- Hereditary Breast and Ovarian Cancer syndrome (HBOC)
- Lynch syndrome/Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
- Familial Adenomatous Polyposis (FAP)/Attenuated Familial Adenomatous Polyposis (AFAP)
- MUTYH-associated Polyposis syndrome (MAP)
- MUTYH-associated Colon Cancer Risk
- Melanoma Cancer Syndrome (MCS)
- Li-Fraumeni Syndrome (LFS)
- PTEN Hamartoma Tumor syndrome (PHTS)
- Peutz-Jeghers Syndrome
- Hereditary Diffuse Gastric Cancer (HDGC) Syndrome
- Juvenile Polyposis Syndrome (JPS)
- Juvenile Polyposis Syndrome (JPS) and Hereditary Hemorrhagic Telangiectasia (HHT)
- PALB2-associated Cancer Risk
- CHEK2-associated Cancer Risk
- ATM-associated Cancer Risk
- NBN-associated Cancer Risk
- BARD1-associated Cancer Risk
- BRIP1-associated Cancer Risk
- RAD51C-associated Cancer Risk
- RAD51D-associated Cancer Risk
- Polymerase Proofreading-associated Syndrome (PPAS)
- Hereditary Mixed Polyposis Syndrome (HMPS)
Peutz-Jeghers Syndrome (PJS) STK11 ASSOCIATED CANCER RISKS
Peutz-Jeghers Syndrome (PJS)
STK11 ASSOCIATED CANCER RISKS
What does it mean to have a STK11 gene mutation, and a diagnosis of Peutz-Jeghers Syndrome (PJS)?
People with mutations in the STK11 gene have a condition called Peutz-Jeghers Syndrome, or PJS. People with PJS have a high risk for many different types of cancer, including breast, colon, pancreatic, stomach, small bowel, cervical, and endometrial. Women with PJS can also develop a type of ovarian tumor called a sex cord tumor, and men can develop tumors of the testes. These tumors do not usually become cancerous, but they do require medical attention. Cancers in people with PJS are often diagnosed at young ages.
One of the most common symptoms of PJS is an unusual type of polyp in the colon and other parts of the gastrointestinal system. These “Peutz-Jeghers polyps” can cause bleeding and/or blockages in the digestive system.
What can be done to protect people with PJS from cancer?
The National Comprehensive Cancer Network (NCCN) provides recommendations for lowering the risk of cancer in men and women with PJS. These recommendations include starting screening at younger ages than normal and having the screenings more often. For example, colonoscopies to check for colon cancer should begin in the late teenage years, and should be done every 2 to 3 years. Women with PJS should begin breast screening in their 20’s, and should have MRIs instead of, or in addition to, mammograms.
Because PJS is associated with many different cancer risks, it is recommended that people with mutations in the STK11 gene be cared for by healthcare professionals with experience in treating this condition.
Additional details about STK11 gene mutations and PJS, including information about the risks for different kinds of cancer, specific recommendations for medical care, and useful information for relatives of people who have a diagnosis of PJS, are available within our Support Organizations pags
Associated Syndrome Name: Peutz-Jeghers Syndrome (PJS)
STK11 Summary Cancer Risk Table
|Cancer||Genetic Cancer Risk|
|Female Breast||High Risk|
STK11 gene Overview
Peutz-Jeghers Syndrome (PJS) 1, 2, 3, 4, 5
- Individuals with mutations in the STK11 gene have a condition called Peutz-Jeghers Syndrome (PJS).
- Women with PJS have a risk for breast cancer that is significantly increased over the 12.5% lifetime risk for women in the general population of the United States. Individuals with PJS have high risks for a variety of other cancers, including colorectal, endometrial, gastric, pancreatic, small bowel, cervical and lung cancers. These cancers are often diagnosed at relatively young ages.
- The cervical cancer associated with PJS, adenoma malignum, which is also known as minimal deviation adenocarcinoma (MDA), may be difficult to diagnose.
- Women with PJS have an increased risk for ovarian neoplasms, including adenocarcinomas. However, sex cord tumors are the most common ovarian tumor found in these patients.
- Males with PJS have an increased risk for testicular tumors, particularly large cell calcifying Sertoli cell tumors (LCCSCT). These tumors have a low risk for malignancy, but if left untreated may lead to feminizing changes, advanced skeletal age and short stature.
- Patients with PJS are likely to develop hamartomatous gastrointestinal polyps with a distinctive Peutz-Jeghers histology. The most common location of these polyps is the small bowel, but they may also be found in the stomach, colon and nasal passages. Polyps may require treatment due to bleeding with subsequent anemia, recurrent obstruction and/or intussusception.
- Patients with PJS are likely to develop pigmented spots around the mouth, eyes, nostrils, anus and on the fingers during childhood. These spots are usually present by age 5 and often fade during puberty and adulthood.
- Although there are high risks for cancer and other medical problems in patients with PJS syndrome, these risks can be reduced with appropriate medical management. Guidelines from the National Comprehensive Cancer Network (NCCN) are listed below, and additional detailed discussions of medical management options are also available from other sources (see van Lier MG et al., Am J Gastroenterol. 2010, 105:1258-64 and Beggs AD et al. Gut. 2010, 59:975-86). Due to the complexity of the condition it is recommended that patients with STK11 mutations and a diagnosis of PJS be managed by a multidisciplinary team with experience in the prevention and treatment of the complications associated with this condition.
