Management Strategies

Individuals with suspected HDGC should undergo thorough pedigree analysis, education and counseling in regards to genetic testing, disclosure and interpretation of the results, and determination of cancer risk. A comprehensive review of surveillance strategies, chemo-prevention, surgical prophylaxis with its limitations and potential adverse effects, and the need for lifelong follow-up and screening for other malignancies is essential. Genetic testing and counseling guidelines for HDGC are provisional at this time and are only provided on an investigational basis. These guidelines are likely to change to parallel the ongoing scientific discovery of the genes responsible for the syndrome. Molecular techniques employed to detect germline mutations are summarized in Table 3. No currently available technique can guarantee the identification of all cancer-predisposing mutations in the CDH1 gene. The molecular method with the highest level of sensitivity in situations where a familial mutation has not yet been identified is DNA sequencing. Mutation-specific clinical testing is utilized primarily in families in which a mutation has previously been identified.

Table 2 Characteristics of the 18 families reported in the literature to have DHGC syndrome

Ethnic background Mutation Location and type of mutation Age at diagnosis of DGC (years)

Table 2 Characteristics of the 18 families reported in the literature to have DHGC syndrome

Maori[8]

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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