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IBD Chromoendoscopy — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyIBD ChromoendoscopyRACP Adult Medicine

A 19-year-old with an APC pathogenic variant has hundreds of colorectal adenomas, including several lesions no longer controllable endoscopically. There is no metastatic cancer. Which management principle is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Refer for prophylactic colorectal surgery with procedure tailored to rectal burden

Explanation lettering: B = shown as A · E = shown as B · A = shown as E

B is correct. Classic FAP with uncontrollable polyposis requires prophylactic colorectal surgery; rectal burden, phenotype and patient factors determine colectomy with ileorectal anastomosis versus proctocolectomy/pouch. A and D wait for preventable cancer. C chemoprevention is adjunctive. E segmental surgery leaves the remaining colon at near-certain malignant risk.

Reference: Cancer Council Australia, Clinical practice guidelines for colorectal cancer: https://www.cancer.org.au/clinical-guidelines/bowel-cancer