Skip to main contentShah's Gastro, Cancer & Robotic Surgery Centre · Ahmedabad & Gandhinagar
Last updated: 15-Oct-2026
Inherited bowel and stomach cancer · Gota OPD, Gota, Ahmedabad · Apollo Hospital, Bhat, Gandhinagar
Some families carry a gene change that makes bowel, stomach or womb cancer much more likely. Finding it early lets cancer be prevented, not only treated.
Most people with such a gene never need a large operation straight away. Regular checks, polyp removal and sometimes medicines come first.
The person found first is only the start. Testing brothers, sisters, children and parents is where most of the benefit lies.
Each syndrome comes from a change in a known gene. The gene decides which organs are at risk and which checks you need.
Shah’s Gastro, Cancer & Robotic Surgery Centre. Two higher degrees in surgery of the digestive system, and 18 years of experience in GI and cancer surgery. Colonoscopy and upper endoscopy, genetic counselling, the tumour board, surgery, the stoma nurse, the dietitian and follow-up work in one pathway.
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Every patient with a known or suspected syndrome is discussed at a tumour board that includes genetics, before any cancer operation.
| Syndrome | Gene | Organs that need watching |
|---|---|---|
| Lynch syndrome. | MLH1, MSH2, MSH6, PMS2 or EPCAM. | Bowel and womb most of all. Also ovary, stomach, small bowel, urine tract and pancreas. |
| Familial adenomatous polyposis, or FAP. | APC. | The whole large bowel, then the duodenum. Also desmoid tumours and the thyroid. |
| Attenuated FAP. | APC. | Large bowel, later in life and with fewer polyps. Also the duodenum. |
| MUTYH-associated polyposis. | Both copies of MUTYH. | Large bowel and duodenum. |
| Peutz-Jeghers syndrome. | STK11. | Small bowel polyps that can block the bowel. Also breast, pancreas and stomach. |
| Juvenile polyposis. | SMAD4 or BMPR1A. | Large bowel and stomach. SMAD4 carriers also need blood vessel checks. |
| Hereditary diffuse gastric cancer. | CDH1. | The stomach, and the breast in women. |
| PTEN hamartoma syndrome. | PTEN. | Bowel, breast, thyroid, womb and kidney. |
Serrated polyposis is also covered. It is diagnosed from the number and type of serrated polyps. Within Lynch syndrome, the exact gene matters. MLH1 and MSH2 carry a higher and earlier bowel risk than MSH6 and PMS2. Checks and surgery are set for your gene, not for the syndrome name alone.
Testing starts with a family history and with a test on the tumour itself. Either can point to an inherited cause.
Every colon, rectal and womb cancer treated here has a test on the tumour, called MMR or MSI. It is done whatever your age or family history. This is how most Lynch families are found. Stomach and small bowel cancers are tested when needed.
| What is seen | What it may point to |
|---|---|
| Bowel or womb cancer before the age of 50. | Lynch syndrome. |
| A tumour test showing the MMR or MSI change, without a non-inherited explanation. | Lynch syndrome. |
| More than one Lynch-type cancer in one person. | Lynch syndrome. |
| Two or more relatives with Lynch-type cancers. | Lynch syndrome. |
| Ten or more bowel adenomas over a lifetime. | FAP, attenuated FAP or MUTYH polyposis. |
| More than a hundred adenomas. | Classic FAP. |
| A desmoid tumour, a jaw bone lump or certain skin cysts. | FAP. |
| Dark spots on the lips or mouth, small bowel polyps, or a blocked bowel in a young person. | Peutz-Jeghers syndrome. |
| Five or more juvenile polyps, or a family history of them. | Juvenile polyposis. |
| Diffuse stomach cancer before 50, two family cases, or lobular breast cancer. | Hereditary diffuse gastric cancer. |
A family tree covering three generations is taken from every patient with a GI cancer. It lists each cancer, the age it was found and the side of the family. It takes about five minutes, and it is the step most often missed.
A gene test is never done blind. Counselling comes first, so you know what a result can mean for you and your family.
Cost matters, so it is talked about at the start. Testing one affected person with a panel, and then testing relatives only for that one known change, costs far less than a panel for everyone.
