lynch Syndrome Surveillance

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Advanced MCQ – Lynch Syndrome Surveillance
A 32-year-old woman is diagnosed with Lynch syndrome after genetic testing reveals a pathogenic MSH6 mutation. She has completed childbearing and asks about her cancer risks and recommended surveillance strategy. Which statement is MOST accurate?
  • A. Her lifetime CRC risk exceeds 60%
  • B. Annual colonoscopy beginning at age 40 is appropriate
  • C. Annual transvaginal ultrasound with endometrial biopsy should be considered starting at age 30–35
  • D. Prophylactic hysterectomy is not recommended
  • E. EPCAM mutations do not require colonoscopic surveillance
Correct Answer: C

Explanation:
• Annual colonoscopy begins at age 20–25 in Lynch syndrome.
• Endometrial cancer screening (TVUS + biopsy) starts at age 30–35.
• Prophylactic hysterectomy should be discussed after completion of childbearing.
• EPCAM deletions silence MSH2 and follow MSH2 surveillance guidelines.
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