Colonic polyp: Difference between revisions
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In [[medicine]], '''colonic polyps''' are "discrete tissue masses that protrude into the lumen of the [[colon]]. These [[polyp]]s are connected to the wall of the colon either by a stalk, pedunculus, or by a broad base."<ref>{{MeSH}}</ref> | In [[medicine]], '''colonic polyps''' are "discrete tissue masses that protrude into the lumen of the [[colon]]. These [[polyp]]s are connected to the wall of the colon either by a stalk, pedunculus, or by a broad base."<ref>{{MeSH}}</ref> Colonic polyps may become [[colorectal cancer]]. | ||
==Classification== | ==Classification== | ||
In a study of 2531 volunteers 50 years of age or older:<ref name="pmid18799557">{{cite journal |author=Johnson CD, Chen MH, Toledano AY, ''et al'' |title=Accuracy of CT colonography for detection of large adenomas and cancers |journal=The New England journal of medicine |volume=359 |issue=12 |pages=1207–17 |year=2008 |month=September |pmid=18799557 |doi=10.1056/NEJMoa0800996 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18799557&promo=ONFLNS19 |issn=}}</ref> | |||
* 1629 (64%) had no polyps | |||
* 902 (36%) had polyps | |||
** 512 (57% of the 902) had polyps with the largest being less than 5 mm in size | |||
** 258 (29% of the 902) had 392 polyps with the largest being 5 mm - 9 mm in size | |||
*** 246 (63% of the 392 polyps) were adenomatous | |||
*** 146 (27% of the 392 polyps) were non-adenomatous such as hyperplastic polyps and lipomas | |||
** 132 (15% of the 902) had 155 polyps with the largest being 10 mm or larger in size | |||
*** 121 (78% of the 155 polyps) were adenomatous | |||
*** 7 (5% of the 155 polyps) were carcinomas | |||
*** 27 (17% of the 155 polyps) were non-adenomatous | |||
===Hyperplastic polpys=== | ===Hyperplastic polpys=== | ||
| Line 20: | Line 32: | ||
;Tubulovillous adenomas | ;Tubulovillous adenomas | ||
;Villous adenomas | ;Villous adenomas | ||
==Diagnosis== | |||
CT scan may be used.<ref name="pmid19531785">{{cite journal| author=Regge D, Laudi C, Galatola G, Della Monica P, Bonelli L, Angelelli G et al.| title=Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. | journal=JAMA | year= 2009 | volume= 301 | issue= 23 | pages= 2453-61 | pmid=19531785 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19531785 | doi=10.1001/jama.2009.832 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid18799557" /><ref name="pmid17914041">{{cite journal| author=Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL et al.| title=CT colonography versus colonoscopy for the detection of advanced neoplasia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 14 | pages= 1403-12 | pmid=17914041 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17914041 | doi=10.1056/NEJMoa070543 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid15664225">{{cite journal| author=Rockey DC, Paulson E, Niedzwiecki D, Davis W, Bosworth HB, Sanders L et al.| title=Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. | journal=Lancet | year= 2005 Jan 22-28 | volume= 365 | issue= 9456 | pages= 305-11 | pmid=15664225 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15664225 | doi=10.1016/S0140-6736(05)17784-8 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15989310 Review in: ACP J Club. 2005 Jul-Aug;143(1):22] <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
==Prognosis== | ==Prognosis== | ||
{| class="wikitable" align=right | {| class="wikitable" align=right | ||
|+ Risk depends on polyp size (adapted from Table 2 in Butterly<ref name="pmid16527698">{{cite journal |author=Butterly LF, Chase MP, Pohl H, Fiarman GS |title=Prevalence of clinically important histology in small adenomas |journal=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association |volume=4 |issue=3 |pages=343–8 |year=2006 |month=March |pmid=16527698 |doi=10.1016/j.cgh.2005.12.021 |url= |issn=}}</ref>) | |+ Risk depends on polyp size (adapted from Table 2 in Butterly<ref name="pmid16527698">{{cite journal |author=Butterly LF, Chase MP, Pohl H, Fiarman GS |title=Prevalence of clinically important histology in small adenomas |journal=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association |volume=4 |issue=3 |pages=343–8 |year=2006 |month=March |pmid=16527698 |doi=10.1016/j.cgh.2005.12.021 |url= |issn=}}</ref> and Johnson<ref name="pmid18799557" />) | ||
