Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps

Age‐related vulnerabilities of older adults with colon adenomas

“…Moreover, CRC incidence nearly doubles each decade until around age 80 years, and 5-year survival rates are comparable among persons Ͻ 65 years and Ͼ 65 years, making the older population a key CRC screening target. 40 Ideally, older patients with colon adenomas should have follow-up colonoscopy screening Confidence (1)(2)(3)(4)(5) in ability to change all health habits in the next 6 mos (mean Ϯ SD) 3.7 Ϯ 0.9 3.7 Ϯ 0.9 NS SD: standard deviation; CRC: colorectal carcinoma; NS: not significant. a P values were based on Student t tests for continuous dependent variables and on chi-square tests for categoric dependent variables.…”

“…2 CRC arises from neoplastic adenomatous polyps, 5 the prevalence of which increases from 20% to 25% at age 50 years and to 50% percent by ages 75-80 years. 6 Research demonstrates that, although most CRC can be prevented by early endoscopic resection of colon adenomas, 5 patients who have polyps removed have a 30% likelihood of developing recurrent polyps, 7,8 and many do not undergo additional screening. 9 Because polyp risk increases with age, interventions among older adults to prevent recurrent polyps likely would reduce the absolute number of CRC diagnoses among those at highest risk for the disease.…”

Pathology of Staging of Early Colorectal Lesions During Surveillance Programmes

“…Whilst the morbidity and mortality associated with colonoscopy might be considered acceptable for patients with signs and symptoms of the disease, they are unacceptable as a first line population screening. Perforation and clinically significant bleeding occur after colonoscopic polypectomy in about 0.2% and 1% of cases, respectively (Bond, 2000). Flexible sigmoidoscopy carries significantly lower risk but will miss some 30 to 40% of proximal lesions (Halloran, 2009).…”

“…Histologically, colorectal polyps are divided into neoplastic or nonneoplastic and it is well known that more than 95% of CRC arise from neoplastic adenomatous polyps (adenomas) (Bond, 2000;Morson, 1966) through the well documented adenoma-carcinoma sequence (Muto et al, 1975). By definition, all adenomas show dysplasia and is divided into either low or high grade Riddell et al, 1983) and architecturally into either tubular, tubulovillous or villous types according to the WHO classification (Hamilton and Aaltonen, 2000).…”

“…Another review of endoscopically resected polyps with poor prognostic factors (poorly differentiated cancer, margin involvement, or presence of lymphatic or vascular invasion) reported residual cancer in 8.5% and 14.4%, for patients with pedunculated and sessile malignant polyps, respectively (Coverlizza et al, 1989). The American College of Gastroenterologist recommends no further treatment if the polyp is considered to be completely excised by the endoscopist, the cancer is not poorly differentiated and there is no vascular or lymphatic permeation and the margin of excision is free (Bond, 2000). Invasion of the stalk of a pedunculated polyp, by itself, is not an unfavorable prognostic finding, as long as the cancer does not extend to the margin of resection (Bond, 2000).…”