Hereditary colorectal cancer and polyposis syndromes

Colorectal cancer (CRC) is the second leading cause of death in the United States, with approximately 10–30 % of patients having a positive family history. Lynch syndrome is the most common inherited CRC accounting for approximately 5–10 % of all CRC cases. Familial adenomatous polyposis (FAP) is the next common, accounting for approximately 1 % of all CRC cases. Other polyposis syndromes include attenuated FAP (aFAP), MYH-associated polyposis (MAP), Peutz–Jeghers syndrome (PJS), and juvenile polyposis syndrome (JPS). Each of these polyposis syndromes confers with it a higher lifetime risk of development of CRC due to their unique genetic mutations, necessitating early surveillance protocols and possible prophylactic surgical intervention. Extracolonic manifestations and cancer risks are also increased, emphasizing vigilance and early recognition of these anomalies. Preclinical trials have shown clear benefit in NSAIDS and COX inhibitors to exert their effects against all clinical stages of colorectal neoplasia. However, trials for deducing the specific aspects of adenoma reduction are still ongoing, especially in high-risk individuals with FAP and Lynch syndrome.