.handle.net/11370/5e989f1a-7cf7-43ef-94dd-6a81366da004