Familial Adenomatous Polyposis: Treatment, Cost and Side Effects

Familial Adenomatous Polyposis or FAP is a rare hereditary disorder which leads to the development of cancerous tissue in the Large Intestine and the rectum. It is caused by the congenital defect in the adenomatous polyposis coli or APC gene. Those who inherit the defective gene are predisposed to develop cancer in the fourth decade of their life. The symptoms include the formation of hundreds to thousands of polyps in the colon and the rectum. Often, the colon is removed from the body to prevent the onset of cancer. The condition is also known to be responsible for the cancer of other parts of the body such as bile duct, pancreas, thyroid, liver, small intestine and central nervous system. It is advised to regularly visit the doctor for screening if one has a family history of FAP.

In the initial stages of the disorder, the small polyps can be removed by the doctor during the colonoscopy exam. However, surgery is performed when the polyps are big and pervasive throughout the colon. Generally, partial or complete removal of the colon is recommended to prevent the development of cancer.

The minimally invasive colorectal surgery is performed by the surgeon to remove the colon or the rectum from the body causing the least amount of distress to the patient. Usually, the surgery is taken as soon as possible to prevent the onset of cancer. Therefore, the surgery is often performed on children in their late teens during long holiday breaks. In many cases, more than one surgery may be required to completely secure the patient against cancer.

The surgery is as follows:

The minimally invasive colorectal surgery is performed by the surgeon to remove the colon or the rectum from the body causing the least amount of distress to the patient. Usually, the surgery is taken as soon as possible to prevent the onset of cancer. Therefore, the surgery is often performed on children in their late teens during long holiday breaks. In many cases, more than one surgery may be required to completely secure the patient against cancer. Depending on the condition of the patient, there are different surgeries performed. These are mentioned below:

1. Total proctocolectomy – Total bowel mucosa is removed from the body in this procedure. It completely protects the patient from the threat of cancer. This surgery has been known to cause discomfort in excretion as both the colon and rectum are removed from the body.
2. Colectomy with IRA – The surgery can be performed laparoscopically. This procedure involves the removal of the colon and the rectum. Then, the small intestine is joined to the rectum. The surgery requires frequent screening of the abdomen and the rectum. This is so because the risk of the cancer of the rectum increases when a person is in their 50s.
3. RPC – This procedure involves the removal of all the large bowel organs from the body. The surgery may also affect the genital organs of the patient. The fertility in the women is halved and males may experience erectile dysfunction.
4. Secondary proctectomy – In a few cases where develop rectal polyps, secondary protectomy is performed. The surgery removes the rectum form the body.

People below 60 years of age will have to check with the doctor for their body condition to go through the treatment. However, most of the patients are declared eligible for the minimally invasive colorectal surgery.

Any recent surgeries may have you out of the eligibility list.

The patients are at huge risk after the surgery as the complications of FAP may develop after the surgery. So, screening is mandatory.

Follow up after the surgery is crucial in controlling the risks of duodenal and peri-ampullary adenomatosis. The patients usually undergo screening every six months after the surgery. The screening involves colonoscopy, upper endoscopy and CT or MRI to screen for desmoid tumours. Desmoids are more likely to develop in the abdominal region if there has been a family history.

The recovery time is slow as the patient has to undergo 4 minimum screening tests.

The screening tests, such as colposcopy costs about Rs. 3000 to the patient. A patient might have to undergo 4-5 such screening tests. The price of the surgery varies Depending on the kind of surgery you opt for. However, the surgery usually costs between Rs3 lac to Rs. 5 lac. This includes the cost of both the surgeries to be performed, one of the removals of the colon and the rectum and the other in which the left organs are joined together to complete the bowel route of the body.

The surgery is performed as a preventive measure against cancer. In most of the cases, the surgery has been successful in substantially reducing the risk of cancer. However, in very few cases, cancer is caused even after the surgery. This occurs usually when the partial rectum is removed. In such cases, further surgeries have proven to be helpful. The surgery does not alter the gene defect. So, it is essential to understand that if the person who has undergone surgery decides to give birth to children, those children will be at risk of Familial Adenomatous Polyposis. The children should be screened at regular intervals for the development of cancerous tissues in the colon and the rectum.

Depending on the condition of the patient, there are different surgeries performed. These are mentioned below:

1. Total proctocolectomy – Total bowel mucosa is removed from the body in this procedure. It completely protects the patient from the threat of cancer. This surgery has been known to cause discomfort in excretion as both the colon and rectum are removed from the body.
2. Colectomy with IRA – The surgery can be performed laparoscopically. This procedure involves the removal of the colon and the rectum. Then, the small intestine is joined to the rectum. The surgery requires frequent screening of the abdomen and the rectum. This is so because the risk of the cancer of the rectum increases when a person is in their 50s.
3. RPC – This procedure involves the removal of all the large bowel organs from the body. The surgery may also affect the genital organs of the patient. The fertility in the women is halved and males may experience erectile dysfunction.
4. Secondary proctectomy – In a few cases where develop rectal polyps, secondary proctectomy is performed. The surgery removes the rectum form the body.