! Polyp size !! Cancer<br>%!! Villous histology or<br>high-grade dysplasia<br>%!! Total<br>% | ! Polyp size !! Cancer<br>% ([[confidence interval]])!! Villous histology or<br>high-grade dysplasia<br>% ([[confidence interval]])!! Total<br>% ([[confidence interval]]) | ||
|- | |||
| <u><</u> 4 mm || align=center|0 (0–.36)||align=center| 1.68 (.87–2.49) ||align=center| 1.68 (.87–2.49) | |||
|- | |- | ||
| | | 5–9 mm ||align=center| 0.87% (.26–1.48)||align=center| 9.23 (7.32–11.14) ||align=center| 10.10 (8.11–12.08) | ||
|- | |- | ||
| | | <u>></u> 10 mm ||align=center| 5%||align=center| ||align=center| | ||
|} | |} | ||
Adenomatous colonic polyps may progress to [[colorectal cancer]]; however, less than 10% do so.<ref name="pmid17167138"/> | Adenomatous colonic polyps may progress to [[colorectal cancer]]; however, less than 10% do so.<ref name="pmid17167138"/> The rate of progression to invasive cancer among polyps of at least 10 mm size is about 1% per year.<ref name="pmid3653628">{{cite journal |author=Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL |title=Natural history of untreated colonic polyps |journal=Gastroenterology |volume=93 |issue=5 |pages=1009–13 |year=1987 |month=November |pmid=3653628 |doi= |url= |issn=}}</ref> | ||
High risk colonic polyps are defined as either:<ref name="pmid16697750">{{cite journal |author=Winawer SJ, Zauber AG, Fletcher RH, ''et al'' |title=Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society |journal=Gastroenterology |volume=130 |issue=6 |pages=1872–85 |year=2006 |month=May |pmid=16697750 |doi=10.1053/j.gastro.2006.03.012 |url=http://www.gastrojournal.org/article/S0016-5085(06)00561-0/fulltext |issn=}}</ref> | High risk colonic polyps are defined as either:<ref name="pmid16697750">{{cite journal |author=Winawer SJ, Zauber AG, Fletcher RH, ''et al'' |title=Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society |journal=Gastroenterology |volume=130 |issue=6 |pages=1872–85 |year=2006 |month=May |pmid=16697750 |doi=10.1053/j.gastro.2006.03.012 |url=http://www.gastrojournal.org/article/S0016-5085(06)00561-0/fulltext |issn=}}</ref> | ||
* 3 or more synchronous adenomas | * 3 or more synchronous adenomas | ||
* | * Adenomas ≥1 cm in diameter | ||
* | * Villous histology or high-grade dysplasia | ||
A | The risk of current [[dysplasia]] depends on the size of the polyp (see table).<ref name="pmid16527698">{{cite journal |author=Butterly LF, Chase MP, Pohl H, Fiarman GS |title=Prevalence of clinically important histology in small adenomas |journal=Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association |volume=4 |issue=3 |pages=343–8 |year=2006 |month=March |pmid=16527698 |doi=10.1016/j.cgh.2005.12.021 |url= |issn=}}</ref> Similar numbers have been reported by other studies.<ref name="pmid18941093">{{cite journal |author=Pickhardt PJ, Hassan C, Laghi A, ''et al'' |title=Clinical management of small (6- to 9-mm) polyps detected at screening CT colonography: a cost-effectiveness analysis |journal=AJR Am J Roentgenol |volume=191 |issue=5 |pages=1509–16 |year=2008 |month=November |pmid=18941093 |doi=10.2214/AJR.08.1010 |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=18941093 |issn=}}</ref> The risk of recurrence of future high risk histology is also correlated with size.<ref name="pmid18347350">{{cite journal |author=Laiyemo AO, Murphy G, Albert PS, ''et al'' |title=Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years |journal=Ann. Intern. Med. |volume=148 |issue=6 |pages=419–26 |year=2008 |month=March |pmid=18347350 |doi= |url=http://www.annals.org/cgi/content/full/148/6/419 |issn=}}</ref> | ||
==References== | ==References== | ||
{{reflist}}[[Category:Suggestion Bot Tag]] | |||
Latest revision as of 16:00, 30 July 2024
| Colonic polyp | |
|---|---|
 Colonic polyp | |
| ICD-9 | V12.72 |
| OMIM | 175100 |
| MeSH | D003111 |
In medicine, colonic polyps are "discrete tissue masses that protrude into the lumen of the colon. These polyps are connected to the wall of the colon either by a stalk, pedunculus, or by a broad base."[1] Colonic polyps may become colorectal cancer.
