The Four Lynch Syndromes: A Patient's Guide to Inherited MSI Cancer

Table of Contents

• Key Points
• Background: Why This Research Matters
• Study Methods: How the Research Was Conducted
• Key Findings: Colonoscopy and Cancer Risk
• The Four Lynch Syndromes
• Survival After Cancer Detection During Follow-Up
• The PLSD Database: A Practical Tool for Patients
• A Related Condition: CMMRD
• Timing of Cancers and the Benefits of Early Diagnosis
• Why Family History Alone Isn't Enough
• Limitations of Earlier Research on Colonoscopy
• Combined Results: Two Pathways to Cancer
• Clinical Implications for Patients
• Recommendations for Patients and Families
• What This Study Couldn't Prove
• Frequently Asked Questions
• Source Information

Key Points

• Lynch syndrome is four distinct inherited cancer syndromes — MSH2, MLH1, MSH6, and PMS2 — each with its own cancer risks, age patterns, and outcomes, rather than one single disease.
• In a large prospective database of carriers under colonoscopy surveillance, colorectal cancer incidence was increased in MLH1 and MSH2 carriers, not reduced; colonoscopy may still improve survival by finding cancers earlier.
• Aspirin reduces colorectal and other cancers in Lynch syndrome, and immunotherapy helps the immune system destroy MSI cancers, though most historical survival data predates immunotherapy.
• Risk estimates not broken down by gene and sex are essentially meaningless for individuals; the PLSD website at www.plsd.eu gives organ-specific lifetime risk by age, sex, and variant.

Background: Why This Research Matters

About ten years ago, updated guidelines were issued for the clinical management of a group of inherited cancer predisposition syndromes that affect adults. These syndromes are caused by inherited mutations (called pathogenic variants) in one of four mismatch repair (MMR) genes: MLH1, MSH2, MSH6, and PMS2. All of these conditions were referred to collectively as "Lynch syndrome." At that time, doctors did not yet have a solid understanding of the cancer risks associated with each individual gene.

The job of MMR genes is to fix mistakes that occur when DNA is copied inside our cells. When these "repairman" genes are faulty, cells accumulate errors, leading to a condition called microsatellite instability (MSI) — a kind of genetic chaos that can eventually lead to cancer.

Interestingly, while the MMR genes are active throughout the body, the organs most affected are those that develop from the embryonic endoderm — the innermost cell layer of the early embryo. These organs include the lining of the stomach, the large and small intestine, the pancreas, bile duct, urinary tract, prostate, and the endometrium (lining of the uterus).

Lynch syndrome–related ovarian cancers are often of a subtype called endometrioid, meaning they arise from cells similar to those found in the endometrium. This suggests a close biological relationship between these two cancers.

One additional gene, EPCAM, does not itself cause Lynch syndrome, but deletions can silence the neighboring MSH2 gene, producing a distinct pattern of Lynch syndrome cancers.

The story of how Lynch syndrome cancers develop has turned out to be more complicated than doctors originally thought. Early assumptions held that all colorectal cancers grew from precancerous polyps called adenomas, and that removing these polyps during colonoscopy would prevent cancer. But it soon became clear that colonoscopy did not reduce colorectal cancer incidence in Lynch syndrome patients as much as anticipated. This paper, published by a large European collaborative group, discusses the new knowledge that has emerged over the past decade to explain why.

Study Methods: How the Research Was Conducted

In 2012, the European Hereditary Tumor Group — then called the Mallorca Group — launched the Prospective Lynch Syndrome Database (PLSD). They gathered follow-up information on individuals carrying pathogenic MMR gene variants across multiple specialist cancer centers worldwide. The goal was to answer three specific questions:

1. To what degree does colonoscopy surveillance reduce colorectal cancer (CRC) incidence in carriers of pathogenic MMR variants?
2. What are the penetrance (the likelihood that carriers develop cancer) and expressivity (the range of cancers that occur) of pathogenic variants in each of the four Lynch syndrome–associated genes?
3. What is the survival of carriers when they are followed up as recommended, to enable early diagnosis and treatment?

The researchers faced an important ethical obstacle. A randomized controlled trial — the "gold standard" of medical research — would have required withholding colonoscopy and other recommended interventions from a control group. That was considered impossible. Instead, they conducted an open, prospective observational study, following carriers over time as they received standard care.

