American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which condition is excluded in the Amsterdam Criteria for HNPCC?

1. Familial adenomatous polyposis

2. Chronic atrophic gastritis

3. Zollinger-Ellison syndrome

4. Endometrial cancer

The correct answer is: Familial adenomatous polyposis

The Amsterdam Criteria for hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, focus primarily on the identification of specific familial patterns that indicate a predisposition to certain types of cancer, particularly colorectal and endometrial cancers. These criteria require the presence of colorectal cancer in several family members and specific age criteria. Familial adenomatous polyposis (FAP) is a well-defined genetic condition characterized by the development of hundreds to thousands of polyps in the colon and rectum, typically beginning in teenage years. It is caused by mutations in the APC gene. Because FAP has a distinct genetic basis and predictive clinical presentation separate from the criteria that define HNPCC, it is excluded from the Amsterdam Criteria. On the other hand, chronic atrophic gastritis, Zollinger-Ellison syndrome, and endometrial cancer can be considered in the context of HNPCC due to their potential association with the syndrome. Endometrial cancer, for example, is recognized as an important aspect of HNPCC and is explicitly included in the risk profile for mutation carriers. Therefore, the exclusion of familial adenomatous polyposis is in line with the aim of the Amsterdam Criteria to focus on colorectal cancer synd