eMedicine Specialties > Gastroenterology > Colon

Colonic Polyps: Follow-up

Author: Gregory H Enders, MD, PhD, Member, Fox Chase Cancer Center
Coauthor(s): Wafik S El-Deiry, MD, PhD, Professor of Medicine, Department of Hematology/Oncology; Co-Program Leader, Radiation Biology Program, Abramson Comprehensive Cancer Center, University of Pennsylvania School of Medicine
Contributor Information and Disclosures

Updated: Aug 22, 2008

Follow-up

Further Inpatient Care

  • Provide further inpatient care as needed.

Further Outpatient Care

  • Most gastroenterologists now advocate repeat colonoscopy 5 years following complete removal of a low-risk adenomatous polyp (as defined histologically). Colonoscopy is repeated in 3 years if the polyp has higher-risk features. Repeat colonoscopy may be advised in 3-12 months if the adequacy of polyp removal is a matter of substantial doubt. If no colonic polyps are found at the initial examination, follow-up colonoscopy at approximately 5-year intervals is recommended.

Inpatient & Outpatient Medications

  • Consider aspirin in select patients with a high risk of colon cancer (and coronary artery disease) and a low risk of gastrointestinal bleeding or hemorrhagic stroke.

Deterrence/Prevention

  • Currently, no firm guidelines exist regarding the prevention of the development of colonic polyps.
    • Calcium may be modestly protective.
    • Fiber may also have some activity; the best evidence is for cereal fiber.
    • Aspirin may be considered in select patients.
    • Studies have demonstrated that a diet high in antioxidants has no impact on colonic polyp recurrence.
    • Supplementary folate was also found to have no benefit in a recent study, although this conclusion bears the caveat that the tested population had substantial basal folate intake. Thus, some folate intake may be protective.

Complications

  • Complications of colonic polyps include bleeding, obstruction, diarrhea, and development of cancer.
  • Complications of polypectomy are uncommon but include bleeding and, rarely, intestinal perforation.

Prognosis

  • Colonic polyps are curable if removed. If not treated, the patient may develop complications, such as bleeding, and the condition may even be fatal if malignant transformation occurs.
  • Fortunately, colonic polyps grow slowly; cancer development is estimated to usually occur about 10 years after formation of a small colonic polyp.
  • Hereditary nonpolyposis colorectal cancer (HNPCC) is an exception. Progression to cancer appears to be more rapid because of increased genetic instability in the lesion. Patients with HNPCC should undergo screening for colonic polyps at more frequent intervals (every 1-2 y) than patients at average risk.

Patient Education

  • Patients with a family history of colonic polyps must be aware of the potential benefits of screening for colonic polyps.
  • Patients with FAP must be aware of the potential benefits of screening the upper GI tract and screening family members, beginning at puberty, for the mutant APC gene. Screening is particularly important because of the inevitable development of colon cancer in affected individuals and the benefits associated with colonic resection.
  • Patients with HNPCC should receive colon screening at frequent intervals and are at risk for development of tumors at additional sites, including the uterus and the ovaries in female patients. These patients should consider screening for tumor development at such sites or prophylactic resection.

Miscellaneous

Medicolegal Pitfalls

  • The ability to prevent colon cancer by polypectomy implies a responsibility to do so when possible. No screening tool is 100% effective; inevitably, colonic polyps will be missed. However, once detected, ensuring that the colonic polyp does not develop into a cancer is usually within the physician's ability.
  • The efficacy of removal of pedunculated polyps by polypectomy can usually be accurately assessed by histology. In contrast, sessile lesions are often removed in pieces or have cautery artifact precluding correct determination of the resection margin. If the endoscopist is uncertain whether a lesion has been eliminated, follow-up colonoscopy in 3-12 months may be advisable. Otherwise, a repeat colonoscopy in 3 years is usually recommended for sessile polyps and other higher-risk polyps.
 
Acknowledgments

Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.



More on Colonic Polyps

Overview: Colonic Polyps
Differential Diagnoses & Workup: Colonic Polyps
Treatment & Medication: Colonic Polyps
Follow-up: Colonic Polyps
References
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References

  1. Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology. Nov 1987;93(5):1009-13. [Medline].

  2. Powell SM, Petersen GM, Krush AJ, Booker S, Jen J, Giardiello FM, et al. Molecular diagnosis of familial adenomatous polyposis. N Engl J Med. Dec 30 1993;329(27):1982-7. [Medline].

