Unknown

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Unknown 133
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Case Presentation

• A healthy 53-year-old man has a colonoscopy as
  part of a routine screening examination. The
  endoscopist notes a single, 3.5 cm sessile polyp,
  which is resected and sent for pathologic
  evaluation.
• There is no family history of cancer or polyposis
  syndromes.

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Pathology report

• The pathologic report returns and describes the
  polyp as an adenoma with 70 tubular histology
  and 30 villous histology, extending to the
  margin of the polyp.

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Question

• When should you recommend the patient return for
  his next surveillance colonoscopy?
• 4 months
• 1 year
• 3 years
• 7-10 years
• No further colon cancer surveillance recommended

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Question

• When should you recommend the patient return for
  his next surveillance colonoscopy?
• 4 months
• 1 year
• 3 years
• 7-10 years
• No further colon cancer surveillance recommended

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Polyp surveillance

• Hyperplastic polyps require no increase in
  routine surveillance (unless part of a
  hyperplastic polyp syndrome)
• All adenomous polyps are considered dysplastic
  and should be thoroughly evaluated for risk of
  malignancy

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Polyp surveillance

• 1-2 small tubular adenomas with no or low grade
  dysplasia 5-10 years
• 3-10 adenomas, any villous, any high grade
  dysplasia or any gt1cm 3 years
• More than 10 adenomas 3 years at the longest
  use clinical judgment look for polyposis
  syndrome
• Sessile polyps removed piecemeal or if there is a
  concern that it was not fully resected (i.e.,
  margins not clear) 2-6 months to verify removal
• FAP / HNPCC more frequent surveillance

Winawer, SJ, Zauber, AG, Fletcher, RH, et al.
Guidelines for colonoscopy surveillance after
polypectomy a consensus update by the US
Multi-Society Task Force on Colorectal Cancer and
the American Cancer Society. Gastroenterology
2006 1301872.
OBJECTIVE Recommend future colon cancer
screening in a patient with adenomatous colonic
polyps on initial colonoscopy.