Management of colonic polyps by colonoscopic polypectomy

Colonoscopic polypectomy is an important therapeutic advance as it enables most colonic polyps to be removed entirely and studied pathologically and has virtually replaced surgical treatment. The clinical and pathological features of patients with colonic polyps treated by colonoscopic polypectomy over a five-year period are reported. Seventy-four patients (37 men, 37 women) with a mean age of 57 years had 109 polyps removed by snare polypectomy. Rectal bleeding was the predominant symptom and was present in 63.5 percent. Lower abdominal pain was present in 12 percent. The majority of polyps were located in the sigmoid (38.5 percent) and descending (40.3 percent) colon. Ninety-five polyps were pedunculated and 14 were sessile. Of the neoplastic polyps, 61.6 percent were pure tubular adenomas, 25.2 percent were mixed tubulo-villous adenomas and 1 percent were pure villous adenomas. There were no complications arising from colonoscopy or snare polypectomy. Colonoscopic polypectomy is a safe, reliable and cost-effective therapeutic procedure that has revolutionized the management of pre-cancerous neoplastic colonic polyps.(AU)

Family studies in colon cancer - abstract

Colon cancer is the commonest cancer in the Western world with the exception of skin cancer. More men die of lung cancer and more women die of breast cancer but mainly because these are more lethal tumours. The prognosis for cure of early colon cancer is excellent, however. It is generally accepted that almost all of colon cancers start out as benign polyps. There is considerable evidence that aggressive treatment of polyps can prevent colon cancer. The challenge therefore is to identify patients at risk of colon cancer or those having colonic polyps, diagnosing the malignant tumours early and in identifying and removing the polyps before they become malignant. High risk groups for colon cancer include people who have had previous cancer, patients known to have had colonic polyps, patients with inflammatory bowel disease (ulcerative colitis) and first degree relatives of patients with colon cancer. We investigated asymptomatic relatives of patients who had colon cancer. Our study had two objectives. The first was to prove our hypothesis that these patients would have polyps at a higher rate than the general population which is about 10 percent. The second was to test the actual feasibility of doing aggressive G.I. investigations on asymptomatic individuals, who are first degree relatives of patients with colon cancer. Approximately 200 relatives of about 35 patients with colon cancer were examined. A little under 40 percent of these people had adenomatous polyps. This is approximately 3« to 4 times the risk of having polyps in the general population. This observation needs to be confirmed in a larger series and in different populations (such as the West Indies). If these results are confirmed, then they have important implications not only for the management of patients and their families but for all those who have first degree relatives who develop colon cancer (AU)