Podcast: Sue Clark – FAP: Familial Adenomatous Polyposis

To see our latest courses, or to donate to the St Mark's Hospital Foundation, please visit our channel description for details. Title: FAP: Familial Adenomatous Polyposis Speaker: Sue Clark Event: St Mark's Podcast Year: 2019 In this episode, Prof. Sue Clark, a leading colorectal surgeon and internationally recognised expert in hereditary colorectal cancer, provides a clear and authoritative overview of Familial Adenomatous Polyposis (FAP). She begins by outlining the genetic basis of the condition, explaining how pathogenic variants in the APC gene lead to the development of hundreds to thousands of colorectal adenomas, with an almost inevitable progression to cancer without intervention. Prof. Clark discusses the natural history of FAP, emphasising the importance of early diagnosis through genetic testing and the role of cascade screening in affected families. She highlights the need for lifelong surveillance, noting that management extends far beyond the colon to include duodenal, gastric, thyroid, and desmoid disease monitoring. A major focus of the episode is timing and choice of prophylactic surgery. Prof. Clark compares colectomy with ileorectal anastomosis and restorative proctocolectomy with ileal pouch formation, outlining the indications, functional outcomes, and long‑term cancer risks associated with each. She stresses that surgical decision‑making must be individualised, balancing polyp burden, rectal involvement, patient age, and lifestyle considerations.