Polipy jelita grubego – Rokowania, prognozy i postęp choroby

Polipy jelita grubego
Rokowania, prognozy i postęp choroby

Polipy jelita grubego wykazują zróżnicowany potencjał złośliwości, zależny od wielkości, liczby, typu histologicznego oraz cech morfologicznych. Polipy o średnicy ≥10 mm, zwłaszcza gruczolaki kosmkowe (villous adenoma), oraz polipy większe niż 20 mm wykazują istotnie wyższe ryzyko transformacji nowotworowej, sięgające nawet 50-75%. Usunięcie polipów neoplastycznych zmniejsza ryzyko rozwoju raka jelita grubego o około 80%. W przypadku złośliwych polipów (MP) z inwazją do błony podśluzowej, kluczowe jest rozpoznanie cech wysokiego ryzyka, takich jak dodatni margines resekcji, głęboka inwazja podśluzówkowa (>1 mm), słabe zróżnicowanie, inwazja naczyń, pączkowanie guza (tumor budding) oraz resekcja fragmentaryczna, które wskazują na konieczność kolektomii. Pięcioletnie przeżycie po polipektomii wynosi około 95%, a po kolektomii 82%, bez istotnej statystycznie różnicy (P=0,15).

Prognozy dla pacjentów z polipami jelita grubego

Ryzyko rozwoju raka w polipach
Przeżywalność po leczeniu polipów złośliwych
Czynniki ryzyka prognostyczne w polipach złośliwych
Znaczenie wczesnego wykrycia i odpowiednich badań kontrolnych
Rodzinne obciążenie i ryzyko raka jelita grubego
Znaczenie nowoczesnych technologii w diagnozowaniu polipów
Ocena objawów w kontekscie ryzyka raka jelita grubego
Podsumowanie czynników prognostycznych
Kolejne rozdziały

Prognozy dla pacjentów z polipami jelita grubego

Polipy jelita grubego mają zróżnicowane prognozy w zależności od ich rodzaju, wielkości, liczby oraz zastosowanego leczenia. Rokowanie dla pacjentów, u których polipy zostały skutecznie usunięte, jest zazwyczaj bardzo dobre. Niewłaściwie leczone polipy mogą z czasem rozwinąć się w raka jelita grubego, choć należy zaznaczyć, że większość polipów nie jest nowotworowa w momencie wykrycia. ¹²

Ryzyko rozwoju raka w polipach

Potencjał złośliwości polipów jelita grubego zależy od kilku kluczowych czynników. Ogólnie rzecz biorąc, tylko około 5% gruczolaków (adenoma) przekształca się w raka, jednak indywidualne ryzyko jest trudne do precyzyjnego określenia. Usunięcie polipów neoplastycznych zmniejsza ryzyko rozwoju raka jelita grubego o około 80%. Warto jednak pamiętać, że pacjenci, u których wcześniej wykryto polipy, mają zwiększone ryzyko ich ponownego wystąpienia. ¹²

Czynniki zwiększające ryzyko złośliwej transformacji polipów obejmują:

Wielkość polipu – ryzyko zwiększa się wraz z wielkością; polipy o średnicy 10 mm lub większej są uznawane za mające wyższe ryzyko transformacji nowotworowej ¹
Liczba polipów – większa liczba polipów zwiększa ryzyko rozwoju raka oraz ryzyko pojawienia się nowych polipów w przyszłości ²
Typ histologiczny – gruczolaki kosmkowe (villous adenoma) mają wyższe ryzyko przemiany nowotworowej ³
Zaawansowane gruczolaki – progresja do raka następuje szybciej niż w przypadku innych gruczolaków, a tempo to wzrasta z wiekiem pacjenta ⁴

Badania wskazują, że w przypadku polipów większych niż 20 mm (2 cm), w zależności od typu i innych czynników, nawet do 50% może już być nowotworowych. W przypadku polipów osiągających 35 mm (3,5 cm) częstość występowania raka może sięgać nawet 75%. ⁵⁶

Przeżywalność po leczeniu polipów złośliwych

Badania długoterminowego przeżycia pacjentów po leczeniu złośliwych polipów jelita grubego wykazują dobre wyniki. Analiza metodą tablic przeżycia wykazała 5-letnie przeżycie na poziomie 82% dla grupy pacjentów poddanych kolektomii (chirurgicznemu usunięciu fragmentu jelita) oraz 95% dla grupy poddanej jedynie polipektomii (usunięciu polipa). Różnica ta nie była statystycznie istotna (P = 0,15). ¹

