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Discuss polyp cancer?
American College of Gastroenterology guidelines recommend that no further treatment is necessary if all the following criteria are fulfilled:
When all of these low risk criteria are not met, the decision to proceed to surgical resection needs to be individualized, taking into account the age and comorbidity of the patient. Surgical resection is generally recommended for any invasive cancer in a sessile adenoma where the patient is otherwise well.
Cancerous polyp are often described using Haggitt levels.
Cancerous polyps are classified according to Haggitt level:
Level 0- carcinoma in situ
Level 1- submucosa in the head of the polyp
Level 2- submucosa in the neck of the polyp
Level 3- submucosa in the stalk of the polyp
Level 4- submucosa beyond the stalk
Polyps classified as Haggitt level 3 or lower have a less than 1% likelihood of lymph node metastasis and can be treated with polypectomy alone when they meet the following pathologic criteria:
Specimen margins are greater than 2 mm
There is no evidence of lymphovascular invasion and
The tumour is well differentiated.
Haggitt level 4 polyps have a 12-25% risk of lymph node metastasis and should be treated with segmental colectomy.
Reference:
American College of Gastroenterology Guidelines (Archived copy at WebCite)
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