Treatment

At first, your doctor will remove any small polyps found during your colonoscopy exam. Eventually, though, the polyps will become too numerous to remove individually, usually by your late teens or early 20s. Then you will need surgery to prevent colon cancer. You will also need surgery if a polyp is cancerous. You may not need surgery for AFAP.

Minimally invasive colorectal surgery

Your surgeon may decide to perform your surgery laparoscopically, through several small incisions that require just a stitch or two to close. This minimally invasive surgery usually shortens your hospital stay and allows you to recover more quickly.

Depending on your situation, you may have one of the following types of surgery to remove part or all of the colon:

• Subtotal colectomy with ileorectal anastomosis, in which the rectum is left in place
• Total proctocolectomy with a continent ileostomy, in which the colon and rectum are removed and an opening (ileostomy) is created, usually on the right side of your abdomen
• Total proctocolectomy with ileoanal anastomosis (also called J-pouch surgery), in which the colon and rectum are removed and a part of the small intestine is attached to the rectum

Follow-up treatment

Surgery doesn't cure FAP. Polyps can continue to form in the remaining or reconstructed parts of your colon, stomach and small intestine. Depending on the number and size of the polyps, having them removed endoscopically may not be enough to reduce your risk of cancer. You may need additional surgery.

You will need regular screening — and treatment if needed — for the complications of familial adenomatous polyposis that can develop after colorectal surgery. Depending on your history and the type of surgery you had, screening may include:

• Sigmoidoscopy or colonoscopy
• Upper endoscopy
• Thyroid ultrasound
• CT or MRI to screen for desmoid tumors

Depending on your screening results, your doctor may additional treatments for the following issues:

• Duodenal polyps and periampullary polyps. Your doctor may recommend surgery to remove the upper part of the small intestine (duodenum and ampulla) because these types of polyps can progress to cancer.
• Desmoid tumors. You may be given a combination of medications, including nonsteroidal anti-inflammatory drugs, anti-estrogen and chemotherapy. In some cases, you may need surgery.
• Osteomas. Doctors may remove these noncancerous bone tumors for pain relief or cosmetic reasons.

Potential future treatments

Researchers continue to evaluate additional treatments for FAP. In particular, the use of pain relievers such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), as well as a chemotherapy drug, are being investigated.