The choice of risk management strategy should take into account current age, other health issues and residual cancer risk.
|Colorectal cancer (CRC)
- Total colectomy is not recommended unless the number and size of polyps makes it impossible to remove all polyps >5 mm in which case colectomy and ileorectal anastomosis should be considered
- If CRC is diagnosed in a patient with SPS, option of partial colectomy and debulking of any remaining colorectal polyps OR total colectomy to avoid frequent colonoscopy depending upon patient preference
- Clearance phase at presentation with polyposis: Removal of all relevant polyps## with repeat colonoscopy at 3- to 6-monthly intervals until 2 colonoscopies are clear of polyps. May require 2 to 4 colonoscopiesr
- Surveillance phase: Colonoscopy every 1 to 2 years with polypectomy of all polyps >5 mm or smaller polyps with appearance of adenoma/sessile serrated lesions by optical aspect. This may be personalised to yearly or 2-yearly depending on surveillance findingsr with annual colonoscopy only if certain types or numbers of polyps are found###
- Repeat colonoscopy may be advised if there is inadequate bowel preparation
- Unless contraindicated, aspirin should be actively considered to reduce the risk of CRC. A low dose (100-300 mg per day) is recommended for at least 2.5 years from age 50 years
# The impact of lifestyle on cancer risk should be discussed e.g. exercise regularly, maintain healthy weight, have a healthy diet, limit alcohol intake, do not smoke and avoid excessive sun exposure.
## All sessile serrated lesions (SSLs), traditional serrated adenomas (TSAs) and conventional adenomas, as well as all hyperplastic polyps (HPs) ≥5 mm in diameter.
### Annual colonoscopy if there are: >1 advanced serrated SP (TSA and/or >10 mm and/or containing dysplasia), >1 advanced adenoma (>10 mm and/or >25% villous histology), >5 SSLs irrespective of size and/or adenomas (irrespective of size) and/or HPs >5 mm.