From the Guidelines
The surveillance interval for Familial Adenomatous Polyposis (FAP) should be every 1 to 2 years starting at the age of 10 to 11 years for classic FAP and every 2 years starting at the age of 18 to 20 years for attenuated FAP, with adjustments based on polyp burden and surgical history. For individuals with FAP who have not undergone colectomy, sigmoidoscopy or colonoscopy is recommended, with the choice of procedure depending on the clinical context and patient factors 1. After colorectal surgery, surveillance of the rectum or pouch should be carried out every 6 to 12 months if rectal tissue remains and every 6 months to 5 years if ileoanal pouch, depending on polyp burden 1. The decision on the type of colorectal surgery in FAP depends on several factors, including the age of the patient, the severity of rectal polyposis, and the wish to have children 1. Upper endoscopy for duodenal and gastric polyps should be performed every 6 months to 5 years, depending on the polyp burden, and screening for extracolonic manifestations such as thyroid cancer and desmoid tumors should be considered when colorectal polyposis is diagnosed or at the age of 25 to 30 years, whichever comes first 1. Regular surveillance is essential for early detection of advanced adenomas or early cancers, allowing for timely intervention and improved outcomes. Key factors to consider in determining the surveillance interval include the patient's clinical status, surgical history, and polyp burden, as well as the presence of extracolonic manifestations 1. By prioritizing regular surveillance and adjusting the interval based on individual patient factors, healthcare providers can help improve outcomes for patients with FAP. The importance of surveillance is highlighted by the high risk of colorectal cancer development in FAP patients due to the presence of hundreds to thousands of adenomatous polyps throughout the colon and rectum caused by germline mutations in the APC gene 1. Some patients with attenuated FAP can be conservatively managed with colonoscopy and polypectomy every 1 to 2 years, while others may require more frequent surveillance or surgical intervention 1. Ultimately, the goal of surveillance is to detect and remove adenomas before they progress to cancer, and to improve quality of life for patients with FAP.
From the Research
Surveillance Interval for FAP
The surveillance interval for Familial Adenomatous Polyposis (FAP) is not explicitly stated in the provided studies. However, the following points can be noted:
- FAP patients are at high risk of developing colorectal cancer, and regular surveillance is crucial to reduce this risk 2, 3, 4.
- Colonoscopy and lower endoscopy are the principal examinations for surveillance in FAP patients 4.
- Upper endoscopy is also necessary for surveillance to reduce the risk of ampullary and duodenal cancer 2.
- The frequency of surveillance may depend on the individual patient's risk factors, such as family history, genotype, and presence of extracolonic manifestations 3, 5.
- There is no clear consensus on the optimal surveillance interval for FAP patients, and further research is needed to determine the most effective surveillance strategy 3, 5.
Key Considerations
- FAP patients should undergo regular surveillance to reduce the risk of colorectal cancer and other extracolonic manifestations 2, 3, 4.
- A multidisciplinary approach to management, including surgery, endoscopy, and pharmacotherapy, may be necessary for optimal patient care 3, 5.
- Further research is needed to develop more effective surveillance and treatment strategies for FAP patients 3, 5.