Flat “polyp” resection (follow up)

In two earlier articles I wrote about this interesting “polyp” that was found incidentally during a colonoscopy for a separate indication. If you remember, this lesion was removed and actually turned out to be a very small tumor, i.e., an early stage colon cancer. This is the endoscopic picture of the lesion before being removed:

Flat ulcerated lesion (between red arrows) in the transverse colon showing the 'mucous cap' sign.

Flat ulcerated lesion (between red arrows) in the transverse colon showing the ‘mucus cap’ sign.

This was the appearance of the site after performing endoscopic mucosal resection, and closing the site with clips:

The appearance after the mucosal defect is closed with clips.

The appearance after the mucosal defect is closed with clips.

If you’re just joining us now, here are the links to the prior articles about this lesion: Flat “polyp” resection (part one) and (part two).

So what eventually happened? Did the resection work, or did the patient ultimately need surgery? Well, after a CT scan and a surgical opinion, and given the patient’s age and preferences, we decided to repeat the colonoscopy 3 months after the initial resection and see what the area looked like. If it looked good, the patient would avoid surgery. If there was residual cancer or dysplasia, the patient would need that section of the colon removed surgically. Since I put a tattoo near the site of the lesion to mark it for future surveillance, it was easy to find again on repeat colonoscopy. Here is what the tumor site looked like three months after endoscopic resection:

The excavated area between the two red arrows is a healed postpolypectomy scar.

The excavated area between the two red arrows is a healed postpolypectomy scar.

The scar was completely clean with no residual adenomatous (polyp) tissue. Just to be safe, I took multiple biopsies of the scar center, edges, and the surrounding mucosa. All biopsies revealed normal tissue.

The bottom line? The patient avoids having surgery in exchange for a follow up colonoscopy in 1 year. Not a bad deal.

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  • 			Rossyrico@gmail.com			

    Hi Dr. Gandolfo.
    Thank you for sharing such detailed explanation on this particular case dated 2016.
    I would like to know more about the Follow Up Colonoscopy Result.
    Did you find growth , changes , or new polyps in same or other places ?
    Would you say that this particular case
    might represent also a sign of a high risk Colon cancer ?

    I ask this because my husband had almost the same situation but only difference was the size “ 0.8 mm “ and after a year , our follow up colonoscopy revealed a new polyp of 0.6mm but in another place.
    Now we are waiting for lab results .
    I wonder if this means that he is more likely to develop Colon Cancer ?
    Also, I wonder if a persons height is related with Cancer Growth ?
    My husband is tall for asians 180cm,
    his brother is 173cm and had a clean colonoscopy.
    Thanks a lot for your time.

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