Who Would Benefit from Colorectal Cancer Genetic Testing?
1
A person with a strong family history of certain types of cancer
Determine if they carry a gene mutation that increases their risk. If they do have an inherited mutation, they might want to have screening tests to look for cancer early, or even take steps to try to lower their risk.
2
A person already diagnosed with cancer
This is especially true if there are other factors to suggest the cancer might have been caused by an inherited mutation (such as a strong family history or if the cancer was diagnosed at a young age). Genetic testing might show if the person has a higher risk of developing cancer. It can also help other family members decide if they want to be tested for the mutation.
3
Family members of a person known to have an inherited gene mutation that increases their risk of cancer
Testing can help them know if they need screening tests to look for cancer early, or if they should take steps to try to lower their risk.
How Do I Order a Test?
A printed copy of the requisition form must be submitted with the specimen if you are not placing your order through the online portal. You can find and print a copy of the requisition form here. If you need to modify your order, please contact client services.
Colorectal Panel Best Practices
Preferred Specimen
2mL whole blood in a purple-top EDTA tube (K2EDTA or K3EDTA)
Alternate Specimens
- Saliva
- Buccal swab
- gDNA
Let's get started!
How to Ship Your Samples
Follow IATA Regulations
Please note that Psomagen sample collection kits are built to protect the samples from being damaged during transport and to comply with the International Air Transport Association (IATA) regulation. If you are using packaging other than that provided by Psomagen, please make sure to follow the "three layers of packaging" rule to avoid the risk of having the package destroyed by the courier:
- A primary sample receptacle sealed (collection tube).
- A leak-proof specimen bag containing absorbent material.
- An outer packaging that meets the local postal regulations and is labeled as “Exempt Human Specimen.”
For more information please refer to page 187 of IATA Dangerous Goods Regulation.
Additional Shipment Requirements
For saliva, ship at room temperature (overnight shipping is not necessary).
For blood, we recommend using overnight shipping the same day that the blood is collected.
- Blood can be kept at room temperature for up to 48 hours.
- We request that blood is refrigerated no longer than two weeks.
- Please do not freeze blood as deletion/duplication analysis is not supported for frozen or partially frozen blood.
Please ship the specimen in a crush-proof container via FedEx Priority Overnight (in accordance with the FedEx Packaging Guidelines for Clinical Samples.
Our US Shipping Address
Attn: Clinical Laboratory Testing Personnel
Psomagen Inc.
1330 Piccard Drive, Ste 103
Rockville, MD 20850
Test for 22 related genes
Gene List
AXIN2
BMPR1A
CDH1
CHEK2
FAN1
GALNT12
GREM1
MLH1
MSH2
MSH6
MUTYH
PMS2
POLD1
POLE
SMAD4
STK11
TP53
Test Methodology and Limitations
DNA sequencing involves the extraction of genomic DNA from specimens collected in approved containers and provided the specimen meets required sample minimum quantity (e.g. volume, weight, etc). This is followed by quantification and qualification to ensure the adequacy of amount and purity for sequencing. Subsequently, whole exome sequencing is conducted on an IlluminaTM short read sequencing (SRS) platform (e.g., Novaseq X PlusTM) at Psomagen, Inc.’s laboratories (CLIA # 21D2062464, CAP # 8742212).
DNA sequence alignment, variant calling, and variant filtering are performed utilizing the Illumina DRAGENTM bioinformatics pipeline (version 4.2.4.) and various tool sets, which align reads to the human reference genome (GRCh38) and identify single nucleotide variants (SNVs) and small insertions/deletions (InDels). Variant annotations are performed using a pipeline available in Fabric Enterprise. Variant review and interpretation are conducted according to the standards and guidelines set forth by the American College of Medical Genetics and Genomics (Richards S, et al., Genet Med., 2015) by Fabric Clinical Labs (CLIA #45D2281059, CAP # 9619501). Only variants classified as pathogenic or likely pathogenic are reported. The following quality filters are applied to all variants: coverage <40x, allele balance outside 0.3-0.7.
Variants in the following genes are reported: APC, AXIN2, BMPR1A, CDH1, CHEK2, EPCAM, FAN1, GALNT12, GREM1, MLH1, MLH3, MSH2, MSH6, MUTYH, NTHL1, PMS2, POLD1, POLE, PTEN, SMAD4, STK11, TP53
This test is designed to detect single nucleotide variants (SNVs) and small insertions/deletions (InDels). Next-Generation Sequencing (NGS) coverage may vary across the genome, potentially resulting in missed variants in regions with low coverage depth. Some genetic abnormalities may be undetectable with the current version of this test. While the DRAGEN bioinformatics pipeline demonstrates high accuracy for variant calling, there remains a possibility of false positive or false negative results due to variant interpretation which relies on current scientific knowledge and available databases. This may lead to the reclassification of reported variants as new information emerges from ongoing research and is updated in the ACMG guidelines. Furthermore, systematic chemical, computational, or human errors may contribute to false positives or false negatives of DNA variants. For any reported variants, confirmation by orthogonal technology and subsequent consultation with a genetic counselor or qualified healthcare provider can help to establish definitive risk. This result should be considered preliminary until such confirmation has been performed.
