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