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Colorectal polyps in the elderly: what should be done?
Kenneth Miller1, Jerome D Waye
1Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, New York, USA.
Drugs & Aging
|August 1, 2002
Summary
Colorectal cancer screening detects adenomatous polyps. Removing polyps prevents cancer, but surveillance is needed for recurrence, with calcium carbonate offering modest benefits.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- Colorectal cancer (CRC) is a significant cause of mortality, particularly in Western nations and the elderly.
- The adenoma-carcinoma sequence posits that CRC is preventable through the removal of adenomatous polyps.
- Increased CRC screening leads to the discovery of more patients with adenomatous polyps.
Purpose of the Study:
- To outline management strategies for the growing population of patients diagnosed with adenomatous polyps.
- To inform surveillance protocols for patients post-polypectomy.
- To explore potential chemopreventive measures for adenoma recurrence.
Main Methods:
- Review of current medical understanding regarding the adenoma-carcinoma sequence.
- Discussion of surveillance program recommendations following polypectomy.
- Evaluation of chemopreventive agents for adenoma recurrence.
Main Results:
- Patients with adenomas require surveillance for recurrent adenomas after initial polypectomy.
- Surveillance intervals are individualized based on polyp characteristics (size, grade, histology) and patient history (family history, number of polyps).
- No chemopreventive treatment has proven effective enough to alter current surveillance practices.
Conclusions:
- Post-polypectomy surveillance is crucial for managing patients with a history of colonic adenomas.
- Current evidence does not support altering surveillance intervals based on chemoprevention.
- A modest benefit in adenoma recurrence may be associated with dietary calcium carbonate (3 g/day).