Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome predisposing affected individuals to gastrointestinal (GI)
cancers through a high burden of polyposis.
Colorectal cancer rates reach 100% by the age of 45, making early
colectomy a mainstay of treatment. While most patients undergo
colectomy at an early age, ongoing screening and surveillance of the upper gastrointestinal tract and rectal pouch must continue throughout adulthood. Endoscopic
therapy of gastric, duodenal, ampullary and rectal pouch
polyps is critical to reduce morbidity and
cancer related mortality. Management of these lesions is not uniform, and is dependent on their location, size, histology, and risk of malignant potential. Medical
therapies targeting pathways that reduce the malignant progression of pre-cancerous lesions have been studied for many years. While studies on the use of
aspirin and non-steroidal
anti-inflammatories (
NSAIDs) in
chemoprevention have shown encouraging results in
Lynch syndrome and primary
colorectal cancer, the potential benefits of these medications have not been duplicated in FAP cohorts. While data remains limited on
chemoprevention in FAP, a number of randomized trials are currently underway examining targeted
therapies with the potential to slow the progression of the disease. This review aims to provide an in-depth review of the literature on current endoscopic options and chemopreventive
therapies targeting FAP. While the endoscopic management has robust data for its use,
chemoprevention in FAP is still in its infancy. The complementary use of chemopreventive agents and endoscopic
therapy for FAP patients is quickly becoming a growing and exciting area of research.