Classification
In a study of 2531 volunteers 50 years of age or older:[2]
- 1629 (64%) had no polyps
- 902 (36%) had polyps
- 512 (57% of the 902) had polyps with the largest being less than 5 mm in size
- 258 (29% of the 902) had 392 polyps with the largest being 5 mm - 9 mm in size
- 246 (63% of the 392 polyps) were adenomatous
- 146 (27% of the 392 polyps) were non-adenomatous such as hyperplastic polyps and lipomas
- 132 (15% of the 902) had 155 polyps with the largest being 10 mm or larger in size
- 121 (78% of the 155 polyps) were adenomatous
- 7 (5% of the 155 polyps) were carcinomas
- 27 (17% of the 155 polyps) were non-adenomatous
Hyperplastic polpys
Adenomatous polyps
Adenomatous colonic polyps are common and are present in 25% of men and 15% of women undergoing screening colonoscopy.[3]
- Tubular adenomas
- Tubulovillous adenomas
- Villous adenomas
Diagnosis
CT scan may be used.[4][2][5][6]
Prognosis
| Polyp size | Cancer % (confidence interval) |
Villous histology or high-grade dysplasia % (confidence interval) |
Total % (confidence interval) |
|---|---|---|---|
| < 4 mm | 0 (0–.36) | 1.68 (.87–2.49) | 1.68 (.87–2.49) |
| 5–9 mm | 0.87% (.26–1.48) | 9.23 (7.32–11.14) | 10.10 (8.11–12.08) |
| > 10 mm | 5% |
Adenomatous colonic polyps may progress to colorectal cancer; however, less than 10% do so.[3] The rate of progression to invasive cancer among polyps of at least 10 mm size is about 1% per year.[8]
High risk colonic polyps are defined as either:[9]
- 3 or more synchronous adenomas
- Adenomas ≥1 cm in diameter
- Villous histology or high-grade dysplasia
The risk of current dysplasia depends on the size of the polyp (see table).[7] Similar numbers have been reported by other studies.[10] The risk of recurrence of future high risk histology is also correlated with size.[11]
References
- ↑ Anonymous (2024), Colonic polyp (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 2.2 Johnson CD, Chen MH, Toledano AY, et al (September 2008). "Accuracy of CT colonography for detection of large adenomas and cancers". The New England journal of medicine 359 (12): 1207–17. DOI:10.1056/NEJMoa0800996. PMID 18799557. Research Blogging.
- ↑ 3.0 3.1 Levine JS, Ahnen DJ (December 2006). "Clinical practice. Adenomatous polyps of the colon". The New England journal of medicine 355 (24): 2551–7. DOI:10.1056/NEJMcp063038. PMID 17167138. Research Blogging.
- ↑ Regge D, Laudi C, Galatola G, Della Monica P, Bonelli L, Angelelli G et al. (2009). "Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer.". JAMA 301 (23): 2453-61. DOI:10.1001/jama.2009.832. PMID 19531785. Research Blogging.
- ↑ Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL et al. (2007). "CT colonography versus colonoscopy for the detection of advanced neoplasia.". N Engl J Med 357 (14): 1403-12. DOI:10.1056/NEJMoa070543. PMID 17914041. Research Blogging.
- ↑ Rockey DC, Paulson E, Niedzwiecki D, Davis W, Bosworth HB, Sanders L et al. (2005 Jan 22-28). "Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison.". Lancet 365 (9456): 305-11. DOI:10.1016/S0140-6736(05)17784-8. PMID 15664225. Research Blogging. Review in: ACP J Club. 2005 Jul-Aug;143(1):22
- ↑ 7.0 7.1 Butterly LF, Chase MP, Pohl H, Fiarman GS (March 2006). "Prevalence of clinically important histology in small adenomas". Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 4 (3): 343–8. DOI:10.1016/j.cgh.2005.12.021. PMID 16527698. Research Blogging.
- ↑ Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL (November 1987). "Natural history of untreated colonic polyps". Gastroenterology 93 (5): 1009–13. PMID 3653628. [e]
- ↑ Winawer SJ, Zauber AG, Fletcher RH, et al (May 2006). "Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society". Gastroenterology 130 (6): 1872–85. DOI:10.1053/j.gastro.2006.03.012. PMID 16697750. Research Blogging.
- ↑ Pickhardt PJ, Hassan C, Laghi A, et al (November 2008). "Clinical management of small (6- to 9-mm) polyps detected at screening CT colonography: a cost-effectiveness analysis". AJR Am J Roentgenol 191 (5): 1509–16. DOI:10.2214/AJR.08.1010. PMID 18941093. Research Blogging.
- ↑ Laiyemo AO, Murphy G, Albert PS, et al (March 2008). "Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years". Ann. Intern. Med. 148 (6): 419–26. PMID 18347350. [e]