A 45-year-old woman is diagnosed with Lynch syndrome (MSH2 mutation) during colorectal cancer screening. She has not yet developed endometrial cancer. She asks about prophylactic measures. The most effective option to reduce her lifetime endometrial cancer risk is:

• A Annual endometrial biopsy from age 35
• B Levonorgestrel IUS insertion to suppress endometrium
• C Prophylactic hysterectomy + bilateral salpingo-oophorectomy after completion of family ✓
• D Combined oral contraceptive pill for 5 or more years

Explanation

Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) due to MLH1, MSH2, MSH6, or PMS2 mutations confers a lifetime endometrial cancer risk of 40–70% (highest with MSH2). After completion of childbearing, prophylactic risk-reducing hysterectomy and bilateral salpingo-oophorectomy is the most effective strategy, eliminating the risk of both endometrial and ovarian cancer. Surveillance by annual biopsy can detect early disease but does not prevent cancer. LNG-IUS and COCPs are not proven to adequately reduce risk in Lynch syndrome.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.