Table 2.

Gynecologic cancer screening and surveillance guidelines for LS (6)

Endometrial cancer:
Women should be educated about the reporting of any abnormal uterine bleeding, which could include further evaluation through endometrial biopsy.
Hysterectomy is a risk-reducing option to be considered because it can reduce the incidence of endometrial cancer. Depending on whether childbearing is complete, comorbidities, family history, and LS gene mutation, the timing of a hysterectomy should be an individualized discussion.
Endometrial biopsy every 1–2 years can be considered as a diagnostic tool for women with LS.
Transvaginal ultrasound is not recommended as a screening tool for premenopausal women, but may be used for postmenopausal women at the clinician's discretion.
Ovarian cancer:
The incidence of ovarian cancer can be reduced by a bilateral salpingo-oophorectomy, but it is a an individual risk-reducing option for women who have completed childbearing, comorbidities, family history, LS gene mutation, or menopause status. There is insufficient evidence for MSH6 and PMS2 mutation carriers having a risk-reducing salpingo-oophorectomry.
There is currently no effective screening for ovarian cancer, but education of women on known symptoms including pelvic or abdominal pain, bloating, increased abdominal size, or urinary frequency or urgency over a period of week and/or a change necessitates a prompt evaluation by a doctor.
While screening can be helpful on an individual basis, there is no support for routine ovarian cancer screening for LS women. Transvaginal ultrasound is not sensitive or specific as a screening tool and should be used at the clinician's discretion.
Reproductive options:
For women patients of reproductive age with LS, prenatal diagnosis and assisted reproduction including preimplantation genetic diagnosis should be considered options.
  • Abbreviation: LS, Lynch syndrome.