STK11 gene Cancer Risk Table
|Cancer Type||Age Range||Cancer Risk||Risk for General Population 6|
|Colorectal||To age 702, 4||39%||1.8%|
|Pancreatic||To age 702, 4||11%-36%||0.5%|
|Female Breast||To age 704||45%-50%||7.1%|
|Gastric||To age 702, 4||29%||0.4%|
|Small Bowel||To age 702, 4||13%||0.1%|
|Ovarian||To age 704||18%-21%||0.7%|
|Endometrial||To age 702, 4||9%||1.7%|
|Cervical||To age 702, 4||10%||0.5%|
|Testicular||To age 702||Elevated risk||0.4%|
|Lung||To age 702, 4||15%-17%||2.2%|
STK11 Cancer Risk Management Table
The overview of medical management options provided is a summary of professional society guidelines as of the last Myriad update shown on this page. The specific reference provided (e.g., NCCN guidelines) should be consulted for more details and up-to-date information before developing a treatment plan for a particular patient.
This overview is provided for informational purposes only and does not constitute a recommendation. While the medical society guidelines summarized herein provide important and useful information, medical management decisions for any particular patient should be made in consultation between that patient and his or her healthcare provider and may differ from society guidelines based on a complete understanding of the patient’s personal medical history, surgeries and other treatments.
|Cancer Type||Procedure||Age to Begin||Frequency |
(Unless otherwise indicated by findings)
|Colorectal||Colonoscopy4, 7, 10||Baseline at age 8, or earlier if symptomatic, with follow-up as needed||Every 2 to 3 years after age 18|
|Pancreatic||Magnetic resonance cholangiopancreatography (MRCP) with contrast or endoscopic ultrasound (EUS).4, 7, 9||30 to 35 years, or 10 years younger than the earliest age of diagnosis in the family||Every 1 to 2 years|
|Female Breast||Breast awareness - Women should be familiar with their breasts and promptly report changes to their healthcare provider. Periodic, consistent breast self-examination (BSE) may facilitate breast awareness.7, 12||18 years||NA|
|Clinical breast examination4||25 years||Every 6 months|
|Mammography and breast MRI with contrast4, 8||25 years||Annually|
|Gastric||Upper endoscopy4, 7, 10, 11||Baseline at age 8, or earlier if symptomatic, with follow up as needed||Every 2 to 3 years after age 18|
|Small Bowel||Small bowel visualization with CT, MRI enterography or video capsule endoscopy4, 7, 10||Baseline at 8 years, or earlier if symptomatic, with follow up as needed, but no later than age 18||Every 2 to 3 years after age 18|
|Ovarian||Physical exam, monitor for precocious puberty7||Childhood||Annually|
|Pelvic examination4, 7||18 to 25 years||Annually|
|Consider transvaginal ultrasound.4, 7||25 years||Annually|
|Endometrial||Pelvic examination4, 7||18 to 25 years||Annually|
|Consider transvaginal ultrasound.4, 7||25 years||Annually|
|Cervical||Pap smear4, 7||18 to 25 years||Annually|
|Testicular||Physical and testicular examination and observation for feminizing changes.4, 7, 10||Childhood||Annually|
|Lung||Provide education about symptoms and smoking cessation.4||As needed||As needed|
Information for Family Members
The following information for Family Members will appear as part of the MMT for a patient found to have a mutation in the STK11 gene.
A major potential benefit of myRisk genetic testing for hereditary cancer risk is the opportunity to prevent cancer in relatives of patients in whom clinically significant mutations are identified. Healthcare providers have an important role in making sure that patients with clinically significant mutations are informed about the risks to relatives, and ways in which genetic testing can guide lifesaving interventions.
Since STK11 mutations carry a risk for complications in children and some screenings are recommended to begin by age 8, consideration should be given to the possibility of mutation testing in childhood.
There are reports of cases where individuals with a mutation in STK11 have not inherited the mutation from a parent. In these cases the mutation has developed spontaneously in that individual (a de novo mutation). Once this occurs, the children of that individual are each at 50% risk of inheriting the mutation.1
- McGarrity TJ, et al. Peutz-Jeghers Syndrome. 2016 Jul 14. In: Pagon RA, et al., editors. GeneReviews® [Internet]. Available from http://www.ncbi.nlm.nih.gov/books/NBK1266/ PMID: 20301443.
- van Lier MG, et al. High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol. 2010 105:1258-64. PMID: 20051941.
- Beggs AD, et al. Peutz-Jeghers syndrome: a systematic review and recommendations for management. Gut. 2010 59:975-86. PMID: 20581245.
- Provenzale D, et al. NCCN Clinical Practice Guidelines in Oncology® Genetic/Familial High-Risk Assessment: Colorectal. V 1.2018. July 12. Available at http://www.nccn.org.
- Banno K, et al. Hereditary gynecological tumors associated with Peutz-Jeghers syndrome (Review). Oncol Lett. 2013 6:1184-1188. PMID: 24179492.
- Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute. https://seer.cancer.gov/faststats. (Accessed on 1-2-2017)
- Syngal S, et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015 110:223-62. PMID: 25645574.
- Daly M et al. NCCN Clinical Practice Guidelines in Oncology®: Genetic/Familial High-Risk Assessment: Breast and Ovarian. V 2.2019. July 30. Available at http://www.nccn.org.
- Canto MI, et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut. 2013 62:339-47. PMID: 23135763.
- Achatz MI, et al. Cancer Screening Recommendations and Clinical Management of Inherited Gastrointestinal Cancer Syndromes in Childhood. Clin Cancer Res. 2017 23:e107-e114. PMID: 28674119.
- Ajani JA, et al. NCCN Clinical Practice Guidelines in Oncology®: Gastric Cancer. V 2.2018. May 22. Available at http://www.nccn.org.
- Bevers TB, et al. NCCN Clinical Practice Guidelines in Oncology®: Breast Cancer Screening and Diagnosis. V 2.2018. May 18. Available at http://www.nccn.org.
Last Updated on 07-Nov-2018