Independently, another research group (the International Mismatch Repair Consortium) performed a retrospective segregation analysis in Lynch syndrome families. This complementary work confirmed that cancer incidence in carriers of pathogenic MMR variants is not significantly increased before 25 years of age.

One of the great strengths of the PLSD approach is that it was deliberately free of assumptions. The researchers did not start with a theory about how cancer develops or how interventions work. Instead, they recorded cancers simply as distinct events — by organ and by age — and let the data speak for itself, much like a cancer registry. The patients in the study all received follow-up including colonoscopy surveillance at expert hereditary cancer centers.

Key Findings: Colonoscopy and Cancer Risk

Perhaps the most surprising finding concerned colonoscopy itself. When the researchers compared cancer rates in Lynch syndrome patients under regular colonoscopy surveillance with published estimates from earlier generations who did not have regular colonoscopy, the results were striking:

• Colorectal cancer incidence was increased in carriers of pathogenic MLH1 and MSH2 variants, not reduced.
• Colorectal cancer incidence was not reduced in carriers of pathogenic MSH6 variants.
• Colorectal cancer incidence was possibly reduced (but the difference was not statistically significant) in carriers of pathogenic PMS2 variants under 50 years of age.

This suggests that colonoscopy overdiagnoses colon cancer — meaning it detects cancers that would never have caused clinical problems — and that the procedure does not reduce the overall number of colorectal cancers in most Lynch syndrome carriers. However, as the study authors emphasize, colonoscopy may still improve prognosis by catching cancers earlier.

The PLSD data also revealed specific patterns of cancer risk by gene, sex, and age. Cancers of the endometrium, colon, and ovaries in Lynch syndrome carriers typically begin to appear in early adult life. Cancers in other organs tend to be diagnosed later and mainly in people who survived those earlier cancers. These patterns were unique to each of the four genes.

The Four Lynch Syndromes

Based on all the accumulated data, the authors concluded that there are not one but four distinct inherited MSI cancer syndromes. Each has its own penetrance, its own set of cancers, and its own natural history. Here is what the research showed for each one.

The MSH2 Syndrome

The MSH2 syndrome is inherited in an autosomal dominant pattern — meaning one copy of the altered gene from either parent is enough to increase cancer risk — and its penetrance is high.

People with a pathogenic MSH2 variant face a high risk of cancer in all the organs typically affected across the Lynch syndromes. The earliest cancers tend to appear in the endometrium, ovaries, and colon. The good news is that most carriers survive these first cancers when they are detected early and treated promptly.

However, cancers in other organs — most commonly the rectum, upper urinary tract, prostate, and brain — are often diagnosed later in life, usually in those who survived their early-onset cancers. There are few founder variants (mutations passed down from a common ancestor), meaning the condition has been maintained across generations at low frequency. Most cancer deaths in MSH2 carriers are from non-colorectal cancers: particularly the endometrium, rectum, upper urinary tract, prostate, and brain.

The MLH1 Syndrome

The MLH1 syndrome is also autosomal dominant with high penetrance. It is characterized by an early onset and high incidence of cancer in the colon, endometrium, and ovaries. Again, most carriers survive these first cancers after early detection and treatment.

Cancers in other organs tend to appear later in survivors of the early cancers, and most commonly include the rectum, stomach, small intestine, bile duct, and pancreas. Few founder variants exist, and fitness is low. Most cancer deaths are associated with non-colorectal cancers, especially those of the endometrium, bile duct, and pancreas. Here too, colonoscopy overdiagnoses colon cancer.

In men, most cancers diagnosed before 50 years of age in MLH1 carriers are colon cancers. Cancers in other organs appear later, reflecting improved survival from early-onset colon cancer.

In women, the situation is different. Endometrial and ovarian cancers together are the first and most frequent cancers in MLH1 carriers — even more so than colon cancer.

The MSH6 Syndrome

The MSH6 syndrome is autosomal dominant with sex limitation. Penetrance is high in females but low in males. Women with an MSH6 variant have a high incidence of endometrial and ovarian cancers, which typically begin at older ages than in MLH1 or MSH2 carriers.

Both sexes have an increased incidence of colorectal cancer, though the risk is much lower than in MSH2 or MLH1 carriers. Cancers in other organs are uncommon.

Because of the sex-limited inheritance, detecting MSH6 families through family history alone is difficult — the cancer pattern in a family may not look obviously inherited when only women are affected. There are few founder variants, and fitness is low.

The authors note that the effect of colonoscopy in MSH6 carriers remains inconclusive, largely because relatively few carriers have been reported to the PLSD so far.