Leczenie pacjentów ze złośliwymi polipami musi być zindywidualizowane w oparciu o ewoluujące kryteria. Pacjenci, u których marginesy polipektomii są nieadekwatne, powinni zostać poddani kolektomii. Przy zastosowaniu odpowiednich kryteriów selekcji, pacjenci zakwalifikowani do kolektomii mieli 5-letni wskaźnik przeżycia podobny do wskaźnika osób leczonych wyłącznie polipektomią. ²

Czynniki ryzyka prognostyczne w polipach złośliwych

Złośliwe polipy jelita grubego (MP) to polipy z inwazyjnym rakiem wnikającym do błony podśluzowej, niosące zmienne ryzyko zajęcia węzłów chłonnych, które można oszacować poprzez ocenę cech morfologicznych, endoskopowych i histologicznych. Kluczowe jest rozróżnienie cech histologicznych o niskim i wysokim ryzyku, które wpływają na możliwość występowania pozostałości guza, ryzyko nawrotu i ryzyko przerzutów do węzłów chłonnych, co jest niezbędne do optymalizacji planu leczenia i nadzoru. ¹

Do cech wysokiego ryzyka, które wskazują na konieczność zabiegu chirurgicznego w większości przypadków, należą:

Dodatni margines – niecałkowite usunięcie polipu ¹
Głęboka inwazja podśluzówkowa (>1 mm) ²
Słabo zróżnicowany rak ³
Inwazja naczyń limfatycznych lub krwionośnych ⁴
Pączkowanie guza (tumor budding) ⁵
Resekcja fragmentaryczna (piecemeal) ⁶

Szczególnie ważna jest ocena pączkowania guza (tumor budding), które jest uznanym niezależnym niekorzystnym markerem prognostycznym w raku jelita grubego. W przypadku pacjentów z pT1 CRC (rak jelita grubego ograniczony do błony podśluzowej), pączkowanie guza o stopniu od średniego do wysokiego (Bd2-3) jest niezależnym predyktorem przerzutów do węzłów chłonnych. W raku jelita grubego w II stadium, pączkowanie guza wysokiego stopnia (Bd3) stanowi niekorzystny czynnik prognostyczny, który powinien skłaniać do rozważenia chemioterapii adjuwantowej. ¹

Znaczenie wczesnego wykrycia i odpowiednich badań kontrolnych

Badania kontrolne we właściwym czasie są niezbędne, aby zapobiec rozwojowi raka. Rak jelita grubego jest jednym z najbardziej możliwych do zapobieżenia nowotworów, jeśli jest wcześnie wykrywany poprzez badania przesiewowe. ¹

Zalecenia dotyczące częstotliwości badań kontrolnych zależą od wyników pierwszej kolonoskopii:

Jeśli kolonoskopia nie wykazuje polipów, a pacjent ma przeciętne ryzyko raka jelita grubego, następne badanie jest zazwyczaj zalecane po 10 latach ¹
Jeśli kolonoskopia wykaże jeden lub dwa małe polipy (o średnicy 5 mm lub mniejszej), pacjent jest uważany za osobę o stosunkowo niskim ryzyku ²
Jeśli polipy są większe (10 mm lub więcej), liczniejsze lub mają nieprawidłowy wygląd pod mikroskopem, pacjent może potrzebować powrócić na badanie w ciągu trzech lat lub wcześniej ³

Istnieje 25% do 30% szans, że powtórna kolonoskopia wykaże dodatkowe polipy. ⁴

Rodzinne obciążenie i ryzyko raka jelita grubego

Posiadanie krewnego pierwszego stopnia z polipem jelita grubego wiąże się z wyższym ryzykiem raka jelita grubego (iloraz szans 1,40, 95% przedział ufności 1,35 do 1,45), nawet po uwzględnieniu rodzinnej historii raka jelita grubego. Związek między rodzinną historią polipów a ryzykiem raka jelita grubego jest wzmacniany przez zwiększającą się liczbę krewnych pierwszego stopnia z polipami i zmniejszającym się wiekiem w momencie diagnozy polipa. ¹

Szczególnie silny związek stwierdzono w przypadku wczesnego raka jelita grubego diagnozowanego przed 50. rokiem życia. W analizie łącznej, iloraz szans raka jelita grubego dla osób z dwoma lub więcej krewnymi pierwszego stopnia z polipami, ale bez raka jelita grubego, wynosił 1,79; z jednym krewnym pierwszego stopnia z rakiem jelita grubego, ale bez polipów, wynosił 1,70; a z dwoma lub więcej krewnymi pierwszego stopnia zarówno z polipami, jak i rakiem jelita grubego, wynosił 5,00. ²

