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APC: Options for Managing Cancer Risk
People with an APC mutation have options for lowering their cancer risk. Learn about the screening and prevention guidelines for people with FAP and AFAP.

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Risk Management for People with an Inherited APC Mutation

Familial adenomatous polyposis (FAP) and atypical FAP (AFAP)

Expert guidelines on risk-management for people with FAP and AFAP are listed below. Ask your doctor to explain the signs of cancers related to FAP and report any symptoms to your doctor.

Researchers are looking at new ways to prevent or intercept cancer in people with FAP or AFAP. Speak with your doctor to learn if you are eligible for a clinical trial and to decide if it's the best option for you. 

Importantly, people with a specific APC mutation known as APC variant I1307K do not develop FAP. The guidelines in the large table do not apply to people with this variant. See the bottom section of this page for the specific guidelines for people with APC variant I1307K. 

Guidelines for people with FAP and AFAP

Beginning Age



Physical exam to screen for liver tumors; abdominal ultrasound and AFP (alpha-fetoprotein) blood levels every 3-6 months until age 5. 

10-15 (people with AFAP may start screening at age 18)

Annual high-quality colonoscopy.

Late teenage years

Thyroid ultrasound every 2-5 years, with referral to thyroid expert if findings are abnormal (or more frequently, based on family history of thyroid cancer).

No specified age (depends on personal history of polyps and individual preferences)

Risk-reducing colectomy; speak with health care experts about benefits and risks of each colectomy surgical option. See our section on colectomy for descriptions of the different types of procedures. 

After colectomy

Sigmoidoscopy (frequency depends on type of surgery and amount of tissue remaining) or pouchoscopy.

20-25 (or earlier, based on family history)

Upper endoscopy of the stomach and small intestine (frequency depends on number, size, and type of polyps found), typically with a specialized scope that can evaluate the ampullar of Vater.

No specified age

Consider capsule endoscopy (this involves swallowing a pill-sized camera that takes photos of your intestines as it travels through your digestive tract) or an endoscopic evaluation of the lower small intestine (called an enteroscopy) may be considered on a case by case basis for individuals felt to have a particular risk of polyps in the lower small intestine (the jejunum and the ileum).

No specified age

Routine CT or MRI imaging to evaluate for desmoid tumors is not recommended, but worrisome abdominal symptoms (e.g., unexplained pain) should prompt abdominal imaging. Individuals with known abdominal desmoid tumors may warrant regular surveillance imaging.

No specified age

Learn the signs and symptoms of other FAP-related tumors, including central nervous system cancers and desmoid tumors.

No specified age

Speak with your doctor about the benefits and risks of medications and the availability of clinical trials for managing risk of colorectal cancer. 

Source: NCCN Guidelines: Genetic/Familial High-Risk Assessment: Colorectal, vs. 2 2023

APC variant I1307K 

People with the I1307K variant in the APC gene are recommended to begin colorectal cancer screening at age 40 (or younger depending on family history of cancer). Recommendations include a high-quality colonoscopy every 5 years.   

Open Clinical Trials
Open Clinical Trials

The following are studies that may be of interest to people with FAP or AFAP:

Last updated June 20, 2024