The PMS2 Syndrome

The PMS2 syndrome is autosomal dominant and quite different from the other three. Carriers have only a slightly increased incidence of colorectal and endometrial cancer in young adults, with a higher incidence emerging at older ages. There is no demonstrated increase in cancer in other organs.

Estimating cancer risk in PMS2 carriers is difficult because of ascertainment biases — carriers are often found only after a cancer already occurred. Founder variants do exist in this syndrome, and fitness appears good.

Importantly, unlike the other three syndromes, the low incidence of colorectal cancer in young adult PMS2 carriers undergoing colonoscopy may suggest that colonoscopy does reduce colorectal cancer incidence in this group. Because the cancer risks are much lower, and the mechanisms of colorectal cancer development may differ, the authors caution that the broader research conclusions in their paper may not apply to PMS2 carriers.

Survival After Cancer Detection During Follow-Up

The PLSD data on survival are encouraging. Most early-onset cancers in the endometrium, colon, and ovary that were detected during follow-up were cured. Ten-year survival after cancer in different organs did not differ significantly by gene, although cancers in MSH6 and PMS2 carriers were too infrequent to allow separate survival measurements (except for endometrial cancer in MSH6 carriers).

However, there was an important time trend. In later life, survivors of early cancers often developed cancers in other organs, and these subsequent cancers were associated with lower overall survival.

This finding represents a significant shift: historically, Lynch syndrome was considered a death sentence for many carriers. Today, with early diagnosis and modern treatment (most of which did not yet include immunotherapy), the majority of early-onset cancers are cured. The study's results support the view that there are genuinely four different inherited MSI cancer syndromes, each with its own risk profile.

The PLSD Database: A Practical Tool for Patients

The researchers integrated the PLSD data with the international InSIGHT variant database, which classifies MMR gene variants as disease-associated or not. The PLSD adds crucial information on penetrance and expressivity — in effect, how likely cancers are to develop and which organs are at risk.

You can access this information directly at www.plsd.eu. The website interactively displays the remaining lifetime cancer risk for each organ when you input the carrier's age, sex, and genetic variant. Both patients and healthcare providers will find this tool useful for personal risk assessment and for making decisions about surveillance and prevention strategies.

A Related Condition: CMMRD

When a person inherits a pathogenic MMR gene variant from both parents — a situation called biallelic inheritance — they develop a different, recessively inherited condition known as constitutional mismatch repair deficiency syndrome (CMMRD).

CMMRD is characterized by a high incidence of MSI cancers in non-endodermal tissues (tissues not derived from the inner embryonic layer) early in life. Pathogenic PMS2 variants are the most common cause of CMMRD. Interestingly, MLH1 and MSH2 variants are rarely seen in CMMRD, leading researchers to speculate that most people with two affected copies of these genes may not survive fetal development. A detailed discussion of CMMRD is beyond the scope of this paper.

Timing of Cancers and the Benefits of Early Diagnosis

Most of the frequent and early-onset cancers in all four Lynch syndromes are cured when detected early and treated promptly. This can often be achieved through:

• Regular colonoscopy surveillance
• Regular gynecological examinations (including ultrasound and endometrial sampling)
• Promotion of cancer awareness, with early consultation about "red flag" symptoms such as unusual bleeding, changes in bowel habits, or pelvic pain

However, the study found something unexpected. The occurrence of a first cancer in a non-colorectal organ was not associated with colorectal cancer incidence. Neither was the stage at which colorectal cancer was diagnosed — nor survival after colorectal cancer — associated with the interval between colonoscopies.

These findings challenge the traditional "adenoma-carcinoma sequence" model, which assumes that colorectal cancer develops slowly through a visible polyp stage. Instead, they support a different view: that Lynch syndrome cancers arise from a stochastic (random, probabilistic) process in time, rather than from a predictable linear progression.

The authors summarize this with a powerful statement: "No person has an 'average sex' or a pathogenic variant in an 'average Lynch syndrome gene' — and results that are not stratified by gene and sex will be valid for no one." They note that other inherited factors (called modifiers) may also influence which cancers occur and when, and they call for more research on possible associations between cancers versus purely random events.

Most cancers diagnosed before age 50 in male MLH1 carriers are colon cancers. In female carriers, however, gynecological cancers are the leading manifestation — and treating endometrial cancer often includes hysterectomy, which also prevents that cancer. In addition, gynecological cancers together with urothelial (urinary tract), prostate, and brain cancers are the leading causes of death in carriers receiving colonoscopy follow-up.

