Preventive Treatment for People at High Risk for Colorectal Cancer

For people who have or are suspected to have a genetic colorectal cancer syndrome, specialists at NYU Langone’s Perlmutter Cancer Center can guide you and your family members through risk assessment, screening, diagnosis, treatment, and beyond.

For those who have been diagnosed with IBD, our gastroenterologists, who specialize in the diagnosis and treatment of the condition, can provide the most effective treatment options, colonoscopy screening, and monitoring to reduce colorectal cancer risk.

We have highly specialized experts in gastroenterology, genetic counseling, genetic testing, surgery, gynecology, oncology, psychosocial support, and other areas of care. These experts can provide you with the information, treatment, careful monitoring, support, and assistance you need, and can help you make decisions about your care.

A small percentage of people are at high risk of developing colorectal cancer due to rare genetic syndromes, such as familial adenomatous polyposis, also called FAP, or hereditary non-polyposis colorectal cancer syndrome, also called HNPCC, or Lynch syndrome.

People who have a personal or family history of colorectal cancer, endometrial cancer, or ovarian cancer, as well as some other cancers, may want to speak with their doctors about being assessed for these genetic diseases.

Our genetic counselors, doctors, and other specialists are available to help assess your risk and provide genetic testing. Knowing you have one of these conditions is useful not only to help determine the most effective preventive and treatment options, but also to determine the appropriate risk and preventive strategies for your children and other family members.

Familial Adenomatous Polyposis

In people with FAP, many small precancerous growths called polyps, or adenomas, develop throughout the colon. People with FAP have nearly a 100 percent chance of developing colorectal cancer and need to start screening with colonoscopy and other testing as children. To prevent cancer, they often have their colons removed as teenagers or young adults.

Lynch Syndrome

In Lynch syndrome, or HNPCC, people may develop polyps at a young age. People with this condition may have up to an 80 percent chance of developing colorectal cancer over a lifetime and a significantly increased risk of developing other cancers, such as endometrial, ovarian, stomach, upper urinary tract, brain, and skin.

People with HNPCC should have a colonoscopy and other cancer screenings starting at a young age and on a frequent basis. They and their doctors should discuss their preventive and treatment options, including the possibility of removing the colon to prevent cancer.

Our doctors recommend that people with a strong family history of colorectal cancer or related cancers should see a genetic counselor for assessment and, if needed, genetic testing.

Individuals who have inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, are considered to be at high risk for colorectal cancer, especially if they have had the disease for several years.

For this reason, people with IBD need to be under the care of a gastroenterologist who specializes in IBD to ensure accurate diagnosis, effective treatment, and careful monitoring.

In addition, people with IBD need to have frequent colonoscopy screening so a doctor can examine the colon and take biopsies of the affected tissue. Our IBD specialists provide careful screening and monitoring of people who are affected by this chronic and complex condition.

Our experts work in partnership with those who are at high risk for colorectal cancer to help make decisions about treatment options and medical and surgical strategies to reduce the risk of cancer. Our doctors can help determine which treatments are right for you.

Medications

Some studies have shown that medications such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and cox-2 inhibitors may reduce the risk of polyps or colorectal cancer in some people at high risk for colorectal cancer, such as those with IBD.

However, aspirin, NSAIDs, and cox-2 inhibitors can cause gastrointestinal bleeding, so it is important to talk with your doctor about whether these medications are safe for you to use. This approach is not a replacement for other preventive care and therapies.

Surgery

People with familial adenomatous polyposis or Lynch syndrome may choose to have surgery to remove the entire colon—a procedure called a total colectomy—to help prevent colon cancer.

Your doctor may also recommend removing the rectum if he or she is concerned about polyp growths there. This procedure is called a total proctocolectomy. It may require a temporary or permanent ileostomy, in which an opening called a stoma is created in the abdomen. The stoma allows waste to exit the body and collect in a pouch called an ostomy bag. Our nurses and doctors can help you learn how to care for the stoma and adapt to using an ostomy pouch.

Our surgeons may use open surgery to perform the total colectomy or minimally invasive approaches, such as laparoscopic surgery and robotic surgery, which involve making small incisions to improve recovery time. General anesthesia is required.

Open Surgery

While the majority of colorectal cancer surgeries at Perlmutter Cancer Center are minimally invasive, conventional open surgery, in which doctors make an incision in the abdomen, is sometimes necessary. Open surgery may be used in people who have had multiple operations or who have large tumors. Our surgeons are highly skilled in all approaches and can determine the safest and most effective approach for you.

The usual length of a hospital stay after an open total colectomy is less than a week. If an ostomy is part of the surgery, you may learn to care for the bag and stoma during that time.

Laparoscopic Surgery

With laparoscopic surgery, the surgeon makes several small incisions in the abdomen. A laparoscope, or a tube with a tiny camera at the tip, is inserted through one of the incisions. The camera allows excellent visualization of the colon and the surrounding organs. The doctor then inserts small surgical tools through the remaining incisions to perform the operation.

Laparoscopic surgery can reduce recovery time and cause less scarring than open surgery.

Robotic-Assisted Surgery

Doctors at NYU Langone’s Robotic Surgery Center use a surgical system to perform a total colectomy. This system consists of tiny surgical instruments mounted on several robotic arms. An additional arm contains a camera that generates magnified, high-definition, three-dimensional images on a computer screen, which helps guide the surgeon during the operation.

The surgical instruments and camera are inserted through small incisions in the abdomen. The surgeon controls these instruments and the camera from a console in the operating room.

Robotic surgery provides doctors with enhanced visibility of the colon and the surrounding organs and improves their ability to perform certain procedures. Like laparoscopic procedures, this approach may result in less scarring and recovery time than open surgery.