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Hereditary Cancer in Clinical Practice

Open Access

Controlling the disease in MYH-associated polyposis

  • Lisa LaGuardia1Email author,
  • Margaret O’Malley1,
  • Carol Burke1,
  • Matthew Kalady1 and
  • James Church1
Hereditary Cancer in Clinical Practice20119(Suppl 1):P19

Published: 10 March 2011


Colorectal CancerRectal CancerColorectal AdenomaIleorectal AnastomosisSurveillance Colonoscopy


MYH-Associated Polyposis (MAP) is an autosomal recessive condition caused by bi-allelic mutations in MYH. Individuals with MAP tend to develop numerous polyps in their colon and rectum and have an increased risk of developing colorectal cancer. Recommendations for MAP treatment vary in the literature ranging from frequent surveillance colonoscopy to prophylactic surgery depending on polyp burden. The aim of this study was to report the management and outcome of a single institution series of patients with MAP.


Patients with biallelic mutations in MYH were accrued over 23 years from a query of a comprehensive polyposis database using Cologene© software. Demographics, family history, upper and lower endoscopy frequency, polyp burden, and cancer data, and treatment were recorded.


Thirty-four patients from 26 families with MAP were included. There were 24 cancers in 14 patients. Four of the patients had multiple cancers (14 total), each with a rectal cancer plus a more proximal cancer. 3 patients had more than 2 colorectal cancers. Of the 24 colorectal cancers, 10 (42%) were right sided and 14 (58%) were left sided. Most cancers (90%) were stage I or II and 10% were stage III as shown in Table 1.
Table 1

Demographic Details


Synchronous (N=4)

Solitary (N=10)

No Cancer (N=20)


M – 50%

F - 50%

M – 60%

F – 40%

M – 90%

F – 10%


Mean 40.8

Mean 51

Mean 54

Family History

3/4 yes

4/10 yes (one unknown)

6/20 yes

All patients also had colorectal adenomas. Median polyp number is 20 (range 1-115) for patients with solitary cancer and for multiple cancers median was 100 (range 50-120) (Table 2).
Table 2

Cancer Details


Synchronous (N=4)

Solitary (N=10)

No Cancer (N=20)

Number of polyps

Median 100 (50-200)

Median 20 (1-115)

Median 50 (15-116) Surgery

Median 17 (4 -100) No Surgery

Cancer Stage

Stage I

Stage II

Stage III

1 (25%)

2 (50%)

1 (25%)

5 (50%)

4 (40%)

1 (10%)



100% Right side

50% Left side

100% Rectum

80% Colon

20% Rectum


All patients with cancer had a resection. Four patients underwent segmental colectomy, 5 underwent a colectomy with ileorectal anastomosis, and 5 were treated with total proctocolectomy (4 with ileal anal pouch and one with an end ileostomy). There have been no deaths from colon or rectal cancer and no recurrence at a mean follow-up of 96 months.


MAP is associated with an increased risk of colorectal cancer, but appropriate surveillance and surgical intervention prevents cancer-related deaths.

Authors’ Affiliations

The Sanford R. Weiss, M.D. Center for Hereditary Colorectal Neoplasia, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland, USA


© LaGuardia et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.