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
Copy Rights: Archer USMLE Reviews
c
Colonscopy at 3 yrs and then every 5 years
D
B
Sorry D
d
D
D
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D is the right Answer
D
Risk of Progression to carcinoma is related to both the size & histology of the Adenoma
Higher Risk-Size >1 cm ,Villous& High Grade dysplasia
–>Repeat Colonoscopy 5 yrs following complete removal of low risk adenomatous polyp
—>Repeat Colonoscopy 3yrs following complete removal of High risk adenomatous polyp
**If no Colonic Polyp are found at the initial examination,follow up colonoscopy at approximately 5 yrs interval is recommended(Ref-eMedicine)
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Answer: D
Colon polyp screening guidelines:
a) Low Risk: – 1 to 2 adenomatous polyps, both small 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)
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)
Dr Archer, did you mean, (3,10), (3,5), (1,3,5)?
Low risk single or two, small adenomatous polyp (<1cm), repeat colonoscopy in 3 years. If normal, as per average risk recommendation (i.e, every 10 years). But you said 'every 5 years' twice. (you said 3,5 twice.) Am I missing something?
If this low risk patient also had family history of colorectal cancer, (first degree relative under 60yrs or two first degree relatives have colorectal cancer), then I will repeat every 5 years instead of every 10 years.
If this patient had a previous adenomatous polyp ( 1cm), then what do you recommend? Am I right if I screen based on the previous finding? And what do you recommend if a patient has had one or two small adenomatous polyps twice?
Thank you for your help. I look forward to your response.
dddd
the low risk one, follow up has some problem?