Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint: Follow-up for Lynch syndrome / New or concerning family history suggestive of Lynch syndrome
History of Present Illness:
For follow-up visits, inquire about any new personal or family history findings since the last encounter.
If presenting with a new or concerning family history:
Gather details about affected family members (relationship to patient, age at diagnosis, specific cancer type).
Inquire about availability of genetic testing results for relatives (if applicable).
Past Medical History:
Include the date of Lynch syndrome diagnosis (if applicable).
Mention any personal history of cancer, particularly cancers associated with Lynch syndrome (colorectal, endometrial, ovarian, stomach, small bowel, ureteral, etc.).
List any relevant past medical history, including:
Family history of cancer (any type) in first-degree relatives (parents, siblings, children).
History of polyps on colonoscopy.
Medications:
List any current medications, particularly those related to cancer treatment or chemoprevention (e.g., aspirin).
Family History:
Create a detailed pedigree chart outlining family members with cancer diagnoses (type, age at diagnosis).
Include information on genetic testing results for relatives (if available).
Social History:
Inquire about diet, smoking history, and other lifestyle factors that may increase cancer risk.
Physical Exam:
General observation: Assess for overall health and any signs suggestive of underlying malignancy.
For patients with a personal history of cancer, perform a focused physical exam relevant to the specific cancer type.
Genetic Testing (if performed):
Mention if the patient has undergone genetic testing for Lynch syndrome and the specific gene mutation identified (if positive).
Assessment:
Lynch syndrome status: State whether the patient has confirmed Lynch syndrome (based on genetic testing), suspected Lynch syndrome (based on family history), or is at increased risk for Lynch syndrome (based on family history but not meeting full Amsterdam criteria).
Cancer risk: Briefly describe the patient’s increased risk for specific cancers associated with Lynch syndrome.
Plan:
Cancer surveillance:
Outline a personalized cancer surveillance plan based on the patient’s age, Lynch syndrome status, and specific cancer risks. This may include:
Colonoscopy with increased frequency (starting at a younger age)
Endometrial and ovarian cancer screening (e.g., transvaginal ultrasound, CA-125)
Upper endoscopy/gastric screening (depending on specific risk factors)
Other cancer-specific surveillance tests as indicated
Risk reduction strategies:
Discuss lifestyle modifications to reduce cancer risk (e.g., healthy diet, weight management, smoking cessation).
Consider chemoprevention options (e.g., low-dose aspirin) for specific cancers.
Genetic counseling: Recommend genetic counseling for the patient and at-risk family members to discuss Lynch syndrome inheritance, testing options, and cancer prevention strategies.
Education:
Educate the patient about Lynch syndrome, increased cancer risks, the importance of cancer surveillance, risk reduction strategies, and the availability of genetic counseling for themselves and at-risk family members.
Follow-up:
Schedule regular follow-up visits to monitor for any concerning symptoms and ensure adherence to cancer surveillance recommendations.
Advise the patient to return sooner if they experience any new symptoms suggestive of cancer or have questions about their screening plan.