The authors stress that viewing Lynch syndrome simply as an inherited colorectal cancer syndrome ignores the fact that gynecological cancers are the main manifestation in women and the major drivers of death in carriers under surveillance.

Why Family History Alone Isn't Enough

The way Lynch syndrome families have been identified over the years has been biased from the start. The first clinical criteria — called the Amsterdam 1 criteria — were developed for research purposes to find the causative genes. They reflected an early misconception: that researchers were hunting for an inherited colorectal cancer syndrome, not a syndrome of inherited cancer in many organs. As a result, these criteria mainly identified families with MLH1 mutations.

Later criteria (Amsterdam 2) added endometrial cancer, which led to more MSH2 — and especially MSH6 — families being recognized. But because MSH6 inheritance is sex-limited, many MSH6 families still did not meet clinical criteria that assumed high cancer rates in both sexes.

PMS2 proved even more problematic. The penetrance is so low that distinguishing PMS2 carriers from the general population using family history alone is nearly impossible.

Similar biases occur when genetic testing is done based on family history, or when testing is focused only on young-onset colorectal cancer cases. The authors argue that only when all incidental cancers are tested for all four genes — in all ages, and across all organs — and results are combined, will we be able to understand the full picture of cancer incidence linked to each genetic variant.

There are more specific issues with the Amsterdam criteria as well. The PLSD data show that ovarian cancer should be grouped with endometrial and colon cancers as early-onset cancers in carriers — but ovarian cancer was not included in the Amsterdam 2 criteria. This was a mistake, the authors say, especially because the standard treatment for ovarian cancer often includes hysterectomy, which also prevents endometrial cancer.

On the other hand, grouping colon and rectal cancers together as "one organ," as the Amsterdam criteria did, appears to have been misguided. The PLSD data suggest that colonoscopy may prevent rectal cancer but not colon cancer in Lynch syndrome. Adding other organ cancers to the criteria would likely have little effect on sensitivity, since most of those cancers occur in survivors of early-onset cancers.

Limitations of Earlier Research on Colonoscopy

Despite widespread consensus that colonoscopy reduces colorectal cancer incidence in the general population, the authors found no recognized evidence that this is true for carriers of pathogenic MMR variants.

What evidence does exist? Only three publications, all describing observations from a single cohort of 22 Finnish families. These families were selected based on a single case of very early-onset colorectal cancer with multiple affected relatives.

The authors identify several methodological problems in those reports:

• The original index clusters were not removed when calculating colorectal cancer incidence.
• Researchers incorrectly assumed that family members had a 50% carrier probability after excluding the colorectal cancer–affected cases.
• Lead-time bias (the apparent survival benefit that comes simply from earlier diagnosis, not from better treatment) was not discussed for the non-intervention group.

Because of these issues, the authors argue that the conclusions from those historical reports are questionable. A later segregation analysis of 70 Finnish families (65 of which had an MLH1 variant) reported higher colorectal cancer incidence than what was seen in French families with MLH1 variants — and much higher than the multinational European report. The Finnish studies largely described carriers of a local Finnish founder variant, which may not represent all MLH1 variants worldwide.

Combined Results: Two Pathways to Cancer

The PLSD findings do not mean the traditional adenoma-carcinoma pathway is wrong. Rather, they indicate that it is not the only pathway to colorectal cancer in Lynch syndrome. The original assumption that removing adenomas (polyps) would prevent most colorectal cancer in Lynch syndrome appears to be incorrect.

Thanks to tumor biology and treatment studies conducted independently over the last decade, we now understand there is likely a second pathway. Adult carriers of pathogenic MLH1 and MSH2 variants may at any time have a very large number of colonic crypts (the basic glandular structures lining the colon) that are missing normal MMR gene function — called dMMR crypts. These defective areas may develop directly into cancer without going through a macroscopically visible, non-invasive stage such as an adenoma.

When these dMMR crypts acquire additional mutations, they become MSI and produce abnormal peptides — proteins made from mistranslated DNA — that are recognized by the immune system as foreign. The immune system attacks these abnormal cells, creating a dynamic balance between the production of abnormal cells (a stochastic, random process) and the body's ability to eliminate them.

This understanding has opened the door to immunotherapy, which boosts the immune system's ability to destroy MSI cancers. The combination of cancer biology research and the epidemiological findings from the PLSD paints a clearer picture of how Lynch syndrome cancers develop — and how to stop them.

