Physician Referrals

Who should be referred to a genetics clinic for genetic counselling:

• Individuals from families with a known genetic mutation causing Lynch Syndrome, FAP or other GI related syndromes.

• Individuals with a clinical diagnosis of Peutz-Jeghers syndrome, juvenile polyposis, hereditary mixed polyposis, and their family members.

• Individuals with 10 or more adenomatous polyps verified by pathological examination and their close family members*

• Individuals from families with multiple cases of cancer related to HNPCC. These cancers include colorectal, endometrial, small bowel, ureter, kidney, stomach, ovarian, pancreatic, brain, hepatobiliary, sebaceous adenoma/carcinoma. There must be at least one relative with colorectal cancer or endometrial cancer.

• Individuals diagnosed with colorectal cancer before the age of 35 along with their close family members*

• Individuals with more than one primary HNPCC-related cancer diagnosis (including: colorectal, endometrial, small bowel, ureter, kidney, stomach, ovarian, pancreatic, brain, hepatobiliary, sebaceous adenoma/carcinoma) along with their close family members*

• Individuals from families with familial pancreatic cancer

• Individuals from families with hereditary gastric cancer:

  • three or more family members with gastric cancer, or

  • one family member with gastric cancer diagnosed under the age of 35, or

  • two siblings with early onset of gastric cancer (both under the age of 50)

*Close family member = brother, sister, parent, child, aunt, uncle, grandparent, niece or nephew.

Click here to download the Physician Referral Form

• Please print out the form and fax it back to us at 416-586-5924.

• * Adobe Acrobat Reader will be required to open the file