title: Diagnostic approach and management of Lynch syndrome (hereditary nonpolyposis colorectal carcinoma): a guide for clinicians.
abstract: ABSTRACT diagnostic workup of familial colorectal cancer is an elaborate and time consuming process in which the family and several medical specialists closely collaborate. However, establishing a diagnosis can be very rewarding. If a mutation is detected in the family, a satisfactory explanation can be provided for an accumulation of tumors at young age, and often of untimely death. Appropriate presymptomatic testing can be offered to reduce mortality among at-risk family members, and relatives not at risk can avoid uncertainty and needlessly intensive surveillance. We show the differential diagnostic considerations when an individual with a family history of colorectal carcinoma is encountered, with emphasis on Lynch syndrome (Hereditary Nonpolyposis Colorectal Carcinoma [HNPCC]). Practical recommendations for laboratory workup of suspected Lynch syndrome, including analysis of tumor tissue by microsatellite instability analysis and immunohistochemistry, and germline DNA analysis are given. Furthermore, the clinical management after a molecular diagnosis has been made is described. The diagnostic scheme presented here allows efficient and effective analysis of colorectal carcinoma cases with (suspected) Lynch syndrome, making optimal use of currently available technology.
authors.affiliation: Center of Human and Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Yvonne M C
authors.initials: YM
authors.lastname: Hendriks
authors.forename: Andrea E
authors.initials: AE
authors.lastname: de Jong
authors.forename: Hans
authors.initials: H
authors.lastname: Morreau
authors.forename: Carli M J
authors.initials: CM
authors.lastname: Tops
authors.forename: Hans F
authors.initials: HF
authors.lastname: Vasen
authors.forename: Juul Th
authors.initials: JT
authors.lastname: Wijnen
authors.forename: Martijn H
authors.initials: MH
authors.lastname: Breuning
authors.forename: Annette H J T
authors.initials: AH
authors.lastname: Bröcker-Vriends
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics; D005808:Genes, Recessive; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D006801:Humans; D008487:Medical History Taking; D009154:Mutation; D010375:Pedigree; D010641:Phenotype; D018570:Risk Assessment