A gene result is not a diagnosis of cancer. It tells you how closely to be watched, and whether a preventive step should be discussed.
| Result | What usually follows |
|---|---|
| A clear disease-causing change in a known gene. | A check plan for that gene. Relatives are offered the same single test. |
| A change of unclear meaning. | No operation is done because of it. Checks follow your family history, and the result is reviewed over time. |
| No change found, but a striking family history. | Checks are still set by the family history. Not every inherited cause can be found yet. |
| Your family’s known change is absent in you. | Your risk is usually that of the general public. Your doctor confirms which checks you still need. |
A polyp is a small growth on the bowel lining. Most are not cancer, but some types can turn into cancer if left alone.
Benign growths and cancers can look alike on a scan. Only the colonoscopy, the biopsy and the pathologist’s report tell them apart. The type of polyp also helps name the syndrome.
| What the colonoscopy and biopsy show | What it means |
|---|---|
| A few adenomas, with no family pattern. | Common polyps. They are removed, and checks follow the usual schedule. |
| Many adenomas, or adenomas at a young age. | A polyposis syndrome is looked for. Adenomas are a step before cancer. |
| Hamartomas, which are a different kind of polyp. | Peutz-Jeghers or juvenile polyposis is looked for. They can bleed or block the bowel. |
| Many serrated polyps. | Serrated polyposis is checked against set criteria. |
| A polyp with high-grade change in its cells. | Close to cancer. Removal and a shorter check interval, or surgery, are discussed. |
| A cancer. | It is treated as a cancer. The syndrome then changes how much is removed. |
| A desmoid tumour in a person with FAP. | Not a cancer that spreads, but it can grow and press on organs. It has its own plan. |
Treatment climbs a ladder. Most people stay on the lower steps for years. Surgery is used when checks alone can no longer keep you safe.
Many carriers never need a preventive operation. The decision rests on your gene, your age, what the checks find and your own choice.
| Situation | Usual plan instead of an operation |
|---|---|
| Lynch syndrome without any cancer. | Regular colonoscopy, and an aspirin discussion. Women discuss womb and ovary checks. |
| Attenuated FAP or MUTYH polyposis with few polyps. | Polyps removed through the scope. The operation is put off while this stays safe. |
| A gene change of unclear meaning. | No operation is done because of it. |
| Peutz-Jeghers with polyps that can be reached. | Polyps removed through the scope, and bowel kept at every step. |
| A desmoid tumour after FAP surgery. | Not removed by reflex, because surgery can make desmoids grow. |
| A CDH1 carrier who declines stomach removal. | Close endoscopy with many biopsies, at a specialist centre. It is weaker protection, and you are told so plainly. |
| An older MSH6 or PMS2 carrier with a bowel cancer. | Removing only the affected part, with close checks after, can be a sound choice. |
In a hereditary syndrome, the gene changes the operation. The extent is a shared decision, written down after the tumour board.
| Syndrome | What is discussed | Timing |
|---|---|---|
| Lynch, with a bowel cancer. | Removing most or all of the colon, rather than only the affected part. | At the time of the cancer operation. |
| Lynch, with a rectal cancer. | Removing the colon and rectum, or the rectum alone with checks of the rest. | At the time of the cancer operation. |
| Lynch, in women who have finished their family. | Removing the womb, tubes and ovaries. | Ideally during the bowel operation, to avoid a second one. |
| Classic FAP. | Removing the colon before cancer forms. | Usually late teens to early twenties. |
| Attenuated FAP or MUTYH. | The same choice, guided by the number of polyps. | Later, when polyps cannot be controlled. |
| FAP, duodenum. | Removal through the scope, or an operation on the duodenum. | When duodenal polyps reach the most severe stage, or show high-grade change. |
| Peutz-Jeghers. | Clearing small bowel polyps with a scope during surgery, saving bowel. | For a blocked bowel, or large polyps. |
| CDH1 carrier. | Removing the whole stomach before cancer forms. | Usually between 18 and 40. |
| Juvenile polyposis. | Removing the colon or stomach. | For polyps that cannot be controlled, bleeding or high-grade change. |
For a cancer found in a carrier, the cancer is treated by its own organ plan. You can read how a colon cancer is staged and treated on our colon cancer treatment page, and how stomach cancer is planned on our stomach cancer page. The syndrome then adds to that plan.
