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Lynch Syndrome via the MSH2 Gene

Summary and Pricing

Test Method

Sequencing and CNV Detection via NextGen Sequencing using PG-Select Capture Probes
Test Code Test Copy GenesTest CPT Code Gene CPT Codes Copy CPT Codes Base Price
4863 MSH2 81295 81295,81297 $540 Order Options and Pricing
Test Code Test Copy Genes Test CPT Code Gene CPT Codes Copy CPT Code Base Price
4863MSH281295 81295(x1), 81297(x1) $540 Order Options and Pricing

Pricing Comments

This test is also offered via our exome backbone with CNV detection (click here). The exome-based test may be higher priced, but permits reflex to the entire exome or to any other set of clinically relevant genes.

An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.

Turnaround Time

18 days on average for standard orders or 13 days on average for STAT orders.

Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.

Targeted Testing

For ordering sequencing of targeted known variants, go to our Targeted Variants page.

EMAIL CONTACTS

Genetic Counselors

Geneticist

  • Hannah Cox, PhD

Clinical Features and Genetics

Clinical Features

Lynch Syndrome, also called Hereditary Nonpolyposis Colorectal Cancer (HNPCC), is an inherited cancer syndrome caused by germline pathogenic variants in DNA mismatch repair (MMR) genes. MMR genes encode proteins that repair small sequence errors, or mismatches, during DNA replication. Pathogenic variants in a single mismatch repair gene can cause widespread genomic instability characterized by the expansion or contraction of short tandem repeat sequences, or microsatellites (Grady and Carethers. 2008. PubMed ID: 18773902). This phenomenon of microsatellite instability (MSI) leads to somatic mutations in oncogenes and/or tumor suppressor genes, including TGFβIIR and NF1 among others (Wang et al. 2003. PubMed ID: 12522551). As a result, Lynch Syndrome is marked by early onset and high lifetime risk of cancer, particularly in the right colon but also in the endometrium, ovary, stomach, bile duct, kidney, bladder, ureter, and brain (Jang and Chung. 2010. PubMed ID: 20559516). Clinical hallmarks of Lynch Syndrome, as delineated by the Amsterdam criteria, include heritable colorectal (Type I) or extracolonic (Type II) cancer, present in at least three relatives over at least two consecutive generations, with an onset of cancer before the age of 50 in at least one case, and pathological MSI within tumors (Vasen et al. 1999. PubMed ID: 10348829).

Genetics

Lynch Syndrome is an autosomal dominant disease and caused by germline pathogenic variants in one of six MMR genes: MLH1, MSH2, MSH6 and PMS2 (Peltomäki and Vasen. 2004. PubMed ID: 15528792). Pathogenic variants in MLH1 and MSH2 account for 80-90% of all Lynch patients and most frequently occur in families meeting the Amsterdam I criteria. Pathogenic variants in MSH6 and PMS2 account for the remaining Lynch patients, and are often found in families with atypical HPNCC symptoms, such as low rates of MSI and/or extracolonic carcinomas.

More than 500 pathogenic variants have been reported in the MSH2 gene, half of which are single nucleotide substitutions, small insertions/deletions or splice site mutations (Human Gene Mutation Database, www.hgmd.cf.ac.uk; www.insight-group.org). The other half are large deletions and not detectable by sequencing. In particular, a deletion of exons 1-6 is found in many North American families, but not found in European or Australian patients (Lynch et al. 2004. PubMed ID: 14871915). A germline inversion of exons 1-7 in MSH2 has been reported in fourteen individuals from eleven un-related families clinically presenting with Lynch syndrome associated phenotypes including colorectal, endometrial, gastric, and ovarian cancer (Wagner et al. 2002. PubMed ID: 12203789; Rhees et al. 2013. PubMed ID: 24114314; Mork et al. 2016. PubMed ID: 28004223).

Clinical Sensitivity - Sequencing with CNV PG-Select

Depending on the clinical criteria used to make a diagnosis (Amsterdam or “Revised Bethesda”), 15-20% of Lynch patients have a detectable MSH2 pathogenic variant (Syngal et al. 2000. PubMed ID: 10978352).

Testing Strategy

This test provides full coverage of all coding exons of the MSH2 gene, plus ~10 bases of flanking noncoding DNA. We define full coverage as >20X NGS reads or Sanger sequencing. It also includes testing for the inversion of exons 1-7 in MSH2.

Indications for Test

Candidates for this test are patients with a Lynch Syndrome diagnosis, and relatives of patients who have a verified MSH2 pathogenic variant. This test is specifically designed for heritable germline mutations and is not appropriate for the detection of somatic mutations in tumor tissue.

Gene

Official Gene Symbol OMIM ID
MSH2 609309
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT

Disease

Name Inheritance OMIM ID
Lynch Syndrome I AD 120435

Related Tests

Name
Colorectal Cancer Predisposition via the POLD1 Gene
Colorectal Cancer Predisposition via the POLE Gene
Hereditary Breast and Ovarian Cancer - High Risk and Lynch Syndrome Panel
Hereditary Endometrial Cancer Panel
Lynch Syndrome via the EPCAM Gene
Lynch Syndrome via the MLH1 Gene
Lynch Syndrome via the MLH3 Gene
Lynch Syndrome via the PMS2 Gene
Lynch Syndrome via MSH6 Gene

Citations

  • Grady and Carethers. 2008. PubMed ID: 18773902
  • Human Gene Mutation Database.
  • International Society for Gastrointestinal Hereditary Tumours..
  • Jang and Chung. 2010. PubMed ID: 20559516
  • Lynch et al. 2004. PubMed ID: 14871915
  • Mork et al. 2016. PubMed ID: 28004223
  • Peltomäki and Vasen. 2004. PubMed ID: 15528792
  • Rhees et al. 2013. PubMed ID: 24114314
  • Syngal et al. 2000. PubMed ID: 10978352
  • Vasen et al. 1999. PubMed ID: 10348829
  • Wagner et al. 2002. PubMed ID: 12203789
  • Wang et al. 2003. PubMed ID: 12522551

Ordering/Specimens

Ordering Options

We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.

myPrevent - Online Ordering

  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
  • PGnome sequencing panels can be ordered via the myPrevent portal only at this time.

Requisition Form

  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.

For Requisition Forms, visit our Forms page


Specimen Types

Specimen Requirements and Shipping Details

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ORDER OPTIONS

View Ordering Instructions

1) Select Test Method (Backbone)


1) Select Test Type


2) Select Additional Test Options

STAT and Prenatal Test Options are not available with Patient Plus.

No Additional Test Options are available for this test.

Note: acceptable specimen types are whole blood and DNA from whole blood only.
Total Price: $
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