Osoby z co najmniej dwoma krewnymi pierwszego stopnia z polipami lub krewnym pierwszego stopnia z polipami zdiagnozowanymi w młodym wieku mają zwiększone ryzyko raka jelita grubego, szczególnie choroby o wczesnym początku, i mogą skorzystać z wczesnych badań przesiewowych. ¹

Znaczenie nowoczesnych technologii w diagnozowaniu polipów

Dokładna optyczna charakterystyka polipów jelita grubego w czasie rzeczywistym jest kluczowa dla wyboru optymalnego schematu leczenia podczas kolonoskopii. Nowe urządzenia oparte na sztucznej inteligencji (AI) pokazują potencjał do wspierania mniej doświadczonych endoskopistów w systematycznym osiąganiu wyników ekspertów w optycznej charakterystyce. ¹

Dokładność sztucznej inteligencji w świetle białym (WL) okazała się lepsza niż dokładność niedoświadczonych endoskopistów (iloraz szans 1,875 [1,191-2,953]), a dokładność w świetle niebieskim (BL) okazała się porównywalna. Urządzenia te mają potencjał do standaryzacji praktyki optycznej charakterystyki i zapewnienia takiej samej dokładności we wszystkich kolonoskopiach, jaką można spotkać tylko u nielicznych bardzo doświadczonych lekarzy ekspertów. ²

Ocena objawów w kontekscie ryzyka raka jelita grubego

Obecne dowody sugerują, że powszechna praktyka wykonywania kolonoskopii w celu identyfikacji nowotworów u osób z objawami jelitowymi jest uzasadniona tylko w przypadku krwawienia z odbytnicy i ogólnego objawu utraty masy ciała. Ogólnie rzecz biorąc, tylko krwawienie i utrata masy ciała wykazały istotny związek z rakiem. ¹

Utrata masy ciała była związana z rakiem jelita grubego, z polem pod krzywą ROC (AUC) wynoszącym 0,67, co odpowiada diagnostycznemu ilorazowi szans (DOR) wynoszącemu 2,9. Objawy zwykle uważane za istotne dla diagnozy raka jelita grubego to krwawienie z odbytnicy, zmiana rytmu wypróżnień, ból brzucha, utrata masy ciała, biegunka i zaparcia. Z tych wszystkich, według przeglądu systematycznego, tylko utrata masy ciała i krwawienie z odbytnicy były związane z rakiem jelita grubego. ²

Podsumowanie czynników prognostycznych

Rokowanie dla pacjentów z polipami jelita grubego zależy od wielu czynników, które wpływają na ryzyko rozwoju raka oraz wyniki leczenia. Kluczowe znaczenie mają:

Wielkość polipów – polipy większe niż 10 mm wiążą się z wyższym ryzykiem złośliwości ¹
Liczba polipów – większa liczba polipów zwiększa ryzyko rozwoju raka ¹
Typ histologiczny – niektóre typy polipów, jak gruczolaki kosmkowe, mają wyższe ryzyko złośliwości ²
Cechy wysokiego ryzyka w polipach złośliwych – takie jak dodatni margines, głęboka inwazja, słabe zróżnicowanie, inwazja naczyń, pączkowanie guza ¹
Historia rodzinna – krewni pierwszego stopnia pacjentów z polipami jelita grubego mają zwiększone ryzyko raka jelita grubego ¹
Wczesne wykrycie i usunięcie – kluczowe dla zapobiegania rozwojowi raka ¹²
Regularne badania kontrolne – odpowiednio zaplanowane w zależności od wyników poprzednich badań ²

Podsumowując, rokowanie dla pacjentów z polipami jelita grubego jest zazwyczaj doskonałe, jeśli polipy zostaną odpowiednio i we właściwym czasie usunięte. Indywidualizacja podejścia terapeutycznego, uwzględniająca wszystkie czynniki ryzyka, jest niezbędna dla optymalizacji wyników leczenia i zmniejszenia ryzyka rozwoju raka jelita grubego. ¹²³

