Familial Adenomatous Polyposis

Treatment

Patients with FAP develop too many polyps for removal one at a time, so surgery is often necessary to remove the colon (colectomy), the colon and rectum (proctocolectomy), or the colon, rectum and part or all of the anus. Although surgery doesn't cure FAP, it eliminates or greatly reduces the risk of cancer.

People with FAP usually develop tumors outside the colon that need to be treated separately. See additional signs of FAP.

Colectomy

When only the colon is removed, the end of the small intestine is joined to the top of the rectum (ileorectal anastomosis), allowing bowel movements to pass through the anus. Because the rectum is not removed, the risk of polyp development remains. In some patients, the rectum is removed later.

Proctocolectomy

Proctocolectomy has two forms. One procedure is ileal pouch-anal anastomosis (IPAA), during which the colon and rectum are removed, but the anus is left. A pouch is created from the lower end of the small intestine and joined to the anus. The pouch serves as a rectum and allows bowel movements to pass through the anus. Mayo Clinic surgeons have performed more than 2,000 IPAA procedures since 1981, and the vast majority of patients have had successful outcomes. Mayo Clinic also is a leader in minimally invasive surgery for this procedure.

The other procedure removes the anus as well and creates a permanent ileostomy, where a portion of the intestine is brought out through an opening in the abdominal wall (a stoma) for passage of stool into a bag.

Regular follow-up exams are important after surgery as polyps may develop elsewhere in the digestive tract, including the stomach, the duodenum, the rectum (if still present) and in the surgically created ileal pouch (in the case of IPAA). If found early, most upper intestinal and pouch polyps can be removed with endoscopic (minimally invasive) surgery.

People with FAP also need a yearly medical examination that includes a thyroid examination.

Any new symptoms (such as fever, abdominal pain, change in bowel habits, blood in stool, etc.) should also be investigated.

No medication has been proven to treat FAP successfully, though research is being conducted on medication that may suppress polyp growths and thus decrease risk cancer.