  3. Powell SM. Direct analysis for familial adenomatous polyposis mutations. Mol Biotechnol. Feb 2002;20(2):197-207. [Medline].

  4. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. Oct 4 2007;357(14):1403-12. [Medline].

  5. Itzkowitz SH, Jandorf L, Brand R, et al. Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol. Jan 2007;5(1):111-7. [Medline].

  6. Beach R, Chan AO, Wu TT, et al. BRAF mutations in aberrant crypt foci and hyperplastic polyposis. Am J Pathol. Apr 2005;166(4):1069-75. [Medline].

  7. Bussey HJ, DeCosse JJ, Deschner EE, et al. A randomized trial of ascorbic acid in polyposis coli. Cancer. Oct 1 1982;50(7):1434-9. [Medline].

  8. Cohen LB. A color atlas of colorectal lesions. In: Pazdur R, Hoskins WJ, Wagman L, Coia LR, eds. Cancer Management: A Multidisciplinary Approach. Huntington, NY: Publisher Research & Representation, Inc; 2000:301-305.

  9. Coia LR, Ellenhorn JDI, Ayoub JP. Colorectal and anal cancers. In: Pazdur R, Hoskins WJ, Wagman L, Coia LR, eds. Cancer Management: A Multidisciplinary Approach. Huntington, NY: Publisher Research & Representation, Inc; 2000:273-299.

  10. Cotran RS, Kumar V, Robbins SL. Tumors of the small and large intestines. In: Cotran R, Kumar V, Robbins S, eds. Pathologic Basis of Disease. 5th ed. Huntington, NY: WB Saunders Company; 1994:809-822.

  11. Giardiello FM, Offerhaus GJ, DuBois RN. The role of nonsteroidal anti-inflammatory drugs in colorectal cancer prevention. Eur J Cancer. Jul-Aug 1995;31A(7-8):1071-6. [Medline].

  12. Itzkowitz SH, Kim YS. Colonic polyps and polyposis syndromes. In: Feldman M, Sleisenger MH, Scharschmidt BF, eds. Sleisinger & Fordtran's Gastrointestinal and Liver Disease; Pathophysiology, Diagnosis, Management. Vol 2. 6th ed. Philadelphia, Pa: WB Saunders Company; 1998:1865-1905.

  13. Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. Mar 2007;132(3):874-82. [Medline].

  14. Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell. Oct 18 1996;87(2):159-70. [Medline].

  15. Ladabaum U, Song K. Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterology. Oct 2005;129(4):1151-62. [Medline].

  16. [Best Evidence] Logan RF, Grainge MJ, Shepherd VC, et al. Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterology. Jan 2008;134(1):29-38. [Medline].

  17. Regueiro CR. AGA future trends committee report. Colorectal cancer: a qualitative review of emerging screening and diagnostic technologies. Gastroenterology. Sep 2005;129(3):1083-103. [Medline].

  18. Rex DK, Kahi CJ, Levin B, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. May 2006;130(6):1865-71. [Medline].

  19. 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. May 2006;130(6):1872-85. [Medline].

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Further Reading

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Keywords

colonic polyps, colonic polyp, colon polyp, colon polyps, colon cancer, colon cancer polyp, colon, colonoscopy, colonoscopy polyp, polyps in colon, polyps in the colon, adenomas, hyperplastic polyps, benign epithelial neoplasms, polyposis syndromes, familial adenomatous polyposis, FAP, Gardner syndrome, Turcot syndrome, Peutz-Jeghers syndrome, Cowden disease, familial juvenile polyposis, hereditary nonpolyposis colorectal cancer, HNPCC, dysplasia-associated lesion or mass, DALM, sulindac, polypectomy, colectomy

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Contributor Information and Disclosures

Author

Gregory H Enders, MD, PhD, Member, Fox Chase Cancer Center
Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Gastroenterological Association, American Medical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Wafik S El-Deiry, MD, PhD, Professor of Medicine, Department of Hematology/Oncology; Co-Program Leader, Radiation Biology Program, Abramson Comprehensive Cancer Center, University of Pennsylvania School of Medicine
Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, and American Society of Gene Therapy
Disclosure: Nothing to disclose.

Medical Editor

Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Manoop S Bhutani, MD, FACG, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

BS Anand, MD, Department of Internal Medicine, Division of Gastroenterology, Professor, Baylor University College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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