When the colon is removed for FAP, two operations are possible. The choice depends on polyps in the rectum, the gene site and your wishes.
| Colon removed, small bowel joined to the rectum | Colon and rectum removed, with a pouch | |
|---|---|---|
| Name. | Total colectomy with ileorectal anastomosis. | Restorative proctocolectomy with an ileal pouch. |
| Bowel function. | Better. | More frequent motions. |
| Cancer risk left behind. | The rectum can still form polyps or cancer. | The rectal risk is removed. |
| Checks after. | The rectum is checked for life. | The pouch is checked for life. |
| Suits. | Few polyps in the rectum. | Many polyps in the rectum. |
| Other points. | A later second operation may be needed. | Fertility in women may fall. This is discussed before surgery. |
Checks are the main treatment for most carriers. They start early, continue for life, and are set for your exact gene.
| Syndrome | Usual checks |
|---|---|
| Lynch. | Colonoscopy every one to two years from age 20 to 25, later for MSH6 and PMS2. Womb and ovary review, a stomach scope, and urine tests where needed. |
| FAP. | Colonoscopy every year from age 10 to 15 until surgery. A side-viewing upper scope for life. Thyroid ultrasound. Rectum or pouch checks after surgery. |
| Attenuated FAP or MUTYH. | Colonoscopy every one to two years from the late teens or twenties. Upper scope checks. |
| Peutz-Jeghers. | Small bowel checks by capsule or MRI from childhood. Colonoscopy and upper scope. Breast, pancreas, womb, ovary and testis checks. |
| Juvenile polyposis. | Colonoscopy and upper scope from the mid-teens. SMAD4 carriers have blood vessel checks of the lungs and brain. |
| CDH1. | Stomach removal, or close scope checks with many biopsies. Yearly breast MRI from age 30 in women. |
In FAP, removing the colon does not end the checks. The duodenum, near the bile duct opening, now needs the closest watching. A side-viewing scope and a set grading of duodenal polyps decide how often you come back.
Once your gene change is known, each close relative can have a simple test for that same change. A negative result usually means routine checks only.
MUTYH polyposis is passed on differently. Both copies of the gene must be changed. Parents are usually healthy carriers, brothers and sisters may be affected, and children are usually carriers only. Inheritance, pregnancy and family planning options are also discussed.
Some problems cannot wait for the next planned check. These signs need a call to the clinic the same day.
| Sign | What it may mean |
|---|---|
| Cramping belly pain and vomiting in a young person with Peutz-Jeghers. | A polyp has pulled the bowel into itself. It needs urgent care. |
| A lump in the belly after FAP surgery. | A desmoid tumour. Scans and a biopsy come first. |
| Low blood count or yellow eyes after colectomy for FAP. | A growth in the duodenum. An upper scope is needed. |
| Bleeding from the back passage after the rectum was kept. | A polyp or cancer in the rectum. A prompt scope check. |
| Nose bleeds or breathlessness in a SMAD4 carrier. | Abnormal blood vessels. Lung and brain checks. |
| Bleeding, a blocked bowel or a burst bowel in any polyposis patient. | An emergency for the consultant surgeon. |
A preventive operation is done on a well person. It is never rushed, and it is talked through over more than one visit.
| Step | Why |
|---|---|
| Counselling over more than one visit. | You have time to weigh the operation against lifelong checks. |
| A stoma nurse marks a site, where a pouch or rectal removal is planned. | A well-placed stoma is easier to care for, if one is needed. |
| Fertility advice for women before a pouch. | A pouch can lower the chance of pregnancy. |
| A dietitian before stomach removal. | Eating changes for life, so it is planned in advance. |
| Psychological support. | Removing a healthy organ is different from treating a cancer. |
| The usual preparation for that operation. | Blood count, sugar, nutrition and clot prevention, as for any major surgery. |
The operation’s own risks apply. On top of them, each preventive operation changes daily life in its own way, and you are told before you agree.
| Operation | What can change afterwards |
|---|---|
| Most of the colon removed. | Looser and more frequent motions, usually easing over months. |
| A pouch. | Pouch inflammation, frequent motions, and lower fertility in women. |
| Small bowel joined to the rectum. | The rectum stays at risk, so it is checked for life. |
| Whole stomach removed for CDH1. | Small frequent meals, vitamin B12 injections for life, weight loss that may not fully return, and dumping after meals. |
| Any operation in FAP. | Desmoid tumours can form, and surgery can trigger them. |
| Any of these. | Bleeding, infection, a leak from a join, and clots. The risk to life is explained in person. |
The removed organ may show no cancer at all. That is the aim, and it counts as a success, not a wasted operation. Your own figures are explained in person before consent.
