Reviewed on : 16 Dec 2019

Reviewed by : Phil Baragwanath Consultant Colorectal Surgeon UHCW

Expires : 16 Dec 2021

Family history of bowel cancer

Bowel cancer is one of the commonest malignancies in both men and women.

Mostly it occurs due to exposure to dietary and environmental carcinogens, often associated with a western diet or a diet high in red meat.

Some patients have a genetic predisposition. This will often become apparent by the young age of the patient at presentation or by a suggestive family history (FH). Increasingly, genetic analysis can confirm or refute an inherited predisposition to bowel cancer.

The following patients should be referred to the colorectal team for further assessment. We will then decide if referral to the Clinical Genetics Unit at QEH Birmingham is required.

• 1^st degree relative (parent, brother, sister or child) with bowel cancer one being under 50 when diagnosed.
• Two or more first degree relatives with bowel cancer at any age.
• One or more relatives with a known genetic (inherited) condition linked to bowel cancer, such as Lynch syndrome, Familial Adenomatous Polyposis FAP or MUTYH (MYH) associated polyposis MAP.

People with only one affected relative and who do not fulfil any of the above criteria should be reassured and encouraged to engage in population-based screening.

Management

Patients suitable for referral will be seen in the OPD and a detailed FH will be taken.

Strong FH patients will be referred to the Clinical Genetics Unit at the QEH for further assessment.

Patients with a FH not strong enough for genetic assessment may be offered surveillance with colonoscopy, the frequency depending on the strength of the FH:

• Index colonoscopy 5-10years before the youngest index case in the FH
• One off colonoscopy aged 55
• Ongoing 5yearly colonoscopy from age 50-75