What should you know about familial adenomatous polyposis (FAP)?

Familial adenomatous polyposis is an inherited condition causing numerous bowel polyps, so planned surveillance and specialist care are essential. The polyps begin in the large bowel and can develop into bowel cancer if they are not monitored and managed. FAP is linked to a change in the APC gene and can run through families.

Polyps may be present before symptoms appear. Some people develop rectal bleeding, altered bowel habit, abdominal discomfort, tiredness from blood loss, or weight change, but symptoms are not a reliable way to monitor the condition. A family history can be a clue, although a person may be the first in a family to be identified.

The condition needs more than one-off testing. Doctors may assess the large bowel and other digestive areas, review the family history, and arrange genetic counselling. The aim is to find polyps early and choose treatment before they cause obstruction, bleeding, or cancer.

Ask for referral to a specialist team experienced in inherited bowel conditions. Keep every surveillance appointment and follow the planned colonoscopy schedule. During colonoscopy, polyps may be sampled or removed when appropriate. If polyp burden becomes difficult to manage endoscopically, a bowel resection may be discussed; the decision depends on findings, symptoms, anatomy, and personal circumstances.

Genetic counselling can explain testing, inheritance, privacy, and what a result may mean for relatives. Tell close family members that a specialist can help them understand whether assessment is appropriate. Do not stop surveillance because you feel well.

Seek urgent care for heavy rectal bleeding, black stools, severe or worsening abdominal pain, repeated vomiting, a swollen abdomen, inability to pass stool or gas, fainting, or marked weakness. Contact your specialist promptly for a persistent change in bowel habit, unexplained weight loss, or new bleeding, even if your next planned examination is not due.

Has genetic testing confirmed FAP, and should relatives receive counselling? Which areas need surveillance? How often should colonoscopy be scheduled? Can the current polyps be removed endoscopically? When would bowel resection become advisable?