Hereditary Cancer Syndromes > Lynch Syndrome MSH6
CANCER
GENETIC CANCER RISK
Colorectal
High Risk
Endometrial
High Risk
Gastric
Elevated Risk
Ovarian
Elevated Risk
Pancreatic
Elevated Risk
Prostate
Elevated Risk
Skin
Elevated Risk
Other
High Risk
CANCER TYPE
AGE RANGE
CANCER RISK
RISK FOR GENERAL POPULATION
Colorectal (male)
To age 70
22%-69%
2.0%
Endometrial
To age 70
16%-49%
1.9%
Overall cancer risk (Lynch cancers)
Risk for second Lynch-related cancer after a first cancer diagnosis
Increased risk
NA
Colorectal (female)
To age 70
10%-30%
1.5%
Prostate
To age 70
Possibly elevated risk
6.1%
Ovarian
To age 70
Up to 13%
0.6%
Gastric
To age 70
1%-10%
0.3%
Small Bowel
To age 70
Possibly elevated risk
0.1%
Urinary Tract
To age 70
3%-9%
0.7%
Pancreatic
To age 70
Possibly elevated risk
0.6%
Central Nervous System
To age 70
Up to 2%
0.4%
Hepatobiliary Tract
To age 70
Possibly elevated risk
0.5%
Sebaceous Neoplasms (Lynch-associated Skin Tumors)
To age 70
Elevated risk
<1.0%
CANCER TYPE
PROCEDURE
AGE TO BEGIN
FREQUENCY
Colorectal
Colonoscopy
30 to 35 years, or 2 to 5 years younger than the earliest colorectal cancer diagnosis in the family if it is under age 30
Every 1 to 2 years
Colorectal surgical evaluation may be appropriate for some patients
Individualized
NA
Consider the use of aspirin as a risk reduction agent
Individualized
Individualized
Endometrial
Patient education about the importance of quickly seeking attention for endometrial cancer symptoms, such as abnormal bleeding or menstrual cycle irregularities
Individualized
Individualized
Consider pelvic examination, endometrial sampling and transvaginal ultrasound.
30 to 35 years
Every 1 to 2 years
Consider hysterectomy.
After completion of childbearing
NA
Prostate
Currently there are no specific medical management guidelines for prostate cancer risk in mutation carriers. However, the possibility of an increased risk for prostate cancer can be incorporated into the risk and benefit discussion about offering screening with digital rectal examination (DRE) and Prostate Specific Antigen (PSA).
Age 40
Individualized, consider annually
Ovarian
Consider bilateral salpingo-oophorectomy.
Age 40 or after completion of childbearing
NA
Consider transvaginal ultrasound and CA-125 measurement.
30 to 35 years
NA
Consider options for ovarian cancer risk-reduction agents (i.e. oral contraceptives).
Individualized
NA
Patient education about ovarian cancer symptoms
Individualized
NA
Gastric
Consider testing and treating Helicobacter pylori infection.
Individualized
NA
Consider upper endoscopy, particularly for patients with additional risk factors for gastric cancer, such as family history or Asian ancestry. Consider biopsy of the antrum.
40 years
Every 3 to 5 years
Small Bowel
Consider upper endoscopy, particularly for patients with additional risk factors for small bowel cancer, such as family history.
30 to 40 years
Every 3 to 5 years
Urinary Tract
30 to 35 years
Annually
Pancreatic
For patients with a family history of pancreatic cancer, consider available options for pancreatic cancer screening, including the possibility of endoscopic ultrasonography (EUS) and MRI/magnetic resonance cholangiopancreatography (MRCP). It is recommended that patients who are candidates for pancreatic cancer screening be managed by a multidisciplinary team with experience in screening for pancreatic cancer, preferably within research protocols.
45 to 50 years, or 10 years younger than the earliest diagnosis of pancreatic cancer in the family
Annually
Provide education about ways to reduce pancreatic cancer risk, such as not smoking and losing weight.
Individualized
Individualized
Central Nervous System
Patient education about the importance of quickly seeking attention for signs and symptoms of neurologic cancer
Individualized
NA
Hepatobiliary Tract
Currently there are no specific medical management guidelines for hepatobiliary cancer risk in mutation carriers.
NA
NA
Sebaceous Neoplasms (Lynch-associated Skin Tumors)
Consider skin exams
Individualized
Every 1 to 2 years
For Patients With A Cancer Diagnosis
For patients with a gene mutation and a diagnosis of cancer, targeted therapies may be available as a treatment option for certain tumor types (e.g., antibodies to PD-1)
NA
NA