Colon Cancer

FAP is characterized by the presence of hundreds or thousands of colonic polyps, and it accounts for less than 1 percent of colon cancers. Affected individuals are at increased risk of colorectal polyps and malignancy, and they usually develop polyps by age thirty-five and cancer by age forty. Because endoscopic removal of all the polyps is impossible, patients are usually advised to consider colectomy at a relatively young age. In addition to occurring in the colon, polyps occur in the upper digestive tract, and a variety of tumors may develop outside the gastrointestinal tract. Because mutations in the APC gene can be identified in most cases, genetic testing is now available for affected families.

FAP is inherited as an autosomal dominant disorder with 95 percent penetrance, meaning 95 percent of those who inherit one mutated APC gene will develop FAP. At the cellular level, the APC mutation is actually recessive: As long as there is one copy that is not mutated, the cell cycle will remain controlled.

The apparent paradox of a recessive gene causing a dominant disorder is resolved when we consider how a gene defect predisposes a person to cancer. Of the many millions of cells lining the colon, it is highly likely that some will undergo spontaneous mutation in one of the two copies of the APC gene.

For a person not affected by the APC gene, a spontaneous mutation of one allele will not lead to cancer, because the other gene copy remains intact. However, for a person affected who inherits one mutated copy of the APC gene, each of the cells lining the colon begins with one bad gene copy. Any mutation to the remaining good copy will cause the cell to lose control of Digital image of multipolar spindles (green) separating the chromosomes (red) of a cancerous colonic epithelial cell in a late stage of its division. its cell cycle and begin the process of polyp development. Given the number of cells involved, it is almost inevitable that this will occur in some of them. Hence FAP is a dominant condition.