What are the implications of a tubular adenoma found during a colonoscopy (colon examination)?

From the Guidelines

Tubular adenomas found during colonoscopy should be completely removed and followed up with surveillance colonoscopy in 5-10 years for patients with 1-2 small adenomas, and in 3 years for those with 3-10 adenomas or high-risk features, as recommended by the most recent guidelines 1. The management of tubular adenomas involves complete removal during colonoscopy, followed by pathological examination to assess for high-risk features such as high-grade dysplasia or villous components.

• The follow-up colonoscopy timing depends on the number, size, and characteristics of the adenomas found.
• For patients with 1-2 tubular adenomas smaller than 1 cm without high-grade dysplasia, a repeat colonoscopy in 5-10 years is typically recommended, as stated in the guidelines 1.
• For patients with 3-10 adenomas, larger adenomas (≥1 cm), or those with villous features or high-grade dysplasia, more frequent surveillance at 3 years is advised, according to the guidelines 1.
• Patients with more than 10 adenomas at one examination should be examined at a shorter interval, established by clinical judgment, and the clinician should consider the possibility of an underlying familial syndrome, as recommended by the guidelines 1.
• Patients should also be counseled on lifestyle modifications to reduce colorectal cancer risk, including maintaining a healthy weight, regular physical activity, limiting red meat and processed food consumption, avoiding smoking, and limiting alcohol intake, which can help manage the increased risk of developing additional adenomas or colorectal cancer in the future. The guidelines from the American Family Physician 1 and the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society 1 provide the most recent and comprehensive recommendations for the management of tubular adenomas found during colonoscopy.

From the Research

Tubular Adenoma on Colonoscopy

• A tubular adenoma is a type of polyp that can be found in the colon, and its detection is crucial for the prevention of colorectal cancer 2, 3, 4, 5.
• The study by 2 found that CT colonography can detect polyps, including tubular adenomas, and that the size of the polyp is an important factor in determining the risk of malignancy.
• The study by 4 reported two cases of colon tumors with clear cell components, one of which was a tubular adenoma, and found that the clear cell components were negative for certain stains and immunohistochemistry.
• The study by 5 found that CT colonography and optical colonoscopy have different strengths and weaknesses in detecting neoplastic involvement at the surgical anastomosis after colorectal cancer resection, and that tubular adenomas can be detected by both methods.

Detection and Diagnosis

• CT colonography can detect polyps, including tubular adenomas, and can be used to assess the risk of malignancy 2, 5.
• Optical colonoscopy is also effective in detecting tubular adenomas and can be used to remove polyps and prevent colorectal cancer 3, 5.
• The detection of tubular adenomas is important for the prevention of colorectal cancer, and the choice of detection method depends on the individual patient's risk factors and medical history 6.

Treatment and Management

• The treatment of tubular adenomas typically involves removal of the polyp by endoscopic polypectomy or surgical resection 3, 5.
• The management of patients with tubular adenomas depends on the size and location of the polyp, as well as the patient's overall health and medical history 2, 6.
• Follow-up surveillance is important to detect any new or recurrent polyps and to prevent colorectal cancer 6, 5.