Guideline sources The following summarized guidelines for the evaluation and management of lynch syndrome are prepared by our editorial team based on guidelines from the American Gastroenterological Association (AGA 2015). 1 Guidelines 1. Screening and diagnosis Case finding: test the tumors of all patients with colorectal cancer for MSI to identify potential cases of Lynch syndrome. B 2. Classification and risk stratification Risk prediction: consider using risk prediction models as a first-line assessment, rather than proceeding directly with germline genetic testing, in patients without a personal history of colorectal or another cancer but with a family history suggestive of Lynch syndrome. C 3. Diagnostic investigations Surveillance colonoscopy: https://web.pathway.md/diseases/recAIRLxsWoVorL7W 1/2 6/29/23, 5:56 AM Lynch syndrome Pathway Obtain surveillance colonoscopy in persons with Lynch syndrome. B Consider surveillance colonoscopy every 1 to 2 years versus less frequent intervals. C 4. Medical management Aspirin for cancer prevention: consider offering aspirin for cancer prevention in patients with Lynch syndrome. C References 1. Rubenstein JH, Enns R, Heidelbaugh J et al. American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Lynch Syndrome. Gastroenterology. 2015 Sep;149 3 777 82. Open 2. Giardiello FM, Allen JI, Axilbund JE et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-society Task Force on colorectal cancer. Am J Gastroenterol. 2014 Aug;109 8 1159 79. Open 3. Albert de la Chapelle. The incidence of Lynch syndrome. Fam Cancer. 2005;4 3 233 7. Open 4. H T Lynch, P M Lynch, S J Lanspa et al. Review of the Lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramifications. Clin Genet. 2009 Jul;76 1 1 18. Open 5. Sapna Syngal, Randall E Brand, James M Church et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015 Feb;110 2 223 62; quiz 263. Open 6. Monique E van Leerdam, Victorine H Roos, Jeanin E van Hooft et al. Endoscopic management of Lynch syndrome and of familial risk of colorectal cancer: European Society of Gastrointestinal Endoscopy ESGE Guideline. Endoscopy. 2019 Nov;51 11 1082 1093. Open https://web.pathway.md/diseases/recAIRLxsWoVorL7W 2/2