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FAP — RACP Paediatrics MCQ

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HardGIFAPRACP Paediatrics

A well 12-year-old carries the family pathogenic APC variant for classic familial adenomatous polyposis. Baseline high-definition colonoscopy shows six small adenomas without advanced histology. What surveillance plan best follows Australian guidance?

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

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Correct answer: B — Continue annual high-definition colonoscopy while colectomy timing remains individualised

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

B is correct because eviQ recommends annual high-definition colonoscopy from age 12 in classic FAP until colectomy, whose timing depends on polyp number, size, dysplasia and patient factors. A misses the period when classic polyposis emerges. C cannot replace direct mucosal surveillance in a near-certain cancer syndrome. D uses an inadequate interval and can miss proximal disease. E has no proven ability to remove the need for surveillance or surgery. The modest current burden does not justify immediate colectomy solely on age, but it does require expert longitudinal planning.

Reference: eviQ, APC familial adenomatous polyposis risk management: https://www.eviq.org.au/cancer-genetics/adult/risk-management/178-apc-familial-adenomatous-polyposis-risk-ma