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Materiały źródłowe

#1 Colon Polyps: Symptoms, Causes, Types & Removal
https://my.clevelandclinic.org/health/diseases/15370-colon-polyps
Colon polyps can be serious because of their potential to turn into cancer. But most polyps aren’t cancerous when they’re found. Some might grow into cancer over time if they’re left untreated. Healthcare providers remove them when they find them to prevent this from happening. […] Most colon polyps have the potential to become cancerous, which is why healthcare providers remove them during a colonoscopy. But very few of them actually do turn into cancer, and it takes a long time for them to do so. Routine colonoscopies remove polyps before they have the chance to become cancer. […] Removing neoplastic polyps reduces your risk of developing colorectal cancer by 80%. But once you’ve had polyps, you’re likely to have them again. Your healthcare provider will judge your risk of future polyps based on the polyps you’ve had before. They’ll schedule your next screening based on that risk.
#1 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Polyps in the colon and rectum (together called colorectal polyps) are common in people over age 50. They are usually noncancerous, but certain characteristics can increase the likelihood of a polyp becoming cancerous. […] The risk of a polyp becoming cancerous increases with size. Polyps that are 10 millimeters (mm) or larger are considered to have a higher cancer risk than ones that are smaller than 10 mm. […] In general terms, colorectal polyps that are 10 mm (1 cm) or bigger in diameter are considered to have a higher risk of becoming cancerous than those smaller than 10 mm. Adenomas and sessile serrated polyps that are 10 mm or more are classified as advanced. […] The risk that a polyp will become cancerous can continue to rise with the size of the polyp. Depending on the type and other factors, up to 50% of polyps over 20 mm (2 cm) are cancerous.
#1 Long-term survival after treatment of malignant colonic polyps – PubMed
https://pubmed.ncbi.nlm.nih.gov/9269809/
Purpose: This study was designed to evaluate the long-term outcome and survival of patients treated for malignant colonic polyps. […] Life table analysis demonstrated a five-year survival of 82 percent for the colectomy group and 95 percent for the polypectomy group (P = 0.15). […] Treatment of patients with malignant polyps must be individualized based on evolving criteria. Patients in whom polypectomy margins are inadequate should undergo colectomy. With appropriate selection criteria, patients selected for colectomy had a five-year survival rate similar to the rate of those treated by polypectomy alone.
#1 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
Colorectal malignant polyps (MP) are polyps with invasive cancer into the submucosa harboring a variable risk of lymph node involvement, which can be estimated through evaluation of morphological, endoscopic, and histologic features. […] Differentiating low- and high-risk histologic features that influence the possibility of residual tumor, the risk of recurrence and the risk of lymph node metastasis, is crucial to further optimize treatment and surveillance plans. […] While the presence of high-risk features indicates a need for surgery in the majority of cases, location, comorbidities and the patients preference should be taken in account when making the final decision. […] This is a particularly important issue in the management of low rectal MP presenting with high-risk features, where chemoradiotherapy followed by a watch-and-wait strategy has demonstrated promising results.
#1 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
The knowledge of identifiable adverse histologic features, the advances in imaging techniques that allow for optical diagnosis of T1 CRC and the recent advances in endoscopic treatment techniques have led to an increasing awareness of the importance of MP. […] The presence of high-risk features (positive margin, deep SMI (1 mm), poorly differentiated carcinoma, lymphovascular invasion, tumor budding and piecemeal resection) indicates a need for surgery in the majority of cases, although location, comorbidities and patient preference should be taken into account when making the final decision.
#1 Establish a novel tumor budding-related signature to predict prognosis and guide clinical therapy in colorectal cancer | Scientific Reports
https://www.nature.com/articles/s41598-024-52596-1
Tumor budding is a long-established independent adverse prognostic marker for colorectal cancer (CRC), yet assessment of tumor budding was not reproducible. […] The prognostic role of Bd has been widely investigated and currently influences decision making in CRC patients. In patients with pT1 CRC, intermediate to high-grade Bd (Bd2-3) is an independent predictor of lymph node metastasis and is increasingly considered. […] In stage II colorectal cancer, high-grade Bd (Bd3) represents a poor prognostic factor that should warrant consideration of adjuvant chemotherapy. […] The analysis of diagnostic value indicated that our diagnostic model possessed high accuracy and stability for tumor budding diagnosis, which implied great potential for clinical translation. […] In summary, the combination of our genetic diagnostic models and HE staining sections may reduce the low miss rate and improve the precision in tumor budding assessment, which will contribute to the development of more personalized and precise individualized therapy. […] Our study improves tumor budding molecular assessment and provides a promising novel molecular marker for immunotherapy and prognosis of CRC.
