Colonic Polyps Treatment & Management

  • Author: Gregory H Enders, MD, PhD; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 10, 2011
 

Medical Care

Some studies have demonstrated that medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) decreases the number and the size of colonic polyps. However, NSAIDs, such as sulindac, do not prevent cancer development. These drugs do not yet constitute established therapies or chemopreventives for colonic polyps.

One study suggests that aspirin may be beneficial in reducing the incidence of recurrent colonic polyps, particularly advanced colonic polyps in select patients with a high risk of colon cancer and an acceptably low risk of gastrointestinal bleeding or hemorrhagic stroke.[11]

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Surgical Care

  • Polypectomy
    • In the case of a solitary pedunculated polyp, colonoscopic removal can be performed concurrently with the search for other lesions.
    • Removal of a solitary colonic polyp is usually curative for that lesion. However, a complete colonoscopic examination should be performed because the finding of a single adenomatous polyp confers an increased risk for the development of others. The rate of colonic polyp recurrence (discovered at follow-up colonoscopy) at 1-year postpolypectomy is small, and recurrence may in fact represent missed synchronous lesions. Repeat colonoscopy at 3-12 months is sometimes advocated if there is substantial doubt whether a colonic polyp has been completely resected and/or contains high-grade dysplasia.[12]
  • Colonic resection[13]
    • In the case of multiple intestinal polyps associated with FAP, resection remains the only feasible option.
    • Colonic resection is also advocated for patients with long-standing ulcerative colitis who have developed high-grade dysplasia or a dysplasia-associated lesion or mass (DALM).[11]
    • Surgical resection may be advocated for large, sessile polyps that are difficult to remove or for advanced colonic polyps that recur despite adequate initial endoscopic treatment.
    • Several surgical options should be discussed with the patient, including total colectomy, subtotal colectomy with rectal sparing, or segmental resection.
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Consultations

  • Surgical consultation
    • Consultation with a surgeon is critical in patients with multiple polyps, including patients with FAP.
    • Explain and discuss the type and timing of surgery with the patient.
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Diet

A regular diet may be continued. The patient can consider calcium and folate supplements to decrease the risk of colonic polyp recurrence.

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Activity

Activities may be maintained as tolerated.

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Contributor Information and Disclosures
Author

Gregory H Enders, MD, PhD  Associate Professor, 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.

Specialty Editor Board

Manoop S Bhutani, MD  Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor 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.

Alex J Mechaber, MD, FACP  Senior 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

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

References

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