EtienneMoore
Hyperplastic or Metaplastic Polyps
No colonoscopic follow up currentlyrecommended
Benign Adenomatous Polyps
High Risk - (5 or more adenomas smallerthan 10mm) or (3or more adenomas if one is 10mmor larger)
Check colonsocopy again in 1 year ifpatient fit and willing四川省第四人民医院消化内科常玉英
If subsequent colonsocopy is negative foradenomas, low risk or intermediate risk then follow intermediate riskguidelines (next colonoscopy in 3 years).
If subsequent colonoscopy is incompletethen consider computed tomographic colonography (also known as CTC or CTcologram) instead or offer a repeat colonoscopy with a more experiencedcolonoscopist. The risks and benefitsshould be discussed with the patient (and their family and carers ifappropriate) and the patient's decision (or patient's advocate decision forpatient's who cannot consent) documented.
Intermediate Risk - (3 or 4 adenomassmaller than 10mm) or (1or 2 adenomas if one is 10mmor larger)
Check colonoscopy again in 3 years ifpatient fit and willing
If subsequent colonoscopy is negative foradenomas then repeat colonoscopy in 3 years again. Stop colonoscopic surveillance if there is afurther negative result.
If subsequent colonoscopy is low orintermediate risk then follow up as for intermediate risk (next colonoscopy in3 years).
If subsequent colonoscopy is high risk thenfollow up as for high risk (next colonoscopy in 1 year).
If subsequent colonoscopy is incompletethen consider computed tomographic colonography (also known as CTC or CTcologram) instead or offer a repeat colonoscopy with a more experiencedcolonoscopist. The risks and benefitsshould be discussed with the patient (and their family and carers ifappropriate) and the patient's decision (or patient's advocate decision forpatient's who cannot consent) documented.
Low Risk - 1 to 2 adenomas smaller than 10mm
Check colonoscopy again in 5 years ifpatient fit and willing
If subsequent colonoscopy is negative foradenomas then cease follow up.
If subsequent colonoscopy is low risk thenfollow up as for low risk (repeat colonoscopy in 5 years if patient fit andwilling).
If subsequent colonoscopy is intermediaterisk follow up as for intermediate risk (repeat colonoscopy in 3 years).
If subsequent colonoscopy is high riskfollow up as for high risk (repeat colonoscopy in 1 year).
If subsequent colonoscopy is incompletethen consider computed tomographic colonography (also known as CTC or CTcologram) instead or offer a repeat colonoscopy with a more experiencedcolonoscopist. The risks and benefitsshould be discussed with the patient (and their family and carers ifappropriate) and the patient's decision (or patient's advocate decision forpatient's who cannot consent) documented.
High Grade Dysplasia or CarcinomatousPolyps
Urgently refer the patient to the BSUHcolorectal cancer MDT (multi-disciplinary team) coordinator on the telephonevia switchboard or via Trust e-mail so that the patient can be discussed at thenext weekly colorectal cancer MDT meeting.Tell the patient that a member of the colorectal team will contact themafter the colorectal MDT meeting with the next step and please clearly documentin the patient hospital notes what you have told the patient and whether youhave already requested any staging scans or blood tests.
Dictate an urgent clinic letter to GP andcopy letter to colorectal cancer MDT coordinator and also copy to colorectalMacmillan nurses.
Patients with histologically confirmedcolorectal adenocarcinoma should be referred for urgent staging CT contrastscan of chest, abdomen and pelvis. Makesure that renal function blood tests have been arranged if these are necessaryprior to contrast injection (mainly diabetic and renal failure patients). Patients with rectal adenocarcinoma (usuallywithin 15cm of theanal verge on endoscopy) should additionally be referred for urgent pelvic MRIscanning.
Also arrange for the patient to have abaseline CEA tumour marker blood test.