CONSULT REQUEST GUIDELINES                                                                         Print

Familial adenomatous polyposis syndrome (FAP)

Suggested Pre-Referral Evaluation and Management Guidelines Referral is indicated if:
the patient has indication for total colectomy with ileoanal anastomosis.
These include:
- Age > 18
- Colon cancer
- High grade dysplasia

Or other indications for surgical evaluation:
- Desmoid tumor of small bowel mesentery with Symptoms of obstruction

Patients with adenoma of papilla of Vater too large to remove endoscopically, with duodenal cancer or high-grade dysplasia, should be referred to Pancreatic Cancer Clinic
Suggested Additional Test/Management Prior to Specialty Visit Records should be sent to clinician for review prior to visit.

- Colonoscopy and biopsy reports should show > 100 adenomas
- Report (with pictures, if possible) available at clinic visit
- Pathology report and microscope slides at or before clinic visit
- Upper endoscopy with biopsy of duodenal and gastric polyps if present
- If cancer on biopsy, then CT scan of chest, abdomen, pelvis with oral and IV contrast)
- If history of bowel obstruction from desmoid tumor, then CT scan of abdomen and pelvis with oral and IV contrast)
- Medical genetics referral if not already done
Patient Education/Information (includes preps)  
Appointment Timeframe If cancer, 2 weeks
Otherwise, within 6 weeks
How to Get Results to Consultant Any records that are received should be given to consultant to review prior to clinic visit.

UMHS Patients: See MiChart
External Patients: Fax or send appropriate medical documents to program (fax 734-936-6927)
Clinic Contact Information Physician: 800-962-3555
Patient: 734-936-5744
Clinic Location Sites Taubman Health Center
UM Consulting Physician James A Knol, M.D.
Michael William Mulholland, M.D., Ph.D.

Cancer and Desmoid tumor patients are seen by SON
Alfred Edward Chang, M.D.
Arden Marie Morris, MD
Karin M Hardiman, MD
Scott E Regenbogen, MD
Revised on: 12/21/2015



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