From the Guidelines
When a cecal mass is found on colonoscopy, the next step is to obtain tissue samples (biopsies) of the mass for pathological examination. The gastroenterologist will typically take multiple biopsies during the same colonoscopy procedure using specialized forceps passed through the colonoscope. If biopsies weren't obtained during the initial colonoscopy, a repeat procedure would be necessary. Following the biopsy, imaging studies such as a CT scan of the abdomen and pelvis with contrast should be performed to assess for local invasion and distant metastases, as recommended by guidelines for colonoscopy surveillance after cancer resection 1. This staging workup helps determine the extent of disease. Blood tests including complete blood count, liver function tests, and carcinoembryonic antigen (CEA) should also be obtained. After pathological confirmation, usually within 3-7 days, the patient should be referred to a colorectal surgeon for evaluation, typically within 1-2 weeks. The surgeon will discuss treatment options, which often include surgical resection of the affected portion of the colon. This comprehensive approach is necessary because cecal masses are frequently malignant, and early diagnosis and treatment significantly improve outcomes, as supported by the guidelines for colonoscopy surveillance after cancer resection 1. The management plan will be tailored based on the pathology results, imaging findings, and the patient's overall health status.
Some key points to consider in the management of a cecal mass found on colonoscopy include:
- The importance of high-quality perioperative clearing, which can be done by preoperative colonoscopy or computed tomography colonography with intravenous contrast 1
- The need for a colonoscopy 1 year after resection, or 1 year following the performance of the colonoscopy that was performed to clear the colon of synchronous disease 1
- The potential for earlier colonoscopy if there is evidence of hereditary nonpolyposis colorectal cancer or if adenoma findings warrant earlier colonoscopy 1
- The importance of periodic examination of the rectum for the purpose of identifying local recurrence, usually performed at 3- to 6-month intervals for the first 2 or 3 years, after low anterior resection of rectal cancer 1
Overall, the management of a cecal mass found on colonoscopy requires a comprehensive approach that includes biopsy, imaging, and referral to a colorectal surgeon, as well as consideration of the patient's overall health status and any relevant guidelines or recommendations.
From the Research
Next Steps After Finding a Cecal Mass on Colonoscopy
When a cecal mass is found on colonoscopy, the next steps involve further diagnostic procedures to determine the cause and nature of the mass. The following are potential next steps:
- Biopsy and Histological Examination: A biopsy of the mass is crucial to determine if it is malignant or benign 2, 3, 4. Histological examination of the biopsy sample can help identify the type of cells present and guide further management.
- Imaging Studies: Computed Tomography (CT) scans of the abdomen and pelvis can help identify the size and location of the mass, as well as any potential compression or invasion of surrounding structures 2, 5, 6.
- Diagnostic Laparoscopy: In some cases, diagnostic laparoscopy with intraoperative colonoscopy may be necessary to further evaluate the mass and determine its cause 2.
- Surgical Intervention: Depending on the findings of the diagnostic procedures, surgical intervention such as ileocolectomy or right hemicolectomy may be necessary to remove the mass and prevent complications 3, 6.
- Whole-Body PET/CT-Colonography: This imaging modality can be used to stage colorectal cancer and evaluate for distant metastases 5.
Potential Causes of Cecal Mass
The causes of a cecal mass can vary, including:
- Ameboma: A rare condition caused by an amebic infection 4.
- Cecal Tuberculosis: A rare condition caused by tuberculosis infection 4.
- Adenocarcinoma: A type of cancer that can occur in the cecum 3, 4.
- Extrinsic Compression: Compression of the cecum by surrounding structures, such as a hernia mesh 2.
- Gastric Ischemia and Cecal Necrosis: A rare condition caused by simultaneous gastric and cecal ischemia 6.