From the Guidelines
Tubulovillous adenoma (TVA) is a type of precancerous polyp that requires complete removal through colonoscopic polypectomy or surgical resection, and patients should undergo surveillance colonoscopy at an interval of 3 years if they are under 75 years old and have high-risk findings on index colonoscopy, as recommended by the British Society of Gastroenterology guidelines 1.
Diagnosis and Treatment
Tubulovillous adenomas are characterized by finger-like projections extending into the lumen combined with tubular structures, and they carry an intermediate risk of progressing to colorectal cancer. The diagnosis of TVA is typically made through colonoscopy and biopsy, and the treatment involves complete removal of the polyp.
- The size of the polyp is an important factor in determining the risk of malignant transformation, with larger polyps having a higher risk.
- The histological features of the polyp, including the presence of high-grade dysplasia or invasive carcinoma, also play a crucial role in determining the management of TVA.
- Complete excision with clear margins is essential, and pathological examination is necessary to rule out any areas of high-grade dysplasia or invasive carcinoma that would require more aggressive management.
Surveillance
After removal of TVA, patients need regular surveillance colonoscopies to monitor for the development of new polyps or cancer.
- The interval for surveillance colonoscopy is typically 3 years for patients with high-risk findings on index colonoscopy, as recommended by the British Society of Gastroenterology guidelines 1.
- The surveillance interval may be individualized based on the patient's age, family history, and other risk factors.
- Patients who are over 75 years old or have a life expectancy of less than 10 years may not benefit from surveillance colonoscopy, as the risks associated with the procedure may outweigh the benefits 1.
Management
The management of TVA involves a multidisciplinary approach, including gastroenterologists, surgeons, and pathologists.
- Complete removal of the polyp is essential, and pathological examination is necessary to rule out any areas of high-grade dysplasia or invasive carcinoma.
- Patients with TVA should be encouraged to participate in national bowel screening programs, and surveillance colonoscopy should be performed at regular intervals to monitor for the development of new polyps or cancer.
- The British Society of Gastroenterology guidelines provide a framework for the management of TVA, including recommendations for surveillance colonoscopy and management of high-risk patients 1.
From the Research
Diagnosis of Tubulovillous Adenoma (TVA)
- TVA is a type of colorectal polyp that can be diagnosed through colonoscopy, which is a non-invasive method of diagnosis and treatment 2
- Colonoscopy can detect and remove polyps, reducing the incidence of carcinoma 2
- TVA can also be identified on transvaginal ultrasound, as seen in a case report where a patient's symptoms suggested endometriosis, but the ultrasound revealed a colonic tubulovillous adenoma 3
- Proctologic examination, including digital and rigid rectosigmoidoscopy, can also diagnose TVA, especially in cases where the polyp is located in the distal rectum 4
Treatment of Tubulovillous Adenoma (TVA)
- Colonoscopic polypectomy is a common treatment for TVA, where the polyp is removed using a snare loop and a biopsy clamp 2
- Surgical options, such as local resection or segmental colectomy, may be considered for larger polyps or those with high-grade dysplasia 4
- Appendectomy is the appropriate treatment for appendiceal tubulovillous adenoma, as seen in a case report where a patient presented with symptoms of acute appendicitis 5
- Follow-up colonoscopy is recommended for patients with TVA, especially those with high-grade dysplasia or larger polyps, to monitor for recurrence or malignant transformation 6
Risk of Malignant Transformation
- TVA has a relatively high potential for malignancy, especially in larger polyps or those with high-grade dysplasia 4, 2
- Studies have shown that patients with TVA are at higher risk of developing further adenomas with high-grade dysplasia or carcinoma 6
- Malignant transformation can occur in TVA, highlighting the importance of close follow-up and monitoring 4, 2