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Colon Polyp Follow Up Guidelines

by Etienne Moore last modified 2020-03-19 16:03

Click here to see Mr Moore's guidelines for the follow up of patients with polyps found at colonoscopy

Guidelines for post-polypectomy surveillance

First ask if the baseline colonoscopy achieved caecal intubation with adequate bowel prep and clearance of all premalignant polyps.

Consider site-check for 10-19mm non-pedunculated colorectal polyps without histological confirmation of complete excision.

Large (>20mm) non-pedunculated colorectal polyps

With histological R0 en bloc excision - One-off surveillance colonoscopy 3 years later unless >75 years old or life expectancy less than 10 years

Without histological R0 en bloc excision - Site check at 2-6 months then after a further 12 months

High risk findings

2 or more premalignant polyps (serrated polyps (umbrella term for hyperplastic polyps, sessile serrated lesions, traditional serrated adenomas and mixed polyps) (excluding diminutive 1-5mm rectal hyperplastic polyps) and adenomatous polyps) including 1 or more advanced colorectal polyp (serrated polyp >=10mm, serrated polyp with dysplasia, adenoma >=10mm, adenoma with high grade dysplasia) OR 5 or more premalignant polyps

If high risk findings then one-off surveillance colonoscopy 3 years later unless >75 years old or life expectancy less than 10 years

If no high risk findings then no further colonoscopic surveillance.  Participate in bowel screening when invited but if a patient is >10 years younger than screening age and has polyps but no high risk findings then consider colonoscopy at 5 or 10 years

If subsequent colonoscopy is incomplete then consider computed tomographic colonography (also known as CTC or CT cologram) instead or offer a repeat colonoscopy with a more experienced colonoscopist.  The risks and benefits should be discussed with the patient (and their family and carers if appropriate) and the patient's decision (or patient's advocate decision for patient's who cannot consent) documented.

Refer to family history or genetics service if

1 first degree relative diagnosed with colorectal cancer less than 50 years old or

2 first degree relatives diagnosed with colorectal cancer at any age or

Personal history of colorectal cancer less than 50 years old or

Personal history of colorectal cancer at any age with a first degree relative with colorectal cancer at any age or

Less than 60 years old with lifetime total 10 or more adenomas or

Greater than 60 years old with lifetime total 20 or more adenomas or 10 or more adenomas with family history of colorectal cancer or polyposis or

Inherited colorectal cancer predisposition syndromes including Lynch syndrome or other polyposis syndrome or Serrated polyposis syndrome (5 or more serrated polyps >=5mm proximal to rectum with 2 or more >=10mm, or 20 or more serrated polyps of any size including 5 or more proximal to the rectum)

 

High Grade Dysplasia or Carcinomatous Polyps

Urgently refer the patient to the BSUH colorectal cancer MDT (multi-disciplinary team) coordinator on the telephone via switchboard or via Trust e-mail so that the patient can be discussed at the next possible weekly colorectal cancer MDT meeting.  Tell the patient that a member of the colorectal team will contact them after the colorectal MDT meeting with the next step and please clearly document in the patient hospital notes what you have told the patient and whether you have already requested any staging scans or blood tests.  Give the patient a 'What happens next' leaflet.

Ideally discuss the patient with Mr Moore if possible.

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

Patients with histologically confirmed colorectal adenocarcinoma should be referred for urgent staging CT contrast scan of the chest, abdomen and pelvis.  Make sure that renal function blood tests have been arranged if these are necessary prior to contrast injection (mainly diabetic and renal failure patients).  Patients with rectal adenocarcinoma (usually within 15cm of the 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.

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