Upper Digestive Tract and Small Bowel

As mentioned before, adenomas can also develop in the upper digestive tract and the general risk of an adenocarcinoma developing in these sites is 300 times higher than in the general population. Surveillance should start very early in life at 20 years, and full endoscopic examination has to be performed at an interval of 6 months to 1 year, depending on the amount of polyposis. Exams should be performed with forward and side-view instruments in an attempt to enhance the diagnostic power, and with a liberal use of endoscopic staining.

The Spiegelman's classification has defined four stages according to the number of polyps, size, histological pattern (tubular or villous) and degree of dysplasia [15]. The presence of multiple small adenomas is not an indication for therapy, but the development of invasive cancer in the submucosa indicates a clear need for surgical resection. Because of the variety of clinical patterns of the disease, which causes over 500 000 deaths annually all over the world, looking at FAP is like looking in a kaleidoscope. The key to the problem is to better understand the complex mechanisms that promote colon carcinogenesis so that we can better target the diagnostic and therapeutic protocols.

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