Tubular adenoma of the colon?

From the Guidelines

Tubular Adenoma of the Colon

Tubular adenoma of the colon is a type of polyp that has the potential to develop into colorectal cancer over time. It is recommended that all tubular adenomas be removed during colonoscopy to prevent the development of cancer [ 1 ].

Follow-up Recommendations

After removal, follow-up colonoscopy is recommended to monitor for new polyps or recurrence. The interval for follow-up colonoscopy depends on the number and size of the adenomas removed. For patients with 1–2 tubular adenomas <10 mm in size, a follow-up colonoscopy is recommended in 7-10 years [ 1 ]. For patients with 3–4 adenomas <10 mm in size, a follow-up colonoscopy is recommended in 3-5 years [ 1 ].

Management and Chemoprevention

In terms of management, there is no specific medication recommended for the treatment of tubular adenoma. However, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered for chemoprevention in patients with a high risk of colorectal cancer, under the guidance of a healthcare provider [ 1 ]. The typical dose of aspirin for chemoprevention is 81-325 mg per day, but this should only be started after consulting with a doctor.

Lifestyle Modifications

It is essential to follow a healthy lifestyle, including a balanced diet, regular exercise, and avoidance of smoking and excessive alcohol consumption, to reduce the risk of colorectal cancer [ 1 ].

• Key points to consider:
  • Removal of tubular adenomas during colonoscopy
  • Follow-up colonoscopy at recommended intervals
  • Consideration of aspirin for chemoprevention in high-risk patients
  • Adoption of a healthy lifestyle to reduce colorectal cancer risk

From the Research

Definition and Types of Colonic Polyps

• Colonic polyps are growths on the inner lining of the colon or rectum, and they can be classified into different types, including tubular adenomas, villous adenomas, and villotubular adenomas 2.
• Tubular adenomas are a type of neoplastic polyp that has malignant potential, and they are the most common type of adenoma found in the colon 2, 3.

Malignant Potential of Tubular Adenomas

• The malignant potential of tubular adenomas is determined by their histologic type, size, and degree of atypicality 3.
• The incidence of malignancy in tubular adenomas is around 5% 3, and cancerous changes must penetrate the muscularis mucosae for a polyp to be regarded as clinically malignant 2.
• The risk of malignant change in tubular adenomas increases with size, and invasive cancer can be found even in polyps less than 1 cm in diameter 2.

Detection and Removal of Colonic Polyps

• Early detection and complete removal of neoplastic polyps, including tubular adenomas, are essential for the prevention of colorectal cancer 2, 3.
• Colonoscopy is a effective method for detecting and removing colonic polyps, and it can reduce the incidence of colorectal cancer 2.
• The prevalence of tubular adenomas is around 60.15%, and patients with a polyp diameter ≥ 1.0 cm or multiple polyps are at higher risk of developing colorectal carcinoma in situ (CCS) 4.

Risk Factors for Colorectal Carcinoma

• Risk factors for CCS and neoplastic polyps include polyp diameter ≥ 1.0 cm, multiple polyps, and high levels of certain tumor markers such as CA724 and CA211 4.
• Age is also a risk factor for neoplastic polyps, with the risk increasing by 3% for each 1-year increase in age 4.
• Other risk factors for CCS include schistosome egg deposition and high levels of CA199 4.