Posted by Kate Murphy on April 6th, 2007
People with inherited familial adenomatous polyposis (FAP) develop hundreds of polyps in their colons and, without intervention, one hundred percent of them will eventually develop colon or rectal cancer. In addition to colon cancer, they are at risk for cancers and benign tumors outside the intestinal tract including thyroid cancer.
In an attempt to find out how common thyroid cancer was among FAP patients, researchers at Massachusetts General Hospital reviewed charts of over 50 patients who had been diagnosed with FAP at that hospital. Six women (12%) also had thyroid cancer. Their cancers were found at an average age of 33 with an average tumor size of 12 millimeters.
However, all had additional malignant spots in their thyroids smaller than 9 millimeters, and none were evident on ultrasound examination.
Twenty-two (79 percent) of 28 patients who had screening ultrasound had small nodules in their thyroids, almost all had several. Two screened patients had thyroid cancer.
Maite Herraiz from the Thyroid Unit at Massachusetts General Hospital and the research team write in the Journal of Clinical Gastroenterology and Hepatology:
The 12% prevalence of thyroid cancer in this series of FAP patients is significantly higher than in previous reports. Among patients undergoing screening ultrasound, 7% had thyroid cancer. Nodular thyroid disease is very common in FAP. Because small nodules (<9 mm) might also be malignant, close follow-up with ultrasound and fine-needle aspiration might be warranted.
Familial adenomatous polyposis or FAP is inherited directly from parent to child. It is caused by a mutation in the APC tumor suppressor gene allowing cells to grow unchecked. FAP patients develop hundreds and sometimes thousands of small precancerous polyps in the intestinal tract, usually at an early age. Not only are these individuals at inevitable risk for colorectal cancer, they also risk other cancers.
Children and teens whose parents have FAP should be tested early for the gene and watched carefully for the polyps and cancers. Usually their colons are removed in adolescence or early adulthood, but they remain at risk for cancers outside of the colon and need careful follow-up.
SOURCE: Herraiz et. al., Clinical Gastroenterology and Hepatology, Volume 5, Issue 3, March 2007, Pages 367-374.