Clinical Implications for Patients

Several practical takeaways follow directly from this research.

First, surveillance works — but in a different way than previously understood. Colonoscopy does not appear to reduce the number of colorectal cancers that develop in MLH1 and MSH2 carriers, but it does improve outcomes by detecting cancers early. For PMS2 carriers, colonoscopy may actually reduce incidence. Either way, early detection saves lives.

Second, gynecological surveillance is essential for women. Endometrial and ovarian cancers are the most frequent first cancers in female MLH1 and MSH2 carriers. Regular gynecological examinations are crucial for early detection, and hysterectomy during ovarian cancer treatment additionally prevents endometrial cancer.

Third, prevention is possible. Aspirin has been shown to reduce the incidence of colorectal cancer and other cancers in Lynch syndrome. Carriers should discuss aspirin use with their healthcare provider.

Fourth, immunotherapy has changed the treatment landscape. For those who develop MSI cancers, immunotherapy can strengthen the immune system's natural ability to destroy cancer cells. Most patients in this study's historical survival data did not receive immunotherapy, so the future outlook may be even brighter.

Fifth, personalized risk assessment is vital. Because the four Lynch syndromes differ dramatically in their cancer patterns, risk estimates that are not broken down by gene and sex are essentially meaningless for individual patients. The PLSD website supports personalized risk conversations.

Recommendations for Patients and Families

Based on this position statement from the European Hereditary Tumor Group and the Prospective Lynch Syndrome Database, here are the key recommendations for patients living with Lynch syndrome:

1. Know which gene is involved. Your specific genetic variant (MLH1, MSH2, MSH6, or PMS2) determines your risk profile. Ask your doctor to explain what your gene means for your personal cancer risks — and use the PLSD website (www.plsd.eu) for individualized risk estimates.
2. Follow your surveillance schedule. Colonoscopy surveillance is still recommended and can improve your prognosis by detecting cancer early, even though it may not prevent all colon cancers. Women should also follow gynecological surveillance recommendations for endometrial and ovarian cancer.
3. Report "red flag" symptoms early. Unusual bleeding, changes in bowel habits, pelvic pain, or other concerning symptoms should prompt immediate consultation with your healthcare team — don't wait for your next scheduled appointment.
4. Ask about aspirin prevention. Aspirin has been shown to reduce the incidence of colorectal and other cancers in Lynch syndrome. Discuss dosing and potential side effects with your doctor before starting.
5. If you develop cancer, ask about immunotherapy. MSI cancers respond to immunotherapy, which helps your immune system attack the tumor. Treatment options should be discussed with an oncologist experienced in Lynch syndrome.
6. Encourage cascade testing in your family. Because these syndromes are dominantly inherited, close relatives may also carry the familial variant. Genetic counseling and testing can help them understand their own risks and take preventive action.

What This Study Couldn't Prove

This was a prospective observational study, not a randomized controlled trial. While the design was deliberately assumption-free and the results are considered robust, the authors acknowledge several limitations.

• Because a control group of carriers was not denied medical intervention, direct comparisons of outcomes "with versus without" surveillance rely on historical data.
• Existing historical evidence on colonoscopy benefit rests on a small group of Finnish families with multiple methodological concerns, and those families may not represent global experiences.
• Ascertainment biases remain: families are still mostly identified through family history or young-onset cancer, which distorts estimates of variant frequencies, penetrance, and expressivity.
• The data for MSH6 and PMS2 carriers are limited by smaller numbers, making it harder to draw firm conclusions.
• Most patients in the survival data were treated before immunotherapy became available, so the full benefit of modern treatment may be underestimated.

Frequently Asked Questions

What is Lynch syndrome, and is it one condition or several?

Lynch syndrome is not one disease but four distinct inherited cancer syndromes. Each is caused by a different faulty mismatch repair gene: MSH2, MLH1, MSH6, or PMS2. These genes normally repair DNA copying mistakes. When faulty, errors build up — a state called microsatellite instability — which can eventually lead to cancer. Knowing which gene you carry matters, because each syndrome has its own risks and age patterns.

Which gene do I have, and why does it matter for my risks?

Your specific variant — MLH1, MSH2, MSH6, or PMS2 — determines your personal risk profile. Endometrial, colon, and ovarian cancers tend to appear first in early adult life, while cancers in other organs appear later, mainly in people who survived those earlier cancers. These patterns differ for each of the four genes. Ask your doctor to explain what your gene means for you, and use the PLSD website for individualized estimates.

