Saturday, January 9, 2010

NCCN PJS Screening guidelines

You'll need to get your own copy of this article to follow this post. You'll need to register at NCCN (National Comprehensive Cancer Network) or Medscape. It's free and two of 69 pages are devoted to PJS. It would be a great resource to share with your doctor or genetic counselor.

Also available at
http://img.medscape .com/pi/editoria l/articlecme/ 2009/712885/ Colorectal_ Cancer_Screenin_ g_V.1.2010_ Medscape. pdf

The cancer risk estimates are based on this free medical journal article

Like most guidelines, upper endoscopy of the stomach and small bowel is suggested every 2 to 3 years beginning at age 10. Surprisingly the authors don't suggest capsule endoscopy or double balloon enteroscopy or single balloon enteroscopy. For small bowel imaging - CT enterography or small bowel enteroclysis are recommended every 2 to 3 years or with symptoms. (One of the authors told me that capsule endoscopy misses large polyps. Also, enterscopy is considered a treatment, not a screening modality.)

Colonoscopy is recommended every 2 to 3 years beginning in late teens.

Pancreas screening - magnetic resonance cholangiopancreatography and/or endoscopic ultrasound - at every 1 to 2 years beginning at age 30. They suggest the CA 19-9 blood test every 1 to 2 years after age 30.

For males - annual testicular exam and observation for feminizing changes beginning at age 10.

For females - annual mammogram and breast MRI. Every six months, clinical breast exam from age 25. Also for ovary, cervix and uterus - pelvic exam and pap smear annually, consider transvaginal ultrasound.

The risk of lung cancer in PJS people is 15-17% and though no specific recommendations have been made, health care professionals should provide information about symptoms and smoking cessation.

There is one important line about surveillance guidelines in PJS - Surveillance should begin at the approximate ages..., if symptoms have not already occurred and any early symptoms should be evaluated thoroughly.

A recent review from the Netherlands contains surveillance guidelines too. I hope to report on it soon.

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