0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
368 Colon Polyps and Tumors➣colonoscopy is recommended
➣first exam should occur at an age at least 10 years younger than
index family member, and then every 5 years
➣if there are two first-degree relatives or a first-degree relative
with CRC under age 50, hereditary cancer syndrome should be
suspected; if confirmed, colonoscopy every 2 years is recom-
mended
■Prior history of CRC
➣surveillance colonoscopy is recommended
➣cancer in colon: if patient had complete exam prior to resection,
follow-up should be within 1 year; if complete exam of the colon
was not possible prior to resection, then an exam should be com-
pleted within 3–6 months after surgery to rule out synchronous
lesions
■Prior history of adenoma: surveillance colonoscopy is recommended
as follows:
➣1 or 2 tubular adenomas <1 cm at baseline: surveillance at 5
years or more; if negative, routine screening for average risk rec-
ommended
➣if baseline exam revealed 3 or more adenomas, adenoma >1 cm,
villous adenoma or adenoma with high-grade dysplasia: surveil-
lance at 3 years, and if negative every 5 years
➣if baseline exam revealed 10 or more adenomas, surveillance
prior to 3 years should be considered
➣History of ulcerative colitis
➣risk of colorectal cancer increased after 8 years of disease
➣surveillance colonoscopy is recommended every 2 years with
biopsies from each portion of the colon
differential diagnosis
■signs or symptoms of colonic disease: colon polyp vs. colorectal
cancermanagement
■Positive FOBT
➣if any of 3 cards are positive, the test should be considered positive
➣colonoscopy is appropriate follow-up test
■Positive sigmoidoscopy
➣if an adenoma of any size is found in the sigmoid colon, the risk of
advanced proximal neoplasia is 2- to 3-fold higher than patients
who do not have sigmoid adenomas; small polyps should be
biopsied to determine if it is an adenoma