Colonic Polyps Guidelines

Updated: Jun 26, 2018
  • Author: Gregory H Enders, MD, PhD; Chief Editor: BS Anand, MD  more...
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Guidelines

Guidelines Summary

The US Multi-Society Task Force on Colorectal Cancer (MSTF) represents the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE). Their screening and surveillance guidelines are summarized below.

2017 MSTF screening guidelines for colorectal cancer

The MSTF guidelines may be found here. Strong recommendations include the following [5] :

  • Clinicians should offer screening for colorectal cancer beginning at age 50 years for non-black average-risk individuals (beginning at age 45 years for black individuals).

  • Colonoscopy is recommended every 10 years or an annual fecal immunochemical testing (FIT) for those at average risk for colorectal neoplasia.

  • Physicians performing screening colonoscopy should measure quality, including the adenoma detection rate.

  • Computed tomography (CT) colonography is recommended every 5 years or FIT-fecal DNA every 3 years or flexible sigmoidoscopy every 5-10 years in those who refuse colonoscopy and FIT.

  • Clinicians should offer annual FIT to those with one or more first-degree relatives with colorectal cancer or documented advanced adenomas but who decline colonoscopy.

  • It is recommended that adults younger than 50 years with colorectal bleeding symptoms undergo colonoscopy or an evaluation sufficient to identify the cause of bleeding, and that clinicians initiate treatment and thorough follow-up to determine resolution of the bleeding.

Individuals with high-risk family histories not associated with polyp syndromes

For those with a family or personal history of Lynch syndrome, colorectal cancer screening by colonoscopy is recommended every 1-2 years, beginning between ages 20 and 25 years or 2−5 years before the youngest age of diagnosis of colorectal cancer in the family if they were diagnosed before age 25 years. [26]

In the presence of a family history of family colon cancer syndrome X, colonoscopy is recommended every 3-5 years, beginning 10 years before the age of diagnosis of the youngest affected relative. [5]

For those with a family history of colorectal cancer or an advanced adenoma in two first-degree relatives diagnosed at any age OR colorectal cancer or an advanced adenoma in a single first-degree relative at age younger than 60 years, colonoscopy is recommended every 5 years beginning before the age at diagnosis of the youngest affected relative or age 40 years (whichever is earlier). Those with a single first-degree relative with colorectal cancer without significant neoplasia by age 60 years may consider in consultation with their physicians a longer interval between colonoscopies. [5]

In the presence of colorectal cancer or an advanced adenoma in a single first-degree relative who was diagnosed at age 60 years or older, initiate screening at age 40 years and then follow the screening recommendations for tests and intervals for persons at average risk. [5]

2016 MSTF guidelines on colonoscopy surveillance after colorectal cancer resection

These MSTF guidelines may be found here. Strong recommendations include the following [27] :

  • Patients with colorectal cancer should undergo high-quality perioperative clearing with colonoscopy, either preoperatively or, in the case of obstructive colorectal cancer, within a 3-6–month interval after surgery.

  • Patients who have undergone curative resection of either colon or rectal cancer should receive their first surveillance colonoscopy 1 year postoperatively (or 1 year after the clearing perioperative colonoscopy). (Additional recommendations apply for those with rectal cancer, but they are classified as weak with low-quality evidence.)

  • Following the 1-year colonoscopy, the next colonoscopies should be 3 years and then 5 years, and thereafter at 5-year intervals until the benefits of continued surveillance are outweighed by decreased life expectancy. In the presence of neoplastic polyps during any colonoscopy, polyp surveillance intervals should be based on published recommendations.

  • CT colonography is the best alternative to exclude synchronous neoplasms in those with obstructive colorectal cancer precluding complete colonoscopy.

The MSTF indicates there is insufficient evidence to recommend routine use of FIT or fecal DNA surveillance following resection for colorectal cancer. [27]

2012 MSTF guidelines for colonoscopy surveillance after screening and polypectomy

These MSTF guidelines may be found here. Recommendations with moderate to high quality of evidence include the following [28] :

  • In those with average risk for colorectal cancer and no adenomas or polyps on baseline examination, and for those with no adenomas but do have distal small (< 10 mm) hyperplastic polyps, the next evaluation is recommended in 10 years (moderate quality of evidence for both).

  • In those with one to two small (< 10 mm) tubular adenomas on baseline evaluation, the next examination is recommended in 5-10 years (moderate quality of evidence).

  • A 3-year interval is recommended for (1) those with 3-10 adenomas at baseline examination (moderate quality of evidence if any polyp ≥6 mm; low quality of evidence if all polyps < 6 mm), (2) individuals with one or more tubular adenomas of at least 10 mm in size at baseline evaluation (high quality of evidence), (3) individuals with one or more adenomas with villous features of any size (moderate quality of evidence), as well as (4) those with one or more adenomas with high-grade dysplasia (moderate quality of evidence).

  • An interval shorter than 3 years is recommended for those with more than 10 adenomas at baseline examination (moderate-high quality of evidence).

Recommendations for polyp surveillance after first surveillance colonoscopy [28]

In the presence of low-risk or high-risk adenomas at baseline evaluation and then high-risk adenoma at first surveillance, the second surveillance should take place in 3 years. But if low-risk adenomas are present at first surveillance, the next surveillance is in 5 years.

For those with low-risk adenomas at baseline and no adenomas at first surveillance, second surveillance is 10 years. However, in the presence of high-risk adenomas at baseline colonoscopy and no adenomas at first surveillance, the next surveillance is in 5 years; if the results on second surveillance are negative, insufficient evidence exists for the MSTF to make a recommendation.