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International Journal of Colorectal Disease

Published in:

01-12-2013 | Original Article

Quality colonoscopy and risk of interval cancer in Lynch syndrome

Authors: J. F. Haanstra, H. F. A. Vasen, S. Sanduleanu, E. J. van der Wouden, J J. Koornstra, J. H. Kleibeuker, W. H. de Vos tot Nederveen Cappel

Published in: International Journal of Colorectal Disease | Issue 12/2013

Abstract

Purpose

Despite colonoscopic surveillance, Lynch syndrome patients develop colorectal cancer (CRC). Identification of modifiable factors has the potential to improve outcome of surveillance. The aims of this study were to determine (1) characteristics of patients with CRC, (2) endoscopic and histological features of these cancers, and (3) quality of the previous colonoscopy.

Methods

Approximately 2,200 medical reports from proven and obligate mutation carriers identified at the Dutch Lynch Syndrome Registry and two large hospitals were retrospectively analyzed for the presence of an interval cancer defined as CRC diagnosed within 24 months of previous colonoscopy.

Results

Thirty-one interval cancers were detected in 29 patients (median age of 52 [range 35–73]), after a median time of 17 months. All were MLH1 or MSH2 mutation carriers, and 39 % had a previous CRC. In patients without previous surgery for CRC, 84 % was proximally located. Of all interval cancers, 77 % were at local stage (T1–3N0Mx). In three patients (9 %) with an incomplete previous colonoscopy, CRC was located in the unexamined colon. In six of the nine patients with an adenoma during previous colonoscopy, the cancer was detected in the same colonic segment as the previously removed adenoma.

Conclusions

Interval cancers were detected in MLH1 and MSH2 mutation carriers, especially in those with a history of previous CRC and between 40 and 60 years. Interval cancer could be related to incompleteness of previous endoscopy and possibly residual adenomatous tissue. Further reduction of the interval cancer risk may be achieved by optimizing endoscopy quality and individualization of surveillance guidelines.

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Title: Quality colonoscopy and risk of interval cancer in Lynch syndrome
Authors: J. F. Haanstra
H. F. A. Vasen
S. Sanduleanu
E. J. van der Wouden
J J. Koornstra
J. H. Kleibeuker
W. H. de Vos tot Nederveen Cappel
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 12/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-013-1745-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quality colonoscopy and risk of interval cancer in Lynch syndrome

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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