A 65 y-old male undergoes a screening colonoscopy which reveals a 2cm polyp. The histopathology reveals an adenomatous polyp with no atypical cells. The most appropriate follow up for this patient is :
A) Colonoscopy at 10 yrs
B) Colonoscopy at 5 yrs and then every 5 yrs
C) Colonoscopy at 3 yrs and then every 10 yrs
D) Colonscopy at 3 yrs and then every 5 years
E) CEA every 3 months
confusing
d,,any adenoma gretaer than 1 cm 3 year colonoscopy,,not sure if should be foloowed with 5 or 10 later thinking,3 then 5 yrs
don't know whats the follow up , c or d?
i will go with d as 10 yr sounds very far apart
how do we know? Is it recommended at 10 yrs or 5 yrs?
the questions are very close on exam. I chose wrong choice all the time
WE HAVE DISCUSSED THIS Q several times before.
Dinesh, you asked how do we know when we should do follow ups. It depends on their risk of developing colon cancer. Risk of developing colon cancer is greatest in large adenomatous polyps with villous component. How do we know??? We know it from guidelines recommended by Americal college of gastro backed by evidence.
Using the guidelines will prevent your confusion.
These guidelines underneath are from Archer oncology lecture which lays down a protocol for screening in various risk scenarios:
Surveillance colonoscopy after polyp removal should be based on the risk.
It gives classification of risk as
a) Low Risk: - 1 to 2 adenomatous polyps, both small < 1cm
In this low risk, repeat colonoscopy in 5 years . If this is normal, repeat every 10yrs
( remember 5,10)
b) Intermediate Risk : 3 to 10 small adenomatous polyps or
any one adenomatous polyp >1cm or any adenoma with villous features or high grade dysplasia
In this group, repeat Colonoscopy in 3 years. If this is normal or shows only small polyps, repeat colonoscopy every 5 years ( remember 3, 5)
c) High risk:
- Greater than or equal to 10 adenomatous polyps, colonoscopy at 1 year.
- Sessile adenomatous ployp that are removed in pieces --> colonoscopy in 3 to 6 months to ensure that it is completely removed
- Polyp removed in total and has carcinoma insitu with clear margins --> colonoscopy at 1 year and then at 3 years and then, every 5 years ( Remember 1,3 and 5)
i m new to this forum but i think u guys r doing a nice job
nice explanation.