Malignant Colorectal Polyps

When a patient undergoes colonoscopic resection of a colorectal polyp found to contain invasive cancer, I carefully analyze a number of pathologic and clinical features of the case to formulate an effective management plan. I usually consider colonoscopic treatment alone to be definitive therapy when the malignant polyp has favorable prognostic features. I find that the risk of residual colonic cancer or lymph node metastases usually is less than the risk of further cancer surgery when the polyp is considered to be completely resected by the endoscopist; and on pathologic examination, the resection margins are negative; and no evidence of vascular invasion, lymphatic invasion, or high-grade cancer exists. When unfavorable criteria are found and the patient is a good risk for surgery, I find that surgical resection of the involved colonic segment and draining lymphatic system usually is indicated. When formulating a management plan, I individualize treatment according to the location of the malignant polyp, risk of surgery, and wishes of an informed patient. I urge patients to adopt a healthy diet and lifestyle to reduce the risk of colorectal neoplasia. I cannot make specific recommendations for preventive dietary supplements such as vitamins, minerals, or drugs such as aspirin because efficacy and risk-benefit chemopreventive trials are ongoing.