Hyperplastic or Metaplastic Polyps

No colonoscopic follow up currently recommended

Benign Adenomatous Polyps

High Risk - (5 or more small adenomas) or (3 or more adenomas larger than 10mm)

Check colonsocopy again in 1 year

If subsequent colonsocopy is normal, low risk or intermediate risk then follow intermediate risk guidelines

Intermediate Risk - (3-4 small adenomas) or (at least one adenoma larger than 10mm)

Check colonoscopy again in 3 years

If 1 subsequent colonoscopy is normal or low risk then repeat colonoscopy in 3 years again

If 2 subsequent colonoscopies are normal then cease follow up

Low Risk - 1 to 2 adenomas both less than 10mm

Check colonoscopy again in 5 years

If subsequent colonoscopy is normal then cease follow up

High Grade Dysplasia or Carcinomatous Polyps

Discuss patient with Mr Moore.  If Mr Moore is not present in clinic then take patient's contact details and let them know that you will contact them shortly with follow up plan once you have discussed their case with a consultant surgeon.  After clinic, discuss the patient with Mr Moore or Mr Ridings within the next two working days and remember to contact the patient back with the medical management plan.

Dictate an urgent clinic letter to GP and copy letter to colorectal MDT coordinator for MDT discussion and also copy to colorectal Macmillan nurses.

Patients with histologically confirmed colorectal adenocarcinoma should be referred for urgent staging CT chest, abdomen and pelvis.  Patients with rectal adenocarcinoma (usually within 15cm of anal verge on endoscopy) should additionally be referred for urgent pelvic MRI scanning.

Also arrange for the patient to have a baseline CEA tumour marker blood test.