#1 They found colon polyps: Now what? – Harvard Health
https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what
Follow-up exams at the right time are essential to prevent cancer from developing. […] Colorectal cancer is one of the most preventable forms of cancer if you are screened for hidden warning signs while you are still healthy. […] They are not cancer, and most of them have not started to change into cancer. If you get them at the precancerous phase, they don’t have a chance to grow and turn into cancer. […] Overall, only 5% of adenomas progress to cancer, but your individual risk is hard to predict. […] There is a 25% to 30% chance that a repeat colonoscopy will find additional polyps. […] If the colonoscopy finds one or two small polyps (5 mm in diameter or smaller), you are considered at relatively low risk. […] If the polyps are larger (10 mm or larger), more numerous, or abnormal in appearance under a microscope, you may have to return in three years or sooner.
#1 They found colon polyps: Now what? – Harvard Health
https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what
If the exam finds no polyps, you can usually wait 10 years for the next screening if you are at average risk for colon cancer. […] For colonoscopy to prevent cancer, the doctor must find and remove as many precancerous growths as possible. […] After polyp removal, certain steps may lower your risk of colon cancer.
#1 Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden | The BMJ
https://www.bmj.com/content/373/bmj.n877
After adjusting for family history of CRC, having a first degree relative with a colorectal polyp was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). […] The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps and decreasing age at polyp diagnosis. […] A particularly strong association was found for early onset CRC diagnosed before age 50 years. […] In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79, with one first degree relative with CRC but no polyps was 1.70, and with two or more first degree relatives with both polyps and CRC was 5.00. […] After adjusting for family history of CRC, siblings and children of patients with colorectal polyps were found to be at increased risk of CRC, particularly when polyps were diagnosed in more than one first degree relative or before age 60 years.
#1 Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden | The BMJ
https://www.bmj.com/content/373/bmj.n877
The increased risk is more prominent for early onset CRC and heightened in association with a family history of CRC. […] Individuals with at least two first degree relatives with polyps or a first degree relative with polyps diagnosed at a young age are at an increased risk of CRC, particularly early onset disease, and they might benefit from early screening.
#1 A novel AI device for real-time optical characterization of colorectal polyps | npj Digital Medicine
https://www.nature.com/articles/s41746-022-00633-6
Accurate in-vivo optical characterization of colorectal polyps is key to select the optimal treatment regimen during colonoscopy. […] Moreover, CADx accuracy in WL was found superior to the accuracy of non-expert endoscopists (CADxWL/NonExp; OR 1.875 [1.1912.953]), and CADx accuracy in BL was found comparable to it (CADxBL/CADxWL; OR 0.886 [0.6121.282]). […] The proposed intelligent device shows the potential to support non-expert endoscopists in systematically reaching the performances of expert endoscopists in optical characterization. […] In clinical practice, the task of OC performed during live colonoscopy is not a static assessment of a polyp portrait, but rather a fluid and dynamic process of decision build-up in the endoscopists brain. […] A noteworthy result of this study was the disagreement observed between a large panel of endoscopists with heterogeneous expertise and histology. […] This work has limitations. […] In conclusion, this device offers the potential to standardize the practice of OC and to ensure in all colonoscopies the same accuracy that can be met only by a few very experienced expert physicians.
#1 Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-11-65
Current evidence suggests that the common practice of performing colonoscopies to identify cancers in people with bowel symptoms is warranted only for rectal bleeding and the general symptom of weight loss. […] Overall, only bleeding and weight loss showed any significant association with cancer. […] Weight loss was associated with colorectal cancer, with an AUC of 0.67, corresponding to a DOR of 2.9. […] The symptoms usually considered important for colorectal cancer diagnosis are rectal bleeding, change in bowel habit, abdominal pain, weight loss, diarrhoea and constipation. Of these, in our systematic review, only weight loss and rectal bleeding were associated with colorectal cancer, albeit with low DORs and AUCs. […] Our systematic review has shown that, on current evidence, only rectal bleeding and the general symptom of weight loss are associated with colorectal cancer, and may be helpful in selecting patients for further investigation with colonoscopy.
#1 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Some research has found that the incidence of polyp cancer is up to 75% when a polyp reaches 35 mm (3.5 cm). […] Some research has found the risk of a polyp becoming cancerous is particularly high when adenomas: Are large (10 mm or more), Are multiple, Have a villous pathology. […] Research findings have also suggested that advanced adenomas progress to cancer at a higher rate than the average rate for all adenomas, and this advanced rate increases with the age of the person. […] Though polyps 10 cm or larger in size carry a higher risk of cancer, most adenomas (60% to 75%) detected with colonoscopy are smaller than 10 cm. […] The risk of cancer development can increase with multiple polyps, as well as the risk of developing more polyps in the future, with more than 10 adenomas considered the highest risk.
