SH-ZCCDD-RGB
Zane Cohen Centre for Digestive Diseases
Donate

We build knowledge to improve treatment

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