From the Guidelines
A follow-up colonoscopy is recommended 3-10 years after removal of a tubular adenoma in the colon, depending on the size, number, and characteristics of the adenoma that was removed, as per the latest guidelines from the US Multi-Society Task Force on Colorectal Cancer 1. The exact timing of the follow-up colonoscopy depends on several factors, including the size, number, and characteristics of the adenoma that was removed.
- For a single, small (less than 10 mm) tubular adenoma with low-grade dysplasia, a 7-10 year follow-up is typically sufficient, as recommended by the US Multi-Society Task Force on Colorectal Cancer 1.
- For larger adenomas (greater than or equal to 10 mm), multiple adenomas (3 or more), or those with high-grade dysplasia or villous features, a 3-year follow-up is recommended, as stated in the guidelines from the US Multi-Society Task Force on Colorectal Cancer 1. During the follow-up period, maintaining a healthy lifestyle is important, including a diet high in fiber and low in red meat, regular exercise, limiting alcohol consumption, avoiding smoking, and maintaining a healthy weight. These lifestyle modifications may help reduce the risk of developing new adenomas or colorectal cancer, as suggested by various studies, including those referenced by the American Cancer Society 1 and the American Family Physician 1. Tubular adenomas are precancerous polyps that can potentially develop into colorectal cancer if left untreated, which is why regular surveillance is crucial, as emphasized by the US Multi-Society Task Force on Colorectal Cancer 1. The follow-up colonoscopy allows for detection and removal of any new or recurrent adenomas before they have a chance to progress to cancer. It is essential to note that the recommendations for follow-up after colonoscopy and polypectomy may vary depending on individual factors, such as family history, personal history of inflammatory bowel disease, and other factors, as discussed in the guidelines from the US Multi-Society Task Force on Colorectal Cancer 1.
From the Research
Follow-up for Tubular Adenoma in the Colon
- The clinical management of patients with adenomas is crucial due to their malignant potential and the availability of effective intervention by colonoscopy 2.
- Patients newly diagnosed with three or more adenomas, an adenoma of more than 0.5 cm, or with a family history of colorectal cancer should have surveillance colonoscopy at 3 years following the polypectomy 2.
- Surveillance of patients with single, small tubular adenomas can be extended to 5 or more years 2.
- Identification and removal of adenomatous polyps have been shown to reduce colorectal cancer incidence 2.
Detection Methods
- CT colonography is a noninvasive option in screening for colorectal cancer and has been shown to detect 90% of subjects with adenomas or cancers measuring 10 mm or more in diameter 3.
- The per-patient estimates of the sensitivity, specificity, positive and negative predictive values, and area under the receiver-operating-characteristic curve for CT colonography were 0.90,0.86,0.23,0.99, and 0.89, respectively 3.
- Optical colonoscopy is also an effective method for detecting neoplastic lesions, but CT colonography can evaluate both the intra- and extraluminal aspects of the anastomosis 4.
Risk Reduction
- Aspirin and ibuprofen use have been associated with a reduced risk of advanced colorectal adenoma incidence and recurrence and colorectal cancer 5.
- The use of aspirin and ibuprofen has been shown to decrease the risk of incident adenoma, recurrent adenoma, and incident colorectal cancer 5.
- The American College of Gastroenterology recommends CRC screening in average-risk individuals and those with a family history of CRC, and discusses the role of aspirin for chemoprevention 6.