Snapshot A 40-year-old woman presents to her primary care physician with pallor and fatigue. She complains of easy bruising in the past few weeks. A blood test comes back with values consistent with iron-deficiency anemia. On rectal exam, her PCP can feel discrete polyps. Pale red blood coats his finger after the exam. She is adopted and knows no family history of colon cancer. She is sent for a colonoscopy as soon as possible. Introduction Thousands of polyps in intestinal tract from genetic mutation Genetics login to view 5 more bullets Associated conditions login to view 10 more bullets Epidemiology Average age of presentation with symptoms is 36 years Average age of first polyp is 16 years Presentation Symptoms login to view 6 more bullets Physical exam login to view 8 more bullets Evaluation Based on endoscopy, family history, and genetic testing Complete blood count with iron deficiency anemia Endoscopy with biopsy login to view 2 more bullets Genetic testing login to view 1 more bullet Differential Peutz-Jegher syndrome Lynch syndrome Treatment Prophylactic surgical colectomy If severe duodenal polyposis login to view 1 more bullet Routine screening with colonoscopy and endoscopy Complications Inevitable progression to colorectal cancer if no surgery At risk for other malignancies login to view 4 more bullets Prognosis Almost normal prognosis with colonic screening and colectomy