| 8 9 | See page 67 for references · ·In patients with colectomy with ileorectal anastomosis, endoscopic evaluation of the rectum every 6-12 months, depending on polyp burden. · ·In patients with total proctocolectomy with ileal pouch, endoscopic evaluation of the ileal pouch or ileostomy every 1-3 years, depending on polyp burden. Extracolonic surveillance · ·Upper endoscopy (including complete visualization of ampulla of Vater) beginning at age 20–25. Consider baseline upper endoscopy earlier if a colectomy was performed before age 20. Stomach should also be examined at time of upper endoscopy. · ·Conduct annual thyroid exam beginning in the late teenage years. · ·Perform annual abdominal palpation to assess for intra-abdominal desmoids. · ·Consider abdominal MRI or CT within 1 to 3 years post-colectomy and then every 5 to 10 years in patients with a family history of symptomatic desmoids. · ·Consider adding small bowel visualization to CT or MRI for desmoids. · ·Annual physical exam is recommended. · ·Consider liver palpation, abdominal ultrasound, and measurement of AFP every 3 to 6 months during the first 5 years of life to screen for hepatoblastoma. Note: Screening in a clinical trial is preferred. Potential management options: attenuated FAP (AFAP) Colorectal cancer surveillance and surgical options for unaffected individuals · ·Perform colonoscopy every 2-3 years beginning in the late teenage years. · ·If polyps are identified, perform colonoscopy and polypectomy every 1-2 years. · ·If polyp burden can no longer be managed by polypectomy alone, discuss surgical options, including colectomy (see “Colorectal cancer surveillance and surgical options for affected individuals”). Colorectal cancer surveillance and surgical options for affected individuals · ·Colectomy should be performed once polyp burden can no longer be managed by polypectomy alone. In most cases, colectomy with ileorectal anastomosis is preferred, but total proctocolectomy with ileal pouch-anal anastomosis may be considered if rectal polyp burden cannot be managed. · ·In patients with colectomy with ileorectal anastomosis, endoscopic evaluation of the rectum every 6-12 months, depending on polyp burden is recommended. Extracolonic surveillance · ·Upper endoscopy (including complete visualization of ampulla of Vater) beginning at age 20–25. Consider baseline upper endoscopy earlier if colectomy was performed before age 20. · ·Conduct annual thyroid exam beginning in the late teenage years. · ·Annual physical exam is recommended. Potential management options: APC I1307K As discussed above, individuals with the I1307K variant may have a moderate risk for colon cancer but are not expected to develop classic or attenuated FAP. Management may include: · ·Colonoscopy every 5 years, beginning at age 40 or 10 years earlier than the age at which colorectal cancer is diagnosed in a first-degree relative.