Clinical management for this individual should be based on personal and family history, along with other relevant information. If considered relevant to this individual’s clinical presentation and/or family history, targeted testing of appropriate family members of this individual for the reported variants may help to interpret these results. For assistance with the interpretation of these results, healthcare professionals may contact Psomagen directly at (301) 251-1007 or support@psomagen.com.
More Resources
-
Howe JR, Roth S, Ringold JC, et al. Mutations in the SMAD4/DPC4 gene in juvenile polyposis. Science. 1998;280:1086. [PubMed] [Google Scholar]
-
Howe JR, Bair JL, Sayed MG, et al. Germline mutations of the gene encoding bone morphogenetic protein receptor 1A in juvenile polyposis. Nat Genet. 2001;28:184. [PubMed] [Google Scholar]
-
Calva-Cerqueira D, Chinnathambi S, Pechman B, et al. The rate of germline mutations and large deletions of SMAD4 and BMPR1A in juvenile polyposis. Clin Genet. 2009;75:79. [PubMed] [Google Scholar]
-
Gallione CJ, Repetto GM, Legius E, et al. A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4) Lancet. 2004;363:852. [PubMed] [Google Scholar]
-
Hemminki A, Markie D, Tomlinson I, et al. A serine/threonine kinase gene defective in Peutz-Jeghers syndrome. Nature. 1998;391:184. [PubMed] [Google Scholar]
-
Aretz S, Stienen D, Uhlhaas S, et al. High proportion of large genomic STK11 deletions in Peutz-Jeghers syndrome. Hum Mutat. 2005;26:513. [PubMed] [Google Scholar]
-
Buchet-Poyau K, Mehenni H, Radhakrishna U, et al. Search for the second Peutz-Jeghers syndrome locus: exclusion of the STK13, PRKCG, KLK10, and PSCD2 genes on chromosome 19 and the STK11IP gene on chromosome 2. Cytogenet Genome Res. 2002;97:171. [PubMed] [Google Scholar]
-
Mehenni H, Gehrig C, Nezu J, et al. Loss of LKB1 kinase activity in Peutz-Jeghers syndrome, and evidence for allelic and locus heterogeneity. Am J Hum Genet. 1998;63:1641. [PMC free article][PubMed] [Google Scholar]
-
Olschwang S, Boisson C, Thomas G. Peutz-Jeghers families unlinked to STK11/LKB1 gene mutations are highly predisposed to primitive biliary adenocarcinoma. J Med Genet. 2001;38:356. [PMC free article][PubMed] [Google Scholar]
-
Burt RW, Jass J. Hamilton SR, Aaltonen LA, editors. World Health Organisation Classification of Tumours Pathology and Genetics.Berlin: Springer-Verlag; 2000. Hyperplastic polyposis. p. 135.
-
Liaw D, Marsh DJ, Li J, et al. Germline mutations of the PTEN gene in Cowden disease, an inherited breast and thyroid cancer syndrome. Nat Genet. 1997;16:64. [PubMed] [Google Scholar]
-
Marsh DJ, Dahia PL, Zheng Z, et al. Germline mutations in PTEN are present in Bannayan-Zonana syndrome. Nat Genet. 1997;16:333. [PubMed] [Google Scholar]
-
Pilarski R. Cowden syndrome: a critical review of the clinical literature. J Genet Couns. 2009;18:13. [PubMed] [Google Scholar]
-
Carlson GJ, Nivatvongs S, Snover DC. Colorectal polyps in Cowden's disease (multiple hamartoma syndrome) Am J Surg Pathol. 1984;8:763. [PubMed] [Google Scholar]
-
Chen YM, Ott DJ, Wu WC, et al. Cowden's disease: a case report and literature review. Gastrointest Radiol. 1987;12:325. [PubMed] [Google Scholar]
-
Marra G, Armelao F, Vecchio FM, et al. Cowden's disease with extensive gastrointestinal polyposis. J Clin Gastroenterol. 1994;18:42. [PubMed] [Google Scholar]
-
Nelen MR, Kremer H, Konings IB, et al. Novel PTEN mutations in patients with Cowden disease: absence of clear genotype-phenotype correlations. Eur J Hum Genet. 1999;7:267. [PubMed] [Google Scholar]
-
Marsh DJ, Coulon V, Lunetta KL, et al. Mutation spectrum and genotype-phenotype analyses in Cowden disease and Bannayan-Zonana syndrome, two hamartoma syndromes with germline PTEN mutation. Hum Mol Genet. 1998;7:507. [PubMed] [Google Scholar]