#2 Colorectal polyps Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/colorectal-polyps
The outlook is excellent if the polyps are removed. Polyps that are not removed can develop into cancer over time.
#2 They found colon polyps: Now what? – Harvard Health
https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what
Follow-up exams at the right time are essential to prevent cancer from developing. […] Colorectal cancer is one of the most preventable forms of cancer if you are screened for hidden warning signs while you are still healthy. […] They are not cancer, and most of them have not started to change into cancer. If you get them at the precancerous phase, they don’t have a chance to grow and turn into cancer. […] Overall, only 5% of adenomas progress to cancer, but your individual risk is hard to predict. […] There is a 25% to 30% chance that a repeat colonoscopy will find additional polyps. […] If the colonoscopy finds one or two small polyps (5 mm in diameter or smaller), you are considered at relatively low risk. […] If the polyps are larger (10 mm or larger), more numerous, or abnormal in appearance under a microscope, you may have to return in three years or sooner.
#2 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Some research has found that the incidence of polyp cancer is up to 75% when a polyp reaches 35 mm (3.5 cm). […] Some research has found the risk of a polyp becoming cancerous is particularly high when adenomas: Are large (10 mm or more), Are multiple, Have a villous pathology. […] Research findings have also suggested that advanced adenomas progress to cancer at a higher rate than the average rate for all adenomas, and this advanced rate increases with the age of the person. […] Though polyps 10 cm or larger in size carry a higher risk of cancer, most adenomas (60% to 75%) detected with colonoscopy are smaller than 10 cm. […] The risk of cancer development can increase with multiple polyps, as well as the risk of developing more polyps in the future, with more than 10 adenomas considered the highest risk.
#2 Long-term survival after treatment of malignant colonic polyps – PubMed
https://pubmed.ncbi.nlm.nih.gov/9269809/
Purpose: This study was designed to evaluate the long-term outcome and survival of patients treated for malignant colonic polyps. […] Life table analysis demonstrated a five-year survival of 82 percent for the colectomy group and 95 percent for the polypectomy group (P = 0.15). […] Treatment of patients with malignant polyps must be individualized based on evolving criteria. Patients in whom polypectomy margins are inadequate should undergo colectomy. With appropriate selection criteria, patients selected for colectomy had a five-year survival rate similar to the rate of those treated by polypectomy alone.
#2 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
The knowledge of identifiable adverse histologic features, the advances in imaging techniques that allow for optical diagnosis of T1 CRC and the recent advances in endoscopic treatment techniques have led to an increasing awareness of the importance of MP. […] The presence of high-risk features (positive margin, deep SMI (1 mm), poorly differentiated carcinoma, lymphovascular invasion, tumor budding and piecemeal resection) indicates a need for surgery in the majority of cases, although location, comorbidities and patient preference should be taken into account when making the final decision.
#2 Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden | The BMJ
https://www.bmj.com/content/373/bmj.n877
After adjusting for family history of CRC, having a first degree relative with a colorectal polyp was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). […] The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps and decreasing age at polyp diagnosis. […] A particularly strong association was found for early onset CRC diagnosed before age 50 years. […] In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79, with one first degree relative with CRC but no polyps was 1.70, and with two or more first degree relatives with both polyps and CRC was 5.00. […] After adjusting for family history of CRC, siblings and children of patients with colorectal polyps were found to be at increased risk of CRC, particularly when polyps were diagnosed in more than one first degree relative or before age 60 years.
#2 A novel AI device for real-time optical characterization of colorectal polyps | npj Digital Medicine
https://www.nature.com/articles/s41746-022-00633-6
Accurate in-vivo optical characterization of colorectal polyps is key to select the optimal treatment regimen during colonoscopy. […] Moreover, CADx accuracy in WL was found superior to the accuracy of non-expert endoscopists (CADxWL/NonExp; OR 1.875 [1.1912.953]), and CADx accuracy in BL was found comparable to it (CADxBL/CADxWL; OR 0.886 [0.6121.282]). […] The proposed intelligent device shows the potential to support non-expert endoscopists in systematically reaching the performances of expert endoscopists in optical characterization. […] In clinical practice, the task of OC performed during live colonoscopy is not a static assessment of a polyp portrait, but rather a fluid and dynamic process of decision build-up in the endoscopists brain. […] A noteworthy result of this study was the disagreement observed between a large panel of endoscopists with heterogeneous expertise and histology. […] This work has limitations. […] In conclusion, this device offers the potential to standardize the practice of OC and to ensure in all colonoscopies the same accuracy that can be met only by a few very experienced expert physicians.
