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Any time you find Colonic polyps on screening type of Colonoscopy- If they ask the next best step what wud it be ????------Total excision of the polyp and then Histopath or incissional biospsy....
I feel any time we see POLYP on colonoscopy, then next step is remove the polyp TOTALLY and then do histopath and then decide further Colonoscopic surveillance.
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anytime you see a polyp , it is removed and sent to histopath. This polyp may be hyperplastic or adenomatous or may have adenocarcinoma in it.
dr.red oncology lecture says that surveillance colonoscopy after polyp removal should be based on the risk. The following guidelines are for adenomatous opr villous polyps
It gives classification of risk as ( this is also in ACG guidelines)
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)
Next, if it is a hyperplastic polyp - no need to worry. Just follow normal screening guidelines every 10 years.
If there is a cancer in polyp, next question is if margins are clear?
a) If margins are clear and cancer completely removed, just screen with colonoscopy after one year and depending of findings, follow the guidelines.
b) If margins are involved with cancer, that means it is not completely removed. Get a CT abdomen and if there is no lymph nodes or mets, do hemicolectomy. Further management link chemotherapy depends on staging based on lymph node involvement after surgery.
This is all we need to know
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Misshyd, Thanks for the great job!
One clarification though-
I was listening to Archers lectures today and he said it was
3,10,
3,5
and
1,3,5.
Thanks!
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Thanks for the information. But why Dr red says this??
These are the guidelines and every book says same thing, It is not Dr red who determined these guidelines.
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tamtel, you may be right, i listened lecture few months back. But it may have been updated.
I got above explanation from the blog http://usmlestep3blog.com/usmle-step-3-m...e-week-22/
meduploader, i understand your situation! The problem is you must also give us reference to a book that summarizes the guidelines so well so it will be easy for us to know. I will be happy to take your advise ( do not say MTB has it all , it does not.....lol)
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So why this ur genius archer is not writing a book? It would have help for all of us.
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Meduploader let finish CCS thread help me in the surgery part / anyone / Misshy please add your input/ medicine-king, Dalia, stepup....
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not Dalia I mean Mira1978.
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