★★★★★
“(Translated by Google) Dr. Harsh Shah's personality is very nice. He always talks in a good way. He has undergone surgery for colon cancer. Without any problem. Yours faithfully.🙏 (Original) ડૉ હર્ષ શાહ નો સ્વાભાવ ખૂબ જ સરસ છે.તેઓ હમેશા સારી રીત વાત કરે છે .મોટા આંતરડા ના કેન્સર ની સર્જરી એમને કરેલ લી છે. કોઈ પ્રકાર ની તકલીફ નાથી .આપનો અભર.🙏”
— Ismailbhai Shaikh, Google review
★★★★★
“Met with Dr. Harsh Shah for the consultation of one of my relative. Dr. Harsh Shah is an exceptional surgical oncologist in Ahmedabad. His expertise in treating complex GI cancers like liver, pancreas, and colon cancers is truly remarkable. He explains everything clearly and gives patients full confidence in their treatment. Highly recommended for anyone looking for a skilled and compassionate cancer specialist.”
— Nagesh Patidar, Google review
★★★★★
“My father has carcinoma of stomach ,Harsh sir did radical gastrectomy and he is recovering very nicely under Dr.Harsh's observation ,he listen each and every complain calmly and with patience and make patient very comfortable during treatment , during procedure and during stay at hospital. we are satisfied with the treatment and very confident about the fully recovery of disease as we are under treatment of Dr.Harsh & team.Thank you Dr.Harsh & his whole team and staff.”
— tina parmar, Google review
Reviews are shown exactly as written on Google. None of them is from a family with an inherited syndrome. The first describes colon cancer surgery. The other two speak about his cancer care more widely.
A patient’s own account after a colon cancer operation by Dr Harsh Shah, shared with consent. It is not a hereditary syndrome case. Whether any treatment suits you is decided only after your own tests, counselling and the tumour board.
Gene testing, scope checks and surgery are priced very differently. Cost is discussed early, and you get a written estimate before each step.
Apollo Hospital, Bhat works with the major insurers and cashless schemes. Its office handles pre-authorisation for operations. Please bring every report, any gene test result, past operation notes, your medicine list, your insurance card and an ID.
No. It means a higher risk than usual. Regular checks and timely steps can prevent many of these cancers.
Once your change is known, your parents, brothers, sisters and children first. Then wider relatives on that side.
Not always. In classic FAP it is usually advised. In Lynch syndrome it is discussed only when a bowel cancer is found.
Early CDH1 cancers are hard to see on a scope. Removing the stomach protects far more reliably than scope checks, but it is your choice.
In Lynch syndrome, a daily aspirin lowers bowel cancer risk. It is discussed with you, weighing the bleeding risk.
No operation is done because of an unclear result. Checks follow your family history.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultations, family risk review, review of scans and reports, second opinions, follow-up.
Google: Dr Harsh Shah · 4.89 · 216 reviews
Directions to the Gota clinic · +91-63555-64601
Apollo Hospital — Bhat, Gandhinagar
Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar.
Colonoscopy and upper endoscopy, preventive and cancer surgery, intensive care and inpatient care.
Google: Dr Harsh Shah – Robotic GI Surgeon · 4.94 · 18 reviews
Directions to Apollo, Bhat · WhatsApp +91-63555-64601
Patients come to Ahmedabad from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Many relatives with bowel or stomach cancer, cancer at a young age, or many polyps on colonoscopy? The family tree, colonoscopy and biopsy reports, any gene test and past operation notes can be sent ahead, so the consultation starts with them already read. Treatment is decided at the consultation, after examination and at the tumour board. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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