#2 Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-11-65
Current evidence suggests that the common practice of performing colonoscopies to identify cancers in people with bowel symptoms is warranted only for rectal bleeding and the general symptom of weight loss. […] Overall, only bleeding and weight loss showed any significant association with cancer. […] Weight loss was associated with colorectal cancer, with an AUC of 0.67, corresponding to a DOR of 2.9. […] The symptoms usually considered important for colorectal cancer diagnosis are rectal bleeding, change in bowel habit, abdominal pain, weight loss, diarrhoea and constipation. Of these, in our systematic review, only weight loss and rectal bleeding were associated with colorectal cancer, albeit with low DORs and AUCs. […] Our systematic review has shown that, on current evidence, only rectal bleeding and the general symptom of weight loss are associated with colorectal cancer, and may be helpful in selecting patients for further investigation with colonoscopy.
#2 Colon Polyps: Symptoms, Causes, Types & Removal
https://my.clevelandclinic.org/health/diseases/15370-colon-polyps
Colon polyps can be serious because of their potential to turn into cancer. But most polyps aren’t cancerous when they’re found. Some might grow into cancer over time if they’re left untreated. Healthcare providers remove them when they find them to prevent this from happening. […] Most colon polyps have the potential to become cancerous, which is why healthcare providers remove them during a colonoscopy. But very few of them actually do turn into cancer, and it takes a long time for them to do so. Routine colonoscopies remove polyps before they have the chance to become cancer. […] Removing neoplastic polyps reduces your risk of developing colorectal cancer by 80%. But once you’ve had polyps, you’re likely to have them again. Your healthcare provider will judge your risk of future polyps based on the polyps you’ve had before. They’ll schedule your next screening based on that risk.
#3 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Some research has found that the incidence of polyp cancer is up to 75% when a polyp reaches 35 mm (3.5 cm). […] Some research has found the risk of a polyp becoming cancerous is particularly high when adenomas: Are large (10 mm or more), Are multiple, Have a villous pathology. […] Research findings have also suggested that advanced adenomas progress to cancer at a higher rate than the average rate for all adenomas, and this advanced rate increases with the age of the person. […] Though polyps 10 cm or larger in size carry a higher risk of cancer, most adenomas (60% to 75%) detected with colonoscopy are smaller than 10 cm. […] The risk of cancer development can increase with multiple polyps, as well as the risk of developing more polyps in the future, with more than 10 adenomas considered the highest risk.
#3 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
The knowledge of identifiable adverse histologic features, the advances in imaging techniques that allow for optical diagnosis of T1 CRC and the recent advances in endoscopic treatment techniques have led to an increasing awareness of the importance of MP. […] The presence of high-risk features (positive margin, deep SMI (1 mm), poorly differentiated carcinoma, lymphovascular invasion, tumor budding and piecemeal resection) indicates a need for surgery in the majority of cases, although location, comorbidities and patient preference should be taken into account when making the final decision.
#3 They found colon polyps: Now what? – Harvard Health
https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what
Follow-up exams at the right time are essential to prevent cancer from developing. […] Colorectal cancer is one of the most preventable forms of cancer if you are screened for hidden warning signs while you are still healthy. […] They are not cancer, and most of them have not started to change into cancer. If you get them at the precancerous phase, they don’t have a chance to grow and turn into cancer. […] Overall, only 5% of adenomas progress to cancer, but your individual risk is hard to predict. […] There is a 25% to 30% chance that a repeat colonoscopy will find additional polyps. […] If the colonoscopy finds one or two small polyps (5 mm in diameter or smaller), you are considered at relatively low risk. […] If the polyps are larger (10 mm or larger), more numerous, or abnormal in appearance under a microscope, you may have to return in three years or sooner.
#3 Long-term survival after treatment of malignant colonic polyps – PubMed
https://pubmed.ncbi.nlm.nih.gov/9269809/
Purpose: This study was designed to evaluate the long-term outcome and survival of patients treated for malignant colonic polyps. […] Life table analysis demonstrated a five-year survival of 82 percent for the colectomy group and 95 percent for the polypectomy group (P = 0.15). […] Treatment of patients with malignant polyps must be individualized based on evolving criteria. Patients in whom polypectomy margins are inadequate should undergo colectomy. With appropriate selection criteria, patients selected for colectomy had a five-year survival rate similar to the rate of those treated by polypectomy alone.
