Introduction The outcome of colonic cancer in the UK population has sensibly improved since the introduction of the Bowel Cancer Screening Programme (BCSP) in 2006. This is mainly due to early detection of the cancer in its early stages of which the malignant polyp (MP) is often a manifestation. In this study we reviewed the detection rates and management of malignant polyps and their outcomes in the population of north and mid Essex and compared it to national and international experience.
Methods 33 patients with malignant polyps were identified between the start of the North Essex screening programme (February 2009) and December 2010. Data were obtained using patient notes, endoscopy, radiology and histopathology reports.31 patients were included in the study because data of two patients were not available.
Results Of the 31 polyps, the vast majority (94%) was located in the left colon. 19 (61%) were peduncolated. Polyps average size was 1.5 cm, 8 (26%) measured >2 cm and only 2 (6%) measured <1 cm. Haggitt and Kikuchi classifications were used to assess the depth of invasion. Patients were divided into low risk (LR) and high risk (HR) groups according to histologic criteria (depth of invasion, lymphovascular invasion, grade and excision margins >2 mm). 16 (52%) fell into the LR group, 15 (48%) were considered at high risk. 29 (94%) patients had staging CT, with an average waiting time of 3.5 weeks for patients at HR (range 2–13 weeks) and 6 weeks for patients at LR (range 2–24 weeks). Five patients were surgically treated within 10 weeks (4 HR, 1 LR). The remaining patients were followed-up with a repeat endoscopy, with a mean waiting time of 9 weeks for patients at HR (range 4–15 weeks) and 24 weeks for patients at LR (range 9–60 weeks). Residual tumour was identified on endoscopic follow-up in two patients at HR. Surgery was finally performed in 15 patients (48.5%), 13 HR, 2 LR. Lymph nodes (LNs) involvement was present in four patients (30%). Residual tumour was found in 5 (33%). Surgical complications occurred in two patients (13%) and consisted in one anastomotic leak and one bilateral pulmonary embolism. To date cancer recurrence has been found in 2 HR patients (6.5%) who had evidence of LNs involvement (median follow-up of 16 months, range 8–28).
Conclusion CT scans and endoscopic follow-up timing varied greatly between patients, especially for those in the LR group. LNs involvement and recurrence rate (30%) was higher than described in London BCSP centres (9.8%) but still consistent with other published data.1 Further research is needed to clarify the need for staging CT and timing of follow-up endoscopy in patients at LR.
Competing interests None declared.
Reference 1. Hassan C, Zullo A, Winn S, et al. The colorectal malignant polyp: scoping a dilemma. Dig Liver Dis 2007;39:92–100.