digestive disorders
Familial Adenomatous Polyposis
Treatment of Familial Adenomatous Polyposis
Surgical removal of the colon and sometimes the rectum Possibly nonsteroidal anti-inflammatory drugs (NSAIDs) Because nearly all people with familial adenomatous polyposis develop cancer, doctors typically recommend surgery be done soon after the diagnosis is made. There are several procedures. Complete removal of the large intestine and rectum (called total colectomy or proctocolectomy) eliminates the risk of cancer. Because the person then has no rectum, the cut-off end of the small intestine is permanently attached to a surgical opening in the abdominal wall (ileostomy). Bodily wastes (stool) are eliminated through the ileostomy into a disposable bag. As an alternative to ileostomy, sometimes doctors can remove the large intestine and only the lining of the rectum (polyps grow from the lining). Then, they can form the end of the small intestine into a pouch that is connected to the anus. The pouch functions somewhat like a rectum, eliminating the need for an ileostomy. As another alternative to ileostomy, only the large intestine is removed and the rectum is joined to the small intestine. This procedure does not eliminate the possibility of rectal polyps developing, which could then turn into cancer. Thus the remaining part of the rectum must be inspected by sigmoidoscopy frequently, so that new polyps can be removed. If new polyps appear too rapidly, however, the rectum must also be removed and a pouch or ileostomy is needed. After people have their entire rectum and large intestine removed, they should have an endoscopy of the stomach and upper section of the small intestine (duodenum) at regular intervals to look for cancer. Doctors may also recommend people have their thyroid screened every year. Some NSAIDs are being studied for their ability to reverse the growth of polyps in people with familial adenomatous polyposis and in people with polyps or cancer of the large intestine. Their effects are temporary, however, and once these drugs are stopped, the polyps begin to grow again. 