What should be done after hereditary bowel cancer is confirmed? If you are diagnosed with hereditary bowel cancer, you do not need to worry too much because the prognosis of colorectal cancer is relatively good as long as it is detected early and receives regular treatment. Unlike disseminated colorectal cancer, the treatment of hereditary colorectal cancer includes two aspects: treatment for patients themselves and screening for relatives. Familial adenomatous polyposis 1. Patient treatment: For patients with familial adenomatous polyposis without cancer, the main purpose of treatment is to prevent the occurrence of colorectal cancer, and treatment methods include endoscopic polypectomy and prophylactic colectomy. Although surgical resection is the standard treatment for patients with typical familial adenomatous polyposis, it can be disruptive to the patient’s life after all, so endoscopic polypectomy may be considered for some patients with milder forms of the disease. How many patients need to undergo surgical removal between the ages of 15 and 25. However, if the polyps are not detected and operated in time and have become cancerous or even spread and metastasized, then they need to receive standard treatment such as surgery, chemotherapy and radiotherapy depending on the situation. 2.Relatives screening: It is recommended that relatives perform APC gene mutation testing. If there is an APC gene mutation, then the colonoscopy should be started at the age of 12 to 14 years, every 2 years, and continued throughout life. For family members who are not found to have an APC mutation but are at risk, they should be monitored every 2 years until age 40, and between age 40 and 50, every 3 to 5 years, and if polyposis does not occur, testing can be stopped at age 50. Once adenoma is detected, colonoscopy should be done once a year, and treatment and monitoring should be done as directed by the physician. Lynch syndrome 1. Patient treatment: There is no evidence to support prophylactic colectomy for healthy mutation carriers. However, in order to reduce the risk of endometrial cancer as well as ovarian cancer, prophylactic hysterectomy and/or oophorectomy may be considered for female patients with Lynch syndrome who are over 35 years of age and do not have fertility requirements. The treatment of patients with Lynch syndrome also relies mainly on a comprehensive treatment consisting of surgery, chemotherapy, radiotherapy and other treatments, only that the choice of chemotherapy regimen is slightly different from that of disseminated bowel cancer. 2. Relative screening: It is recommended that relatives begin colonoscopy at the age of 2025 and be reexamined every one to two years. No specific upper limit is determined, and the upper limit should be based on the health status of the individual. Screening for endometrial and ovarian cancers can be done annually starting at age 3035 by gynecologic examination, pelvic ultrasound, CA125 testing and aspiration biopsy. When monitoring for gastric cancer, screening for the presence of H. pylori and removal of these bacteria is recommended for mutation carriers. For certain groups with a high incidence of gastric cancer, some experts recommend upper gastrointestinal endoscopy every 1 to 3 years. Surveillance for other Lynch-related cancers is not currently recommended because of the low sensitivity and specificity of the surveillance tools. What is the prognosis for hereditary bowel cancer? The data are controversial as to which group of patients has a better prognosis, hereditary or disseminated colorectal cancer. Some studies suggest that hereditary colorectal cancer has a relatively good prognosis, but most opinions suggest that both have a similar prognosis and that hereditary colorectal cancer appears to have a better prognosis, but there is no statistical difference. In patients with familial adenomatous polyposis, although nonsteroidal anti-inflammatory drugs (aspirin, etc.) have been found to reduce the number and narrow the extent of colorectal adenomas, they do not delay the onset and progression of the disease, so currently nonsteroidal anti-inflammatory drugs (sulforaphane and celecoxib) are only used cautiously as adjuvant therapy when adenoma recurrence is detected after surgery.