Mecklin Jukka-Pekka, Järvinen Heikki J
Department of Surgery, Jyväskylä Central Hospital, 40620, Jyväskylä, Finland.
Fam Cancer. 2005;4(3):267-71. doi: 10.1007/s10689-005-1475-x.
The major aim of surveillance in Lynch syndrome is to diagnose malignant or premalignant lesions at the asymptomatic stage by regular checkups, particularly in the large bowel. Therefore, screening for colorectal adenomas and carcinomas by regular colonoscopies is the main topic of the present review. However, it should be remembered, that primary prevention - whether through the use of chemoprevention or the promotion of a healthy life-style may form a significant part of such surveillance in the future. Observational studies indicate that the adenoma carcinoma sequence is the main pathway in the development of colorectal cancer in Lynch syndrome. A colonoscopy every 1-3 years starting at age 20 to 25 years and the removal of observed adenomas is recommended for individuals known to have Lynch syndrome associated mutations. The incidence of colorectal cancer in family branches screened this way is lower than that in past unscreened generations. The screening of other malignancies associated with Lynch syndrome is more complex. Screening for endometrial cancer has recommended previously, but no benefits have been shown in recent studies. The value of screening for other extracolonic cancers remains also uncertain.
林奇综合征监测的主要目的是通过定期检查在无症状阶段诊断恶性或癌前病变，尤其是在大肠。因此，通过定期结肠镜检查筛查结直肠腺瘤和癌是本综述的主要主题。然而，应该记住，一级预防——无论是通过化学预防还是促进健康的生活方式——在未来可能会成为这种监测的重要组成部分。观察性研究表明，腺瘤-癌序列是林奇综合征中结直肠癌发生的主要途径。对于已知有林奇综合征相关突变的个体，建议从20至25岁开始每1至3年进行一次结肠镜检查，并切除观察到的腺瘤。以这种方式筛查的家族分支中结直肠癌的发病率低于过去未筛查的几代人。与林奇综合征相关的其他恶性肿瘤的筛查更为复杂。以前曾建议筛查子宫内膜癌，但最近的研究未显示出益处。筛查其他结肠外癌症的价值也仍然不确定。
