Programa de vigilância em famílias com Síndroma de Lynch – a eficácia da medicina preventiva

S. Mão de Ferro*, P. Lage*, A. Suspiro*, J. Pereira da Silva*, I. Claro*, P. Fidalgo*, P. Rodrigues*, B. Filipe**, I. Francisco**, P. Chaves**, C. Albuquerque***, C. Nobre Leitão*

  

Resumo

Introdução: A Sindroma de Lynch (SL) confere um elevado risco de desenvolvimento de cancro do cólon e recto (CCR). A vigilância é eficaz na prevenção do CCR em indivíduos em risco.

Objectivos: Avaliar o impacto da colonoscopia na detecção de lesões em indivíduos pertencentes a famílias com SL.

Materiais e Métodos: 165 indivíduos assintomáticos, submetidos a vigilância, de acordo com os grupos: GI- Mutação para SL (n=33), GII- Critérios de Amesterdão (n=95), GIII- Critérios de Amesterdão excepto idade (n=37). Programada colonoscopia anual para GI e bienal para GII e GIII.

Resultados: No primeiro exame foram detectados adenomas em 28 (15,8%) indivíduos. A detecção de adenomas foi apenas influenciada pela idade (p=0,02). As lesões localizaram-se mais frequentemente no cólon direito em GI e GII (p=0,05). Diagnosticaram-se CCR em 7 (4,2%) indivíduos (GI-3, GII-3, GIII-1, idade=45, 31-71 anos), 5 localizados à direita, 4 T1N0M0, 2 T3N0M0, 1 T3N2M1. Efectuaram-se 123 exames de vigilância (77 indivíduos). Detectaram-se adenomas em 13 (23,4%) indivíduos. Não houve CCR de intervalo nem nos exames de vigilância.

Conclusões: Indivíduos com SL apresentaram uma elevada prevalência e incidência de adenomas e CCR, em idades jovens. A ausência do critério de idade não parece determinante para o tipo de vigilância a implementar.

 

Summary

Introduction: Hereditary non-polyposys colorectal cancer (HNPCC) syndrome confers a high risk of colorectal cancer (CRC) development. Colonoscopic surveillance is effective in preventing mortality from CRC.

Aims: To evaluate the incidence and prevalence of colorectal tumours in asymptomatic individuals with HNPCC who undergo screening colonoscopies.

Methods: 165 asymptomatic individuals divided in 3 groups. GI- MMR mutation (n=33), GII- Amsterdam Criteria (n=95), GIII- Amsterdam criteria except for older age at onset (n=35). Surveillance was performed annually for GI and every 2 years for GII and GIII.

Results: In the first colonoscopy we detected adenomas in 26 (15.8%) patients. Adenoma detection was associated only with older age (p=0.02). Patients from GI and GII were more likely to have proximal lesions (p=0.05). Seven (4.2%) patients had CRC (G1=3, GII=3, GIII=1; mean age: 45 years – range: 31-71): four T1N0M0, two T3N0M0 and one T3N2M1. Seventy-seven individuals had follow-up colonoscopies. We detected adenomas in 13 (23.4%) patients – an incidence of 0.13 adenomas/individual/year. No CRC was detected at follow up, nor did interval cancers occur.

Conclusions: Asymptomatic individuals with a family history of CRC present a high incidence and prevalence and a young onset of colorectal tumours. Families that do not fulfil the Amsterdam criteria due to late age at onset seem to benefit from the same surveillance that is applied to patients with HNPCC.

 

 

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Correspondência:

Susana Mão de Ferro

Serviço de Gastrenterologia - IPOLFG.EPE,

R. Prof Lima Basto 1500 - Lisboa

Tel.: 217200422

e-mail: smaodeferro@gmail.com

 

(*) Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal.

(**) Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal.

(***) Centro de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal.

 

 

Recebido para publicação: 11/05/2006

Aceite para publicação: 17/10/2006