Clin Colon Rectal Surg 2015; 28(04): 215-219
DOI: 10.1055/s-0035-1564434
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Malignant Adenomas

Jason F. Hall
1   Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
2   Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
20 November 2015 (online)

Abstract

Most polyps that originate in the colon and rectum are benign. A small subset of polyps will contain a malignancy. Although most malignant adenomas are managed with colonic resection a number can be approached with endoscopic, minimally invasive, and observational techniques. This article reviews the histologic characteristics and adverse risk factors that would portend a poor oncologic outcome and therefore suggest formal colonic resection. Modern endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal resection are discussed.

 
  • References

  • 1 American Cancer Society: Cancer Facts and Figures 2014 Atlanta, GA: American Cancer Society; 2014. Available online. Last accessed May 21, 2014. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf
  • 2 Jen J, Powell SM, Papadopoulos N , et al. Molecular determinants of dysplasia in colorectal lesions. Cancer Res 1994; 54 (21) 5523-5526
  • 3 Ries LA, Wingo PA, Miller DS , et al. The annual report to the nation on the status of cancer, 1973-1997, with a special section on colorectal cancer. Cancer 2000; 88 (10) 2398-2424
  • 4 Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 1992; 84 (20) 1572-1575
  • 5 Ramirez M, Schierling S, Papaconstantinou HT, Thomas JS. Management of the malignant polyp. Clin Colon Rectal Surg 2008; 21 (4) 286-290
  • 6 Rex DK. Optimal withdrawal and examination in colonoscopy. Gastroenterol Clin North Am 2013; 42 (3) 429-442
  • 7 Markowitz AJ, Winawer SJ. Management of colorectal polyps. CA Cancer J Clin 1997; 47 (2) 93-112
  • 8 Burnstein MJ, Hicks TC. Polyps. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, , eds. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer; 2007: 366-368
  • 9 Church JM. Colon cancer screening update and management of the malignant polyp. Clin Colon Rectal Surg 2005; 18 (3) 141-149
  • 10 O'Brien MJ, Winawer SJ, Zauber AG , et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology 1990; 98 (2) 371-379
  • 11 Muto T, Bussey HJR, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975; 36 (6) 2251-2270
  • 12 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 (2) 328-336
  • 13 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993; 25 (7) 455-461
  • 14 Geraghty JM, Williams CB, Talbot IC. Malignant colorectal polyps: venous invasion and successful treatment by endoscopic polypectomy. Gut 1991; 32 (7) 774-778
  • 15 Naqvi S, Burroughs S, Chave HS, Branagan G. Management of colorectal polyp cancers. Ann R Coll Surg Engl 2012; 94 (8) 574-578
  • 16 Netzer P, Forster C, Biral R , et al. Risk factor assessment of endoscopically removed malignant colorectal polyps. Gut 1998; 43 (5) 669-674
  • 17 Gill MD, Rutter MD, Holtham SJ. Management and short-term outcome of malignant colorectal polyps in the north of England(1). Colorectal Dis 2013; 15 (2) 169-176
  • 18 Cooper GS, Xu F, Barnholtz Sloan JS, Koroukian SM, Schluchter MD. Management of malignant colonic polyps: a population-based analysis of colonoscopic polypectomy versus surgery. Cancer 2012; 118 (3) 651-659
  • 19 Inoue H, Endo M. Endoscopic esophageal mucosal resection using a transparent tube. Surg Endosc 1990; 4 (4) 198-201
  • 20 Soehendra N, Binmoeller KF, Bohnacker S , et al. Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy 1997; 29 (5) 380-383
  • 21 Steele SR, Johnson EK, Champagne B , et al. Endoscopy and polyps-diagnostic and therapeutic advances in management. World J Gastroenterol 2013; 19 (27) 4277-4288
  • 22 Moss A, Bourke MJ, Williams SJ , et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140 (7) 1909-1918
  • 23 Brooker JC, Saunders BP, Shah SG, Thapar CJ, Suzuki N, Williams CB. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 2002; 55 (3) 371-375
  • 24 Saito Y, Fukuzawa M, Matsuda T , et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24 (2) 343-352
  • 25 Cruz RA, Ragupathi M, Pedraza R, Pickron TB, Le AT, Haas EM. Minimally invasive approaches for the management of “difficult” colonic polyps. Diagn Ther Endosc 2011; 2011: 682793