Dear OncoLink "Ask The Experts,"
I had my first colonoscopy last month at age 45. A malignant polyp was found and removed. I was told that I had a good chance it was contained to that polyp. However, because of my age and family history of colon cancer, I [was told that I] should have surgery, [specifically] a colon resection, to make certain that there is no other malignancy nearby. What tests [or procedures] other than surgery can better predict the existence or non-existence of more cancer in my colon? I had blood work come back normal, and a CT scan is set for next week. I am very scared of surgery. Is it necessary?
Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and Rectal Surgery, responds:
This is a complicated question. The answer is...generally, it depends upon the polyp, not so much the patient's family history. There are certain circumstances when it may be ok to just excise a polyp that has a small focus of cancer within it. There are other circumstances that make this a risky maneuver in terms of leaving cancer behind.
Generally, the decision to proceed to surgery is made by examining the excised polyp carefully, taking into consideration the shape of the polyp (morphology), the pathologic characteristics of the polyp, and the margins of endoscopic resection. It is far too complicated an analysis to make a specific recommendation here, but after CT scans, blood tests, and endoscopy, there are really no other good tests except pathologic inspection of the area, and this requires a surgical approach.
May 7, 2010 - When gastrointestinal fellows -- especially third-year fellows -- are involved in the performance of routine screening colonoscopies, the detection rates for adenomas and polyps are increased, according to a study in the May issue of Clinical Gastroenterology and Hepatology.
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