From the Guidelines
Based on the most recent and highest quality evidence, the patient with Lynch syndrome should consider prophylactic hysterectomy and bilateral salpingo-oophorectomy after completing childbearing to prevent gynecologic cancers, as well as daily aspirin (600 mg) for colorectal cancer prevention, after discussing the risks and benefits with a healthcare provider 1.
The patient's lack of MSH2 protein expression on immunohistochemistry suggests that she may have Lynch syndrome, which significantly increases her lifetime risk for colorectal cancer (up to 80%), endometrial cancer (up to 60% in women), and other cancers due to inherited mutations in DNA mismatch repair genes that lead to microsatellite instability and accelerated cancer development.
Some key points to consider:
- The NCCN guidelines recommend that women with Lynch syndrome consider prophylactic hysterectomy and bilateral salpingo-oophorectomy after completing childbearing to prevent gynecologic cancers 1.
- Daily aspirin (600 mg) may be considered for colorectal cancer prevention, though this should be discussed with a healthcare provider due to bleeding risks 1.
- Genetic counseling is essential for family members who may also carry the mutation.
- The patient should undergo regular cancer screening, including colonoscopy every 1-2 years beginning at age 20-25, and annual endometrial sampling and transvaginal ultrasound for women starting at age 30-35 1.
Overall, the patient should be informed of the risks and benefits of these preventive measures and work with her healthcare provider to develop a personalized plan for reducing her cancer risk.
From the Research
Recommended Preventive Measures for a Patient with Lynch Syndrome
Based on the provided evidence, the following preventive measures are recommended for a patient with Lynch syndrome:
- Prophylactic hysterectomy and bilateral salpingo-oophorectomy (BSO) to prevent gynecological cancers, as supported by studies 2, 3, 4, 5, 6
- This procedure has been shown to be effective in preventing endometrial and ovarian cancer in women with Lynch syndrome, with a prevented fraction of 100% for both cancers 6
- The optimal timing for this procedure is after the completion of childbearing, as recommended by 5
Considerations for the Patient
Considering the patient's personal history of obesity, long segment Barrett's esophagus, and sebaceous adenomas, as well as her family history of kidney and colon cancer, it is essential to discuss the following:
- The patient's increased risk of endometrial and ovarian cancer due to her Lynch syndrome diagnosis
- The benefits and risks of prophylactic hysterectomy and BSO, including the potential reduction in cancer risk and the impact on reproductive health
- The importance of regular surveillance and screening for other cancers, such as colon and endometrial cancer, as recommended by 5
Response to the Patient's Question
Based on the most likely scenario, the patient should be informed that:
- She should consider total hysterectomy and bilateral salpingo-oophorectomy to prevent gynecological cancers, as supported by the evidence 2, 3, 4, 5, 6
- This procedure is a recommended preventive measure for women with Lynch syndrome, and it has been shown to be effective in reducing the risk of endometrial and ovarian cancer 6