Talk:Colorectal polyp

SSA/p sessile serrated adenoma /polyp a subtype missing uin this article

Smoking

Pretty unambiguous influence of smoking on polyps: doi:10.1053/j.gastro.2007.11.007 JFW | T@lk 07:13, 3 February 2008 (UTC)

Merge from colon polyp

I merged the info in colon polyp into this article (colorectal polyp).

Why?

• Rectal cancer and colon cancer are merged into colorectal cancer.
• Etiology and classification of polyps in the colon and rectum is not different.
• It is not always obvious whether a given polyp is rectal or colonic; the landmark between rectum & colon (colorectal junction) is: were the gastrointestinal tract no longer has a serosa about its circumference... this cannot be determined by colonscopy.
• The management of colonic polyps and rectal polyps is very similar.

Nephron  T|C 04:05, 6 April 2009 (UTC)

Evidence based screening

According to the National Guideline Clearinghouse™ (NGC), a public resource for evidence-based clinical practice guidelines.

at

http://www.guideline.gov/summary/summary.aspx?doc_id=14345

[All emphasis added.]

Colorectal cancer screening clinical practice guideline

MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (evidence-based A-D, I and consensus-based) are provided at the end of the "Major Recommendations" field.

Recommendation 1*: Factors Associated with an Increased Risk of Colorectal Cancer in the General Population

...

Recommendation 2: Effectiveness of Colorectal Cancer Screening Tests

1. Colorectal cancer screening is strongly recommended for all asymptomatic, average-risk adults. (Evidence-based: A) 2. Any of the following tests are acceptable for colorectal cancer screening in asymptomatic, average-risk adults:*

• High-sensitivity' fecal occult blood test (FOBT) (Consensus-based)
• Immunochemical fecal occult blood test (iFOBT/FIT)** (Consensus-based)
• Flexible sigmoidoscopy (Evidence-based: B)
• Colonoscopy** (Consensus-based)
• A combination of high-sensitivity guaiac FOBT test and flexible sigmoidoscopy (Consensus-based)

3. The following additional screening tests are either less-preferred options or not recommended for screening. However, an adult who has had one of these tests is considered screened. Follow-up screening using a preferred option is recommended.

• An annual standard guaiac FOBT is a less-preferred option.*** (Consensus-based)
• Air contrast barium enema is not recommended as a screening strategy for average-risk adults. (Evidence-based: I)
• Virtual colonoscopy is not recommended as a screening strategy for average-risk adults.* (Consensus-based)
• Fecal DNA is not recommended as a screening strategy for average-risk adults.****(Consensus-based)

Note: For fecal blood tests, inform patients of the potential risks associated with false-positive test and false-negative test results, as well as the need for prompt follow-up of a positive test result. For flexible sigmoidoscopy, inform patients that the test has a small risk of complications and is not a complete examination of the entire colon.

*There is insufficient evidence to choose one screening test over another.

• • If a patient has had a normal colonoscopy within the last 10 years, there is insufficient evidence that supplemental FOBT adds any incremental benefit.

• • • Even though there is sufficient evidence in support of this screening modality, it is not a preferred option due to its low sensitivity and low compliance rates.

• • • • Please note that fecal DNA testing and virtual colonoscopy are not listed as "appropriate screening tests" in 2008 HEDIS (Health Plan Employer Data and Information Set) specifications for colorectal cancer screening, and therefore regions may choose to screen members with other appropriate tests.

Recommendation 3: Frequency of Colorectal Cancer Screening

1. The following intervals for colorectal cancer screening in asymptomatic, average-risk adults are recommended*:

• Flexible sigmoidoscopy: at least every 10 years (Consensus-based)
• High-sensitivity guaiac or immunochemical FOBT (iFOBT/FIT): every 1-2 years (Consensus-based)
• Colonoscopy: every 10 years (Consensus-based)
• Combined FOBT and flexible sigmoidoscopy: every 1-2 years for FOBT, at least every 10 years for flexible sigmoidoscopy (Consensus-based)

2. The following additional screening tests are either less-preferred options or not recommended for screening. However, if these tests are performed, then the recommended intervals are as indicated below. Follow-up screening using a preferred option is recommended.

• Standard guaiac FOBT: every 1-2 years (Consensus-based)
• Air contrast barium enema:** every 5 years (Consensus-based)
• Virtual colonoscopy:** every 10 years (Consensus-based)
• Fecal DNA:** every 5 years (Consensus-based)

• The GDT recognizes that these screening intervals differ from current HEDIS measures. Some regions may choose to offer screening at more frequent intervals. HEDIS intervals are as follows: FOBT (annual), flexible sigmoidoscopy (every 5 years), air contrast barium enema (every 5 years), colonoscopy (every 10 years).

• • These modalities are not recommended for screening average-risk adults (see Recommendation #2 above).

Recommendation 4: Age to Begin and End Colorectal Cancer Screening

In the absence of sufficient evidence, the following ages at which to begin and end colorectal cancer screening in asymptomatic average-risk adults are recommended:

1. Initiation of screening is recommended at age 50. (Consensus-based) 2. Discontinuation of screening is generally recommended at age 75, provided that there is a history of routine screening. For those with no history of routine screening, discontinuation is recommended at age 80. The decision to discontinue screening should be based on physician judgment, patient preference, the increased risk of complications in older adults, and existing comorbidities. (Consensus-based) —Preceding unsigned comment added by Ocdcntx (talk • contribs) 15:22, 15 February 2010 (UTC)

Quotes from the hyperplastic section

They have no malignant potential, which means that they are no more likely than normal tissue to eventually become a cancer.

and then ...

Although thought to exhibit no malignant potential it has been shown that hyperplastic polyps on the right side of the colon do exhibit a malignant potential.

The section (and in the second one, even the sentence itself) seems to be contradicting itself. Which is it? Is there malignant potential or not? 76.169.117.255 (talk) 03:53, 25 October 2012 (UTC)