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
dddddddddd
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)
DDDDDDDDDDDDDDDDDDDDDDDDDD
Answer: D
Colon polyp screening guidelines for repeat colonoscopy :
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)
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)
D, larger size polyp >1 cm implies earlier monitoring is reqd, remember 1,3, 5 rule.
dddd