Colon Polyps Flashcards
most polyps that are removed during colonoscopy are _____, the others are _____
adenomatous
serrated
both adenomatous and serrated polyps have an increased risk of _____
malignancy
what do most colon adenocarcinomas arise from?
polyps
polyps in which location may have an increased prevalence of advancing to advanced neoplasia?
polyps in proximal colon
what polyps are non-consequential?
polyps < 5mm in rectosigmoid colon region
have a higher risk for advancing to carcinoma, are > 1cm, have villous features (wart), and high grade dysplasia
advanced adenomas
most adenomas are _____ cm and have a ____ risk of transition to cancer
< 1
low
how long does it take for normal mucosa to turn into dysplastic polyp?
5 years
how long does it take for normal mucosa to turn into cancer?
10 years
arise from hyperplastic polyps and have a similar or greater risk of progression to cancer compared to adenomatous polyps
serrated polyps
why is screening of polyps so important?
they’re usually asymptomatic
what causes blood from rectum and indicates change from polyp to something more severe?
ulcerated polyp
what are 3 possible + labs in polyps?
FOBT
FIT
anemia from chronic blood loss
what is the diagnostic of choice and treatment for polyps?
colonoscopy
what is an acceptable screening tool that requires rectal air insufflation?
CT colonography
what is the treatment of choice for polyps?
colonoscopic polypectomy
polyp is considered completely removed and treatment completed only if: (3)
polyp is completely excised + submitted for histologic exam
clean margins
no vascular or lymphatic involvement
what is required if completely removed/treated polyp criteria is not met?
bowel resection
what is the required f/u for malignant treatment of a polyp?
f/u in 3 months w/ repeat colonoscopy
when should screening for polyps begin?
age 45
what is the recommended polyp surveillance if there are no findings?
10 years
what is the recommended polyp surveillance if there are 1-2 small (<1cm) tubular adenomas without villous features or high-grade dysplasia?
5-10 years
what is the recommended polyp surveillance if there are 3-4 adenomas, adenoma > 1cm, or adenoma w/ villous features or high-grade dysplasia?
3 years
what is the recommended polyp surveillance if there are > 10 adenomas found? (2)
1-2 years + genetic testing (r/o familial polyposis syndrome)
what is the recommended polyp surveillance if there are small (<1cm) serrated polyps without dysplasia?
5 years
what is the recommended polyp surveillance if there are large (>1cm) serrated polyps with cytologic dysplasia?
3 years
what is the recommended polyp surveillance if there are small, typical hyperplastic polyps in the distal colon and rectum?
no surveillance required until 50 yo
germline genetic mutations with high risk for cancer, in which family history is very important in determining screening
hereditary polyposis syndrome
what are the criteria for hereditary polyposis syndrome to be met, that need genetic counseling? (3)
> 1 family member affected by it
personal or FHx of colorectal cancer < 50 yo
personal or FHx of > 20 polyps
development of 100s-1000s of colonic adenomatous polyps and extracolonic manifestations like soft tissue tumors, osteomas, or hypertrophy of retinal pigment
familial adenomatous polyposis (FAP)
what are the mutated genes associated with familial adenomatous polyposis (FAP)? (2)
APC gene (90%)
MUTYH gene (8%)
what is the prognosis for familial adenomatous polyposis (FAP)? (2)
colorectal polyps by 15 yo
cancer by 40 yo
what is the treatment for FAP?
complete proctocolectomy with ileoanal anastomosis
OR
colectomy with ileorectal anastomosis
before 20 yo
what is recommended post-resection of FAP to check for adenomas and carcinomas?
upper endoscopy q 1-3 years
what size lesions found in upper endoscopy of a patient with FAP require resection?
> 2cm
what 2 meds reduce the number and size of polyps in rectal stump but not in the duodenum?
NSAID
COX-2 inhibitor
polyp that exists throughout the intestines (mostly small intestines), presents with pigmented macules on buccal mucosa, lips, and skin. Not malignant but increases changes of malignancy
peutz-jeghers syndrome
> 10 polyps in the colon (possibly adenomatous), genetic defect of 18q and 10q gene
familial juvenile polyposis
AKA cowden disease; presents as polyps and lipomas throughout GI tract, trichilemmomas, and cerebellar lesions
PTEN syndrome
what 2 cancers does lynch syndrome increase the risk for?
colorectal (#1)
endometrial (#2)
few adenomas that are flat w/ villous features or high grade dysplasia; has rapid transformation from benign to cancerous lesion within 1-2 years
lynch syndrome
what patients should receive genetic testing for lynch syndrome?
all colorectal cancer patients
what should be done if lynch syndrome gene mutations are found?
all 1st degree relatives should do genetic testing
what is the bethesda criteria used for?
determine individuals to get genetic testing for lynch syndrome
what is the bethesda criteria? (4)
colorectal cancer < 50 yo
multiple/recurrent colorectal cancer
colorectal cancer with at least 1 first degree relative before age 50
colorectal cancer with 2 or more 2nd degree relatives with colorectal CA orHNPCC
