American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of cancer risk is managed by yearly surveillance following colectomy in patients with familial adenomatous polyposis?

1. Pancreatic cancer

2. Liver cancer

3. Rectal or pouch adenocarcinoma

4. Esophageal cancer

The correct answer is: Rectal or pouch adenocarcinoma

In patients with familial adenomatous polyposis (FAP), yearly surveillance following colectomy is primarily focused on monitoring for the development of rectal or pouch adenocarcinoma. After total colectomy, if the patient has a rectal pouch (such as a J-pouch), the risk of developing cancer can still be significant in the residual rectal tissue or the pouch itself. FAP is characterized by the early onset of hundreds to thousands of colorectal polyps, which inevitably progress to colorectal cancer if left untreated. Although the colectomy significantly reduces the risk of traditional colorectal cancer, it does not eliminate the risk of cancer developing in the rectal remnant or in the new pouch created from the remaining intestinal tissue. Surveillance through regular endoscopic examinations is crucial for early detection of any dysplasia or malignant changes in these areas, allowing for timely intervention and improved outcomes. Other cancers listed in the options, such as pancreatic cancer, liver cancer, and esophageal cancer, are not specifically monitored through the same routine screening protocols post-colectomy in FAP patients. Therefore, focusing on rectal or pouch adenocarcinoma is essential in their long-term management.