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BENIGN TUMORS OF LARGE INTESTINE

By: Ismah Haron

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Adenomatous Polyps• Asymptomatic

• Association of symptoms and risk of malignancy with increasing of size; colonic bleeding, diarrhea, mucus discharged

• Colonoscopy; sessile, pedunculated or mixed

• HPE; Tubular, tubulovillous or villous type

• Resection (e.g. adenoma > 5 mm)

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1. http://www.aboutcancer.com/rectal_polyps2.htm 2. http://www.ajronline.org/content/189/1/35/F3.expansion.html 3. http://avantis.thirdeyecolonoscopy.com/tag/colonoscopy/ 4. http://www.endoatlas.com/co_bt_11.html

Sessile adenomatous polypsPedunculated adenomatous polyps

Norman S. William, et al. Bailey and Love’s Short Practice of Surgery

Familial Adenomatous Polyposis (FAP)

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Familial Adenomatous Polyposis (FAP)

• Asymptomatic or

• Symptomatic- Diarrhea, passage of blood and mucus, abdominal pain, LOW

• Family history

• Colonoscopy, biopsy, genetic testing- Presence of >100 colorectal adenoma- Gene APC

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• Treatment - Risk of colorectal carcinoma

- Surgery at age 17 to 18 y/o or symptomatic or multiple polyps develop

- Colectomy + ileorectal anatomosis or

- Restorative protocolectomy + ileoanal anastomosis

- Follow up

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• Screening policy- At-risk family members are offered genetic testing in their early

teens

- At-risk members of the family should be examined at the age of 10 to 12 years, repeated every year

- Most of those who are going to get polyps will have them at 20 years, and these require operation

- If there are no polyps at 20 years, continue with 5-yearly examination until age 50 years; if there are still no polyps, there is probably no inherited gene

- Examination of blood relatives, including cousins, nephews and nieces, is essential, and a family tree should be constructed and a register of affected families maintained

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Hereditary Non-polyposis Colorectal Cancer (HNPCC) or Lynch’s Syndrome

• Asymptomatic

• Diagnosis; Genetic testing or Amsterdam criteria II- ≥3 family members with HNPCC related ca- 2 successive affected generation- ≥1 of HNPCC related ca diagnosed <50 y/o- Exclusion of FAP

• MLH1, MSH2 genes, colonoscopy, HPE

http://www.creighton.edu/fileadmin/user/Admin/pr_mednews/10_2004.html

Henry T. Lynch

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• Risk of colorectal ca, ca of endometrium, stomach, ovary, small intestine

• Treatment*- Surgery + postoperative surveillance

· Subtotal colectomy with ileorectal anastomosis· Total colectomy ileoanal pull-through· Total colectomy with ileostomy

- Prophylactic hysterectomy, bilateral salphigo-oophorectomy ∙ Age >50 y/o with HNPCC

- Chemoprevention (e.g. folic acid, calcium, vitamin C, vitamin E)- Exercise and diet

*http://emedicine.medscape.com/article/188613-overview

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THANK YOU

REFERENCES:

1. Norman S. William, et al. Bailey and Love’s Short Practice of Surgery.

2. Grey McLatchie, et al. Oxford Handbook of Clinical Surgery.

3. P. Youssefi, et al. Mind Maps in Surgery.