Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer

Abstract

AIMTo determine the frequency and risk factors for colorectal cancer (CRC) development among individuals with resected advanced adenoma (AA)/traditional serrated adenoma (TSA)/advanced sessile serrated adenoma (ASSA).METHODSData was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp.RESULTS84/4610 (1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years (mean 4.89 years), and 1.2% (54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years (mean 6.67 years). Approximately, 30% (25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8% (15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC development at the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site.CONCLUSIONRecognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.

Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

“…Infrequently, patients present with abdominal obstruction. [3][4][5] RISK OF NEW ADENOMA Precancerous polyps, including adenomatous and advanced polyps (polyps >10 mm, villous/tubulovillous features, and high grade dysplasia), have an increased prevalence in the older population. [6][7][8][9] In a large Veterans Affairs Hospital cohort of 17,732 asymptomatic men undergoing colonoscopy screening, the prevalence of advanced neoplasia increased from 5.7% in the youngest patients (50-59 years old) to 13% in the oldest patients (70-75 years old).…”

Primary Colonic Lymphoma: Report of Two Cases and a Literature Review

“…Non-Hodgkin's lymphomas (NHLs) are a group of malignancies that originate from B-cell precursors, Tcell precursors, mature B-cells, mature T-cells, or natural killer cells (in a few cases). Aggressive lymphomas are usually acute or subacute, with manifestations of a rapidly growing mass, systemic B symptoms (i.e., fever, night sweats, weight loss), and/or elevated serum lactate dehydrogenase and uric acid, and include diffuse large B-cell lymphoma, Burkitt's lymphoma, adult T-cell leukemia/lymphoma, and precursor B-and T-cell lymphoblastic leukemia/lymphoma [1][2][3][4][5]. Indolent lymphomas are usually more occult, with manifestations of slowly progressive lymphadenopathy, hepatomegaly, splenomegaly, or hypocytosis, and mainly include follicular lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and splenic marginal zone lymphoma [4][5][6].…”

Nomograms that predict the survival of patients with adenocarcinoma in villous adenoma of the colorectum: a SEER-based study

“…According to current postpolypectomy surveillance guidelines, patients who have adenomas with villous elements are considered at high risk of developing advanced lesions; in addition, the size of the adenoma (> = 10 mm) would increase the risk [15]. Although colonoscopy surveillance and resection could reduce the risk of developing carcinoma, the risk of CRC after adenoma removal remains high, and the removal of adenoma does not always prevent CRC because the initial adenoma features are not well known [16,17]. Even worse is that the knowledge of adenocarcinoma in villous adenoma is still limited to case reports and several studies.…”