Gynecologic cancer as a "sentinel cancer" for women with hereditary nonpolyposis colorectal cancer syndrome.
OBJECTIVE
Women with hereditary nonpolyposis colorectal cancer syndrome have a 40-60% lifetime risk for colon cancer, a 40-60% lifetime risk for endometrial cancer, and a 12% lifetime risk for ovarian cancer. A number of women with hereditary nonpolyposis colorectal cancer syndrome will have more than one cancer in their lifetime. The purpose of this study was to estimate whether women with hereditary nonpolyposis colorectal cancer syndrome who develop 2 primary cancers present with gynecologic or colon cancer as their "sentinel cancer."


METHODS
Women whose families fulfilled Amsterdam criteria for hereditary nonpolyposis colorectal cancer syndrome and who developed 2 primary colorectal/gynecologic cancers in their lifetime were identified from 5 large hereditary nonpolyposis colorectal cancer syndrome registries. Information on age at cancer diagnoses and which cancer (colon cancer or endometrial cancer/ovarian cancer) developed first was obtained.


RESULTS
A total of 117 women with dual primary cancers from 223 Amsterdam families were identified. In 16 women, colon cancer and endometrial cancer/ovarian cancer were diagnosed simultaneously. Of the remaining 101 women, 52 (51%) women had an endometrial or ovarian cancer diagnosed first. Forty-nine (49%) women had a colon cancer diagnosed first. For women who developed endometrial cancer/ovarian cancer first, mean age at diagnosis of endometrial cancer/ovarian cancer was 44. For women who developed colon cancer first, the mean age at diagnosis of colon cancer was 40.


CONCLUSIONS
In this large series of women with hereditary nonpolyposis colorectal cancer syndrome who developed 2 primary colorectal/gynecologic cancers, endometrial cancer/ovarian cancer was the "sentinel cancer," preceding the development of colon cancer, in half of the cases. Therefore, gynecologists and gynecologic oncologists play a pivotal role in the identification of women with hereditary nonpolyposis colorectal cancer syndrome.
Lu
Karen H
KH
Department of Gynecologic Oncology, Division of Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. khlu@mdanderson.org
Dinh
Mai
M
Kohlmann
Wendy
W
Watson
Patrice
P
Green
Jane
J
Syngal
Sapna
S
Bandipalliam
Prathap
P
Chen
Lee-May
LM
Allen
Brian
B
Conrad
Peggy
P
Terdiman
Jonathan
J
Sun
Charlotte
C
Daniels
Molly
M
Burke
Thomas
T
Gershenson
David M
DM
Lynch
Henry
H
Lynch
Patrick
P
Broaddus
Russell R
RR
D000328:Adult; D000368:Aged; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis*; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D013997:Time Factors