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Lynch Syndrome Surveillance — RACP Adult Medicine MCQ

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HardGastroenterologyLynch Syndrome SurveillanceRACP Adult Medicine

A patient undergoing endoscopic eradication for Barrett high-grade dysplasia has a focal nodule resected. Histology unexpectedly shows submucosal adenocarcinoma with lymphovascular invasion. What should happen next?

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Correct answer: DRefer for oesophageal cancer staging and assessment for surgical resection

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

A is correct. Submucosal invasion plus lymphovascular invasion confers nodal risk beyond endoscopic eradication alone and requires cancer MDT staging and surgical assessment. B ignores high-risk histology. C cannot address nodal disease. D is not cancer treatment. E grossly under-surveils an invasive malignancy.

Reference: Cancer Council Australia, Barrett’s oesophagus clinical guidelines: https://www.cancer.org.au/clinical-guidelines/oesophageal-cancer/barretts-oesophagus