Wednesday, May 27, 2015

CF Awareness Post Question Day 27

How does having Lynch Syndrome affect your CF? And vice versa?

For those who are not sure what Lynch (HNPCC – Hereditary Nonpolyposis Colorectal Cancer) is I will tell you.  It is a genetic predisposition to certain types of cancers.  They include colon, anus, pancreas, brain, sebaceous glands (skin), uterus, ovaries, bile duct, urinary tract, stomach and small bowel.  Basically the digestive organs and some reproductive organs. (I have a blog post about it here: I apologize for the text, I have changed my blog layout since it was written!).  My family carries the hMLH1 mutation, but there are four total.  A strong family history means you should probably get tested for the gene.  This quote from the print out I have will help calm anyone out there that is thinking OMG my great granddaddy had colon cancer, and that was it, in my family! “Persons at risk for HNPCC usually have a family history of two successive generations of colon cancer or at least once generation with cancer and one with polyps.” So if only one person in your family has had colon cancer, passed the age of 50, and no one had has polyps, chances are slim you have the gene. NOT saying you DON’T, just saying chances are slim. And remember I am NOT a genetics counselor nor am I a doctor!  If you are concerned that you may have this in your family, talk to your PCP and find a genetics team to discuss your family history with.  They will tell you if you need to be tested or not.  My family history is every generation has had colon cancer and colon polyps on my dad’s mom’s side.  This includes my dad having colon cancer when I was 26 years old, and only a few months old.  So I grew up with knowledge of both CF and Lynch Syndrome (didn’t know the name of LS just that colon cancer was hereditary).

Lynch affects my CF in a lot of ways.  I need to have yearly testing right now to be sure I am not growing any cancerous cells in my body.  Yearly I get colonoscopies, thyroid ultrasound, upper endoscopy and a skin checkup.  Having CF complicates my colonoscopies and upper endoscopies.  A prep for someone without CF only takes the day before the procedure.  If the procedure is on Thursday they stop eating Tuesday night, clean out Wednesday and are nice and clean for Thursday.  Not for me.  I need to stop eating Saturday night and eat clear liquids/foods on Sunday.  Then Monday, Tuesday and Wednesday I have to clean out.  And even with this I am not always “perfect” but enough to get good results. 

Lynch has also played a significant role in my evaluation for a double lung transplant.  The team at BWH was not too sure what to do with me.  They had many meetings and in the end decided I would be an OK candidate.  Under the strict terms that once I am transplanted, those yearly tests become six month tests.  There is a much higher risk for cancer post-transplant because of the immuno-suppressants so my risk will be even greater than that.  As it stands now with my yearly colonoscopies, there are always 3+ adenomas polyps removed (those are the ones that if left to fester can turn into cancer).  My whipple done last July was done only because the transplant team did not want to take the risk that I had precancerous cysts on my pancreas.  They removed me from the list until it was figured out, and it could only be figured out by doing the whipple.  So I had to have this huge surgery to be sure.  I was lucky and have had no real complications so I am fine with having had it done now and thankful they were only CF cysts.  I also had a full hysterectomy in 2011 because of Lynch.  Many years of reproductive issues coupled with my desire to not pass my genes on to children led me to have all my reproductive organs removed.  

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