#4 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Some research has found that the incidence of polyp cancer is up to 75% when a polyp reaches 35 mm (3.5 cm). […] Some research has found the risk of a polyp becoming cancerous is particularly high when adenomas: Are large (10 mm or more), Are multiple, Have a villous pathology. […] Research findings have also suggested that advanced adenomas progress to cancer at a higher rate than the average rate for all adenomas, and this advanced rate increases with the age of the person. […] Though polyps 10 cm or larger in size carry a higher risk of cancer, most adenomas (60% to 75%) detected with colonoscopy are smaller than 10 cm. […] The risk of cancer development can increase with multiple polyps, as well as the risk of developing more polyps in the future, with more than 10 adenomas considered the highest risk.
#4 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
The knowledge of identifiable adverse histologic features, the advances in imaging techniques that allow for optical diagnosis of T1 CRC and the recent advances in endoscopic treatment techniques have led to an increasing awareness of the importance of MP. […] The presence of high-risk features (positive margin, deep SMI (1 mm), poorly differentiated carcinoma, lymphovascular invasion, tumor budding and piecemeal resection) indicates a need for surgery in the majority of cases, although location, comorbidities and patient preference should be taken into account when making the final decision.
#4 They found colon polyps: Now what? – Harvard Health
https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what
Follow-up exams at the right time are essential to prevent cancer from developing. […] Colorectal cancer is one of the most preventable forms of cancer if you are screened for hidden warning signs while you are still healthy. […] They are not cancer, and most of them have not started to change into cancer. If you get them at the precancerous phase, they don’t have a chance to grow and turn into cancer. […] Overall, only 5% of adenomas progress to cancer, but your individual risk is hard to predict. […] There is a 25% to 30% chance that a repeat colonoscopy will find additional polyps. […] If the colonoscopy finds one or two small polyps (5 mm in diameter or smaller), you are considered at relatively low risk. […] If the polyps are larger (10 mm or larger), more numerous, or abnormal in appearance under a microscope, you may have to return in three years or sooner.
#5 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Polyps in the colon and rectum (together called colorectal polyps) are common in people over age 50. They are usually noncancerous, but certain characteristics can increase the likelihood of a polyp becoming cancerous. […] The risk of a polyp becoming cancerous increases with size. Polyps that are 10 millimeters (mm) or larger are considered to have a higher cancer risk than ones that are smaller than 10 mm. […] In general terms, colorectal polyps that are 10 mm (1 cm) or bigger in diameter are considered to have a higher risk of becoming cancerous than those smaller than 10 mm. Adenomas and sessile serrated polyps that are 10 mm or more are classified as advanced. […] The risk that a polyp will become cancerous can continue to rise with the size of the polyp. Depending on the type and other factors, up to 50% of polyps over 20 mm (2 cm) are cancerous.
#5 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
The knowledge of identifiable adverse histologic features, the advances in imaging techniques that allow for optical diagnosis of T1 CRC and the recent advances in endoscopic treatment techniques have led to an increasing awareness of the importance of MP. […] The presence of high-risk features (positive margin, deep SMI (1 mm), poorly differentiated carcinoma, lymphovascular invasion, tumor budding and piecemeal resection) indicates a need for surgery in the majority of cases, although location, comorbidities and patient preference should be taken into account when making the final decision.
#6 Colon Polyp Size Chart: Whatâs Cancerous, Whatâs Not
https://www.verywellhealth.com/colon-polyp-size-chart-8659874
Some research has found that the incidence of polyp cancer is up to 75% when a polyp reaches 35 mm (3.5 cm). […] Some research has found the risk of a polyp becoming cancerous is particularly high when adenomas: Are large (10 mm or more), Are multiple, Have a villous pathology. […] Research findings have also suggested that advanced adenomas progress to cancer at a higher rate than the average rate for all adenomas, and this advanced rate increases with the age of the person. […] Though polyps 10 cm or larger in size carry a higher risk of cancer, most adenomas (60% to 75%) detected with colonoscopy are smaller than 10 cm. […] The risk of cancer development can increase with multiple polyps, as well as the risk of developing more polyps in the future, with more than 10 adenomas considered the highest risk.
#6 Colorectal malignant polyps: a modern approach
https://pmc.ncbi.nlm.nih.gov/articles/PMC8713339/
The knowledge of identifiable adverse histologic features, the advances in imaging techniques that allow for optical diagnosis of T1 CRC and the recent advances in endoscopic treatment techniques have led to an increasing awareness of the importance of MP. […] The presence of high-risk features (positive margin, deep SMI (1 mm), poorly differentiated carcinoma, lymphovascular invasion, tumor budding and piecemeal resection) indicates a need for surgery in the majority of cases, although location, comorbidities and patient preference should be taken into account when making the final decision.