Introduction The national bowel cancer screening programme (BCSP) was rolled out in 2006. Screening is based on a guaiac FOBt strategy, positive tests are offered colonoscopy. In January 2008 implementation commenced in LNR region (pop ~1.6 million).
Polyp cancers present a challenge both to clinicians and patients - optimal management remains unclear. We prospectively followed all patients who underwent primary endoscopic polypectomy.
Methods Patients with polyp cancers resected by polypectomy alone within the BCSP (48 cases as of 31/12/11) have had their outcomes recorded (last update 31/10/12).
Results Demographic data
Mean/median age = 65.92/66 yrs
Males/Females = 33 (68.75%)/15 (31.25%)
Location of polyp cancer
Rectum = 5 (10.4%)/Sigmoid = 41 (85.4%)/Desc colon = 2 (4.2%)
Notes One patient with a Haggitt 1 polyp cancer has subsequently died from ascending colon adenocarcinoma (a new lesion). Of the 13 other polyp cancers, 5 were pedunculated but not assigned Haggitt levels due to incomplete excision or invasive cancer – one of these patients has subsequently died with liver metastases. There were 8 sessile polyp cancers with no recurrences – too small a group to draw any meaningful conclusions.
Conclusion There were 26 patients with Haggitt 1 or 2 polyp cancers. Cumulative follow up of 73.3 yrs has not identified any case of recurrence, suggesting that endoscopic resection of these lesions is curative. The 9 patients with Haggitt 3 polyp cancers (invasion into stalk) have 30.3 yrs cumulative recurrence free time.
It is recognised that there is an increased risk of adverse outcomes (lymph node metastasis/recurrence)1 from Haggitt 4 polyp cancers (invasion into bowel wall submucosa below stalk) and hence factors such as adequate resection margins (despite diathermy artefact) and length of stalk have to be taken into account to ensure that Haggitt 3 polyp cancers are not actually Haggitt 4 polyp cancers.
Patients with Haggitt 3 polyp cancers, where there is evidence of adequate resection margins, should be offered the option of conservative treatment balanced with the risks of formal resection.
Disclosure of Interest None Declared
Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89:328–36.
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