What is the treatment for adenoma (adenomatous polyp) tubular colon?

Treatment of Tubular Adenoma in the Colon

For a tubular adenoma (adenomatous polyp) of the colon, complete endoscopic removal via polypectomy is the recommended treatment, with subsequent surveillance based on polyp characteristics. 1

Initial Management

Polypectomy Approach

• For pedunculated polyps: Snare polypectomy is typically performed
• For sessile polyps: Endoscopic mucosal resection or piecemeal removal may be necessary
• The polyp site should be marked at colonoscopy if cancer is suspected or within 2 weeks of polypectomy when pathology is known 1

Pathological Assessment

• Complete pathological examination is essential to determine:
  • Presence of invasive cancer
  • Margin status
  • Histological features (grade, lymphovascular invasion)
  • Depth of invasion if cancer is present 1

Treatment Algorithm Based on Pathology Results

1. Tubular Adenoma WITHOUT Invasive Cancer

• Complete endoscopic removal is curative
• No additional surgery required 1
• Follow surveillance guidelines based on polyp characteristics

2. Tubular Adenoma WITH Invasive Cancer (Malignant Polyp)

• Decision depends on histological features and completeness of removal:

  a) Favorable histological features:

  • Single specimen completely removed
  • Clear margins (>2mm)
  • Well or moderately differentiated (grade 1-2)
  • No lymphovascular invasion
  • Treatment: Observation only 1

  b) Unfavorable histological features:

  • Fragmented specimen
  • Positive or indeterminate margins (<1mm)
  • Poorly differentiated histology (grade 3-4)
  • Lymphovascular invasion present
  • Treatment: Colectomy with en bloc removal of regional lymph nodes 1

Surveillance After Polypectomy

Low-Risk Findings (1-2 small tubular adenomas <1cm)

• Next colonoscopy in 5 years 1

Intermediate-Risk Findings (3-4 small adenomas or at least one >1cm)

• Next colonoscopy in 3 years 1
• If two consecutive negative examinations, return to 5-year intervals 1

High-Risk Findings (>5 adenomas or >3 adenomas with at least one >1cm)

• Additional examination at 12 months
• Then return to 3-year surveillance intervals 1

Special Situations

• Large sessile adenomas removed piecemeal: Follow-up in 2-6 months to verify complete removal 1, 2
• If recurrent adenoma is found, remove and repeat colonoscopy in 1 year 2

Clinical Considerations and Pitfalls

Important Considerations

• The adenoma-carcinoma sequence is well-established, with most colorectal cancers arising from pre-existing adenomas 3
• Colonoscopic polypectomy has been shown to reduce colorectal cancer incidence by 76-90% 3
• Tubular adenomas have lower malignant potential compared to tubulovillous or villous adenomas, but all adenomas should be completely removed 4

Common Pitfalls

1. Incomplete removal: Ensure complete excision with clear margins
2. Inadequate pathological assessment: The entire polyp should be submitted for histology with multiple level sections 1
3. Loss to follow-up: Adherence to surveillance guidelines is critical for detecting metachronous lesions
4. Failure to mark the polypectomy site: Essential when cancer is suspected or confirmed 1

By following this treatment algorithm, the risk of developing colorectal cancer from adenomatous polyps can be significantly reduced while avoiding unnecessary surgical interventions in appropriate cases.