• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
The Genome
CMECNE

Ovarian or Endometrial Cancer? Consider Lynch Syndrome

image_pdfFavoriteLoadingFavorite

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Discuss the relevance of Lynch syndrome in the management of women with personal or family history of ovarian syndrome
2. Recall which cancers may be associated with Lynch syndrome

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Lynch syndrome, which has been previously referred to as hereditary non-polyposis colorectal cancer syndrome (HNPCC), increases gynecologic cancer risks namely endometrial, ovarian, and urothelial cancers in addition to colorectal and other associated cancers (gastric or small bowel cancers), glioblastoma, pancreatic or biliary tract cancer, and sebaceous adenocarcinoma. 

Lynch syndrome should be considered in women with personal and/or family histories with features such as

  • Personal history of colorectal cancer
    • < age 50 or
    • ≥ age 50 with a 1st degree relative (parent, child or sibling) also having a diagnosis of colorectal cancer or endometrial cancer
  • Women with multiple colorectal cancers or colorectal cancer and endometrial cancer
    • Level of suspicion should also be increased if other Lynch syndrome associated cancers are diagnosed in the patient and close relatives
  • Colorectal or endometrial cancer tumor profiles that demonstrate deficient mismatch repair, or microsatellite instability (MSI)
    • Genes implicated in Lynch syndrome are known as mismatch repair (MMR) genes
  • Women who report a known gene mutation predisposing to cancer in the family
    • Confirm the gene(s) tested and mutation(s) identified

Note: NCCN recommends referral to a genetics service to discuss multi-gene panel testing for anyone with a colorectal cancer diagnosis <50 | Based on emerging data, they also note that genetic testing may be considered for anyone with CRC diagnosed at any age

Lynch Syndrome is Included in ACMG List of ‘Secondary Findings’

  • Because medical interventions can prevent severe morbidity and mortality, Lynch syndrome is on the ACMG list of ‘secondary’ findings
  • In summary, the ACMG document on reporting such findings makes the following recommendations
    • In the course of genetic testing for research or clinical care, the laboratory may identify variants in genes unrelated to the initial indication for testing, but nevertheless may have important health implications
    • Results of such ‘secondary findings’ should be communicated to the individuals who may benefit from this knowledge
    • An individual can ‘opt out’ of receiving ‘secondary findings’
    • ACMG secondary findings recommend reporting out known or expected pathogenic variants in the following MMR genes: MLH1, MSH2, MSH6, and PMS2

SYNOPSIS:

Lynch syndrome is inherited in an autosomal dominant fashion, however because of variable expressivity and reduced penetrance, the patient’s personal and family history must be carefully assessed. It is important to note earlier ages of onset and multiple cancers that may suggest Lynch syndrome or another hereditary cancer syndrome. It is critical that those at high risk be identified and referred for genetic counseling. Genetic counseling will allow for discussion of appropriate genetic testing, cancer screening and risk reduction options.

KEY POINTS:

  • When reviewing the family health history, remember that both the maternal and paternal family histories should both be carefully considered
  • Lynch syndrome greatly increases lifetime risk for:
    • Ovarian cancer: 4-24%
      • Average lifetime risk in general population: 1.31%
    • Endometrial cancer: 25-60%
      • Average lifetime risk in general population: 2.78%
    • Colon cancer: 52–82%
      • Average lifetime risk in general population: 4.35% (females), 4.69% (males)
  • In the case of ovarian cancer, do not automatically assume BRCA1 or BRCA2 – consider Lynch syndrome and assess for additional clues such as other associated cancers
    • ACOG does address multigene panels and finds that “Genetic testing may be performed using a panel of multiple genes through next-generation sequencing technology”
    • Heritable cancer syndromes may overlap such that a strong family history for ovarian cancer may be the result of a pathogenic variant in BRCA1/2 or genes associated with Lynch Syndrome
  • The prospect of hereditary cancer risk can be anxiety provoking for the patient and family members, so it is important to reinforce the importance of information in allowing options for risk reduction and early cancer detection for those at highest risk

Learn more – Primary Sources:

ACMG and NSGC Joint Practice Guidelines: Referral Indications for Cancer Predisposition Assessment

Genetics, diagnosis and treatment of Lynch syndrome: Old lessons and current challenges

ACOG and SGO Joint Practice Bulletin 147: Lynch Syndrome (link through SGO.org)

GeneReviews: Lynch Syndrome (Synonyms: HNPCC, Hereditary Non-Polyposis Colon Cancer)

Lynch syndrome in the 21st century: clinical perspectives

Treatment of epithelial ovarian cancer | The BMJ

ACMG ACT Sheet: Colon Cancer (Asymptomatic)

NIH Medline Plus: Lynch syndrome

ACOG Committee Opinion No. 793: Hereditary Cancer Syndromes and Risk Assessment

NCCN: Genetic/Familial High-Risk Assessment: Colorectal 

MLH1: OMIM

MSH2:  OMIM

MSH6: OMIM

PMS2: OMIM

Locate a genetic counselor or genetics services:

Genetic Services Locator-ACMG

Genetic Services Locator-NSGC

Genetic Services Locator-CAGC

Locate a GYN Oncology Specialist:

Gyn Oncology Locator – SGO

Take a post-test and get CME credits

TAKE THE POST TEST

image_pdfFavoriteLoadingFavorite

< Previous
All The Genome Posts
Next >

Related ObG Topics:

Endometrial Cancer: Beyond The Basics
Screening for Ovarian Cancer – Fantasy or Reality?
Genetic Counseling: Who to Refer and What They Should Expect
What Do You Really Need to Know About Your Patient’s Family History?
Endometrial Hyperplasia – Current Nomenclature and Treatment
Should Women with Endometrial Cancer Receive Universal Screening for Lynch Syndrome?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site