Does colonoscopy actually prevent colorectal cancer if I have Lynch syndrome?

In carriers of MLH1 and MSH2 variants, colorectal cancer incidence was increased rather than reduced under regular colonoscopy, and it was not reduced in MSH6 carriers. Colonoscopy may still improve prognosis by detecting cancers earlier. In PMS2 carriers under 50, incidence was possibly reduced, but that difference was not statistically significant. Discuss what this means for your surveillance plan with your team.

I'm a woman with an MLH1 or MSH2 variant. Which cancers should I watch for?

Endometrial and ovarian cancers together are the first and most frequent cancers in female MLH1 carriers — more so than colon cancer. In MSH2 carriers, the earliest cancers tend to appear in the endometrium, ovaries, and colon. Regular gynecological surveillance, including ultrasound and endometrial sampling, supports early detection. Report unusual bleeding or pelvic pain promptly rather than waiting for your next appointment.

Can aspirin or immunotherapy help reduce my cancer risk or treat it?

Aspirin has been shown to reduce the incidence of colorectal cancer and other cancers in Lynch syndrome. Discuss dosing and possible side effects with your healthcare provider before starting. For those who develop MSI cancers, immunotherapy can strengthen the immune system's ability to destroy cancer cells. Most patients in the survival data analysed did not receive immunotherapy, so the outlook with modern treatment may be brighter.

What is the PLSD website, and how can it help me and my doctor?

The Prospective Lynch Syndrome Database adds information on penetrance and expressivity — how likely cancers are to develop and which organs are at risk. At www.plsd.eu you can interactively enter a carrier's age, sex, and genetic variant to see remaining lifetime cancer risk for each organ. Patients and healthcare providers can both use it when discussing surveillance and prevention strategies.

Should my relatives be tested, and can family history alone identify carriers?

Family history alone is not enough. The original Amsterdam criteria mainly identified MLH1 families; later criteria added endometrial cancer and recognised more MSH2 and MSH6 families, but MSH6 inheritance is sex-limited and PMS2 penetrance is low, so both are hard to spot this way. Because these syndromes are dominantly inherited, ask your doctor about genetic counselling and cascade testing for close relatives.

When should a person with a pathogenic MLH1, MSH2, MSH6, or PMS2 variant seek a second opinion about their Lynch syndrome surveillance and treatment?

Consider a second opinion when a surveillance plan is not clearly matched to the specific gene and sex. Each of the four syndromes has distinct penetrance and cancer patterns. Colonoscopy improves early detection and survival in MLH1 and MSH2 carriers but may not reduce colon cancer incidence; in PMS2 carriers it may reduce incidence. Women need gynecological surveillance for endometrial and ovarian cancer. Reviewing aspirin prevention and immunotherapy options is also appropriate. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Dominantly inherited micro-satellite instable cancer – the four Lynch syndromes - an EHTG, PLSD position statement

Authors: Møller P, Seppälä TT, Ahadova A, Crosbie EJ, Holinski-Feder E, Scott R, Haupt S, Möslein G, Winship I, Bajwa-ten Broeke SW, Kohut KE, Ryan N, Bauerfeind P, Thomas LE, Evans DG, Aretz S, Sijmons RH, Half E, Heinimann K, Horisberger K, Monahan K, Engel C, Cavestro GM, Fruscio R, Abu-Freha N, Zohar L, Laghi L, Bertario L, Bonanni B, Tibiletti MG, Lino-Silva LS, Vaccaro C, Della Valle A, Rossi BM, da Silva LA, de Oliveira Nascimento IL, Rossi NT, Dębniak T, Mecklin JP, Bernstein I, Lindblom A, Sunde L, Nakken S, Heuveline V, Burn J, Hovig E, Kloor M, Sampson JR, Dominguez-Valentin M, on behalf of the Prospective Lynch Syndrome Database and the European Hereditary Tumour Group.

Journal: Hereditary Cancer in Clinical Practice (2023) 21:19. Published as an open-access review article.

DOI: https://doi.org/10.1186/s13053-023-00263-3

Additional resources: Prospective Lynch Syndrome Database (www.plsd.eu) | European Hereditary Tumour Group (www.ehtg.org)

This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace individualized medical advice from your healthcare team. Always discuss your specific risks, surveillance plan, and treatment options with qualified medical professionals.