Colon and Rectal Polyps

Patient referred for colonoscopy by family physician who performed a screening sigmoidoscopy. Sigmoidoscopy revealed a polyp at 14 cm.

Colonoscopy revealed multiple colonic polyps of the ascending, transverse, descending and sigmoid colon. A large superficially spreading mass was seen at 14 cm. The polyps were successfully removed with snare and cautery and pathology report indicated that all polyps were tubular adenomas. Biopsy of the mass at 14 cm revealed adenomatous polyp with high grade dysplasia.

Dysplasia is abnormal development of tissue, high grade refers to a high risk condition consistent with cancer or impeding cancer formation.

These results were discussed with the patient and family, surgical removal was recommended. Due to the patient's other medical problems such as diabetes, obesity and debilitating arthritis the decision for endoscopic removal was chosen.

Original Mass

The patient returned 8 weeks later. Several pieces of the mass were removed with snare and cautery. The pathology report indicated histologic features verging upon carcinoma in-situ with high grade dysplasia. (In-situ refers to localized, has not invaded surrounding tissue, dysplasia is abnormal development of tissue, high grade refers to high risk condition consistent with cancer or impending cancer formation.)

Once again the patient refused surgery despite strong recommendation for such by the gastroenterologist.

The patient returns in two weeks and more pieces of the mass are removed with snare and cautery. Pathology report indicates adenomatous polyp, tubular type: no evidence of in-situ Adenocarcinoma.

Sigmoidoscopy is repeated one month later, biopsy report indicates benign colonic mucosa with changes consistent with hyperplastic polyp.
One month later, the lesion is treated with laser vaporization.
The patient was to have a repeat colonoscopy 4-6 months following the laser procedure. However, despite physician recommendation the patient did not return.

From:  Endoscopy: " An Insiders Look" by Krista M. Stayton, RN.  Used with permission.