-
Tsou HC, Teng DH, Ping XL, et al. The role of MMAC1 mutations in early-onset breast cancer: causative in association with Cowden syndrome and excluded in BRCA1-negative cases. Am J Hum Genet. 1997;61:1036. [PMC free article][PubMed] [Google Scholar]
-
Zhou XP, Waite KA, Pilarski R, et al. Germline PTEN promoter mutations and deletions in Cowden/Bannayan-Riley-Ruvalcaba syndrome result in aberrant PTEN protein and dysregulation of the phosphoinositol-3-kinase/Akt pathway. Am J Hum Genet. 2003;73:404. [PMC free article][PubMed] [Google Scholar]
-
Chibon F, Primois C, Bressieux JM, et al. Contribution of PTEN large rearrangements in Cowden disease: a multiplex amplifiable probe hybridisation (MAPH) screening approach. J Med Genet. 2008;45:657. [PubMed] [Google Scholar]
-
Groden J, Thliveris A, Samowitz W, et al. Identification and characterization of the familial adenomatous polyposis coli gene. Cell. 1991;66:589. [PubMed] [Google Scholar]
-
Nishisho I, Nakamura Y, Miyoshi Y, et al. Mutations of chromosome 5q21 genes in FAP and colorectal cancer patients. Science. 1991;253:665. [PubMed] [Google Scholar]
-
Friedl W, Caspari R, Sengteller M, et al. Can APC mutation analysis contribute to therapeutic decisions in familial adenomatous polyposis? Experience from 680 FAP families. Gut. 2001;48:515. [PMC free article][PubMed] [Google Scholar]
-
Powell SM, Petersen GM, Krush AJ, et al. Molecular diagnosis of familial adenomatous polyposis. N Engl J Med. 1993;329:1982. [PubMed] [Google Scholar]
-
van der Luijt RB, Khan PM, Vasen HF, et al. Molecular analysis of the APC gene in 105 Dutch kindreds with familial adenomatous polyposis: 67 germline mutations identified by DGGE, PTT, and southern analysis. Hum Mutat. 1997;9:7. [PubMed] [Google Scholar]
-
Aretz S, Stienen D, Uhlhaas S, et al. Large submicroscopic genomic APC deletions are a common cause of typical familial adenomatous polyposis. J Med Genet. 2005;42:185. [PMC free article][PubMed] [Google Scholar]
-
Bunyan DJ, Eccles DM, Sillibourne J, et al. Dosage analysis of cancer predisposition genes by multiplex ligation-dependent probe amplification. Br J Cancer. 2004;91:1155. [PMC free article][PubMed] [Google Scholar]
-
De Rosa M, Scarano MI, Panariello L, et al. Three submicroscopic deletions at the APC locus and their rapid detection by quantitative-PCR analysis. Eur J Hum Genet. 1999;7:695. [PubMed] [Google Scholar]
-
Nielsen M, Bik E, Hes FJ, et al. Genotype-phenotype correlations in 19 Dutch cases with APC gene deletions and a literature review. Eur J Hum Genet. 2007;15:1034. [PubMed] [Google Scholar]
-
Sieber OM, Lamlum H, Crabtree MD, et al. Whole-gene APC deletions cause classical familial adenomatous polyposis, but not attenuated polyposis or "multiple" colorectal adenomas. Proc Natl Acad Sci U S A. 2002;99:2954. [PMC free article][PubMed] [Google Scholar]
-
Nielsen M, Hes FJ, Nagengast FM, et al. Germline mutations in APC and MUTYH are responsible for the majority of families with attenuated familial adenomatous polyposis. Clin Genet. 2007;71:427. [PubMed] [Google Scholar]
-
Knudsen AL, Bisgaard ML, Bulow S. Attenuated familial adenomatous polyposis (AFAP). A review of the literature. Fam Cancer. 2003;2:43. [PubMed] [Google Scholar]
-
Al-Tassan N, Chmiel NH, Maynard J, et al. Inherited variants of MYH associated with somatic G:C-->T:A mutations in colorectal tumors. Nat Genet. 2002;30:227. [PubMed] [Google Scholar]
-
Poulsen ML, Bisgaard ML. MUTYH Associated Polyposis (MAP) Curr Genomics. 2008;9:420. [PMC free article][PubMed] [Google Scholar]
-
Aretz S, Uhlhaas S, Goergens H, et al. MUTYH-associated polyposis: 70 of 71 patients with biallelic mutations present with an attenuated or atypical phenotype. Int J Cancer. 2006;119:807. [PubMed] [Google Scholar]