The choice of risk management strategy should take into account current age, other health issues and age-related cancer risk. Risks and benefits of interventions should be discussed with an experienced medical professional.
The impact of lifestyle on cancer risk should be discussed e.g. exercise most days for at least 30 minutes at moderate or strenuous intensity, maintain healthy weight, have a healthy diet, limit alcohol intake, do not smoke and avoid excessive sun exposure.
Cancer/tumour type |
Recommendations |
Colorectal cancer (CRC) |
Surgical |
- 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
|
Surveillance |
- 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
|
Risk-reducing medication |
- 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
|
## 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.