Physician Referrals
Who should be referred to a genetics clinic for genetic counselling:
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Individuals from families with a known genetic mutation causing Lynch Syndrome, FAP or other GI related syndromes.
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Individuals with a clinical diagnosis of Peutz-Jeghers syndrome, juvenile polyposis, hereditary mixed polyposis, and their family members.
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Individuals with 10 or more adenomatous polyps verified by pathological examination and their close family members*
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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.
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Individuals diagnosed with colorectal cancer before the age of 35 along with their close family members*
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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*
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Individuals from families with familial pancreatic cancer
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Individuals from families with hereditary gastric cancer:
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three or more family members with gastric cancer, or
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one family member with gastric cancer diagnosed under the age of 35, or
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two siblings with early onset of gastric cancer (both under the age of 50)
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*Close family member = brother, sister, parent, child, aunt, uncle, grandparent, niece or nephew.
Click here to download the Physician Referral Form
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Please print out the form and fax it back to us at 416-586-5924.
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* Adobe Acrobat Reader will be required to open the file