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Thread: Question regarding polyp and cancer

  1. #1
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    Question regarding polyp and cancer

    Ok, well today I had a colonoscopy and the doctor said he removed a cancerous polyp...and indicated that I'd need another colonoscopy in 5 years. He said they were sending it for testing but that he could tell it was cancerous. My question is....does having a cancerous polyp mean you have colon cancer, or is colon cancer when it actually has spread into the wall? Thanks for any answers or input you may have!

  2. #2
    Super Moderator Top User Baz10's Avatar
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    A polyp is just a polyp unless as you say it has migrated.
    Many removed polyps can be termed pre cancerous, therefore are snared off during the procedure.
    Id take comfort in what the doctor said and keep up the colonoscopies.
    Most colon cancers develop slowly therefor the 5 year interval between colonoscopies is the norm.
    Rest easy
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  3. #3
    Moderator Top User Doug K's Avatar
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    Barry said it well, good news and the followup is essential. I would assume the Doc is giving you his best guess, some polyps are likely recognizable to a practicing gastro doc who has seen more than his or her share. Good for you to have this done. Go enjoy life!

    doug
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  4. #4
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    I don't want to kill the good feelings here but something is terribly wrong here. I don't know how a doctor can tell if a polyp is cancerous or not. Especially when it appears the doctor says to follow up in 5 years with another colonoscopy. My GI doctor is very good but he's not that good to look at a polyp and say if it's cancerous or not. He did call my initial diagnosis as cancer before the biopsy results were done. That situation was different as it wasn't a polyp but an actual tumor measuring about 3 CM. He also had me immediately go consult a CRC surgeon and to get CEA and CT scans done. He said he knew it was cancer by the look and rigidity of the tumor.

    Fast forward a few years and during another colonoscopy, he happened to find a polyp by chance in the opening to my appendix. While it looked ok and had all the characteristics of a non cancerous polyp, he had to rely on pathology. The report came back as high grade dysplasia (pre cancer). My CRC surgeon opted to be more aggressive and did a right hemicolectomy along with taking a bit of my small intestine. The pathology came back on the polyp as stage 0 appendiceal cancer in situ. Meaning the cancer cells that were found were still fully contained in the main body of the polyp. Because it was stage 0 no further treatment was required.

    I'd question heavily on his approach with your care along with wanting to know what the pathology says as I'm assuming the entire polyp was removed. I would have to say if he can tell externally the polyp has cancerous features, I would want to know if any cancer cells are present in the stalk or area which connected it to the wall of your colon. If there is cancer cells there, I would think a resection would be in order to ensure all traces of cancer are removed.

    My gut reaction is that you should seriously consider getting a second opinion.

  5. #5
    Moderator Top User Doug K's Avatar
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    Quote Originally Posted by zx10guy View Post
    I don't want to kill the good feelings here but something is terribly wrong here. I don't know how a doctor can tell if a polyp is cancerous or not. Especially when it appears the doctor says to follow up in 5 years with another colonoscopy. My GI doctor is very good but he's not that good to look at a polyp and say if it's cancerous or not. He did call my initial diagnosis as cancer before the biopsy results were done. That situation was different as it wasn't a polyp but an actual tumor measuring about 3 CM. He also had me immediately go consult a CRC surgeon and to get CEA and CT scans done. He said he knew it was cancer by the look and rigidity of the tumor.

    Fast forward a few years and during another colonoscopy, he happened to find a polyp by chance in the opening to my appendix. While it looked ok and had all the characteristics of a non cancerous polyp, he had to rely on pathology. The report came back as high grade dysplasia (pre cancer). My CRC surgeon opted to be more aggressive and did a right hemicolectomy along with taking a bit of my small intestine. The pathology came back on the polyp as stage 0 appendiceal cancer in situ. Meaning the cancer cells that were found were still fully contained in the main body of the polyp. Because it was stage 0 no further treatment was required.

    I'd question heavily on his approach with your care along with wanting to know what the pathology says as I'm assuming the entire polyp was removed. I would have to say if he can tell externally the polyp has cancerous features, I would want to know if any cancer cells are present in the stalk or area which connected it to the wall of your colon. If there is cancer cells there, I would think a resection would be in order to ensure all traces of cancer are removed.

    My gut reaction is that you should seriously consider getting a second opinion.
    I think you are offering good advice for this situation. On further thought, five year time line seems long to me, maybe one or two years, if clean, then five? Just a thought.

    doug
    MyJourney:
    August 2004 Colonoscopy Clear
    June-July 2013 Abdominal Discomfort Upper Abdomen X-ray, UltraSound, CTScan all clear
    8.23.13 Diagnosed 5cm tumor on rectum wall: adenocarcinoma @age 66
    Aug-Sept2013 Met with Surgeon,Hematologist and Radiation oncologist
    Oct.-Nov.: Xeloda concurrent with radiation: 25 doses
    November CTScan, MRI and surgeon scoped: Tumor gone, scar tissue
    1.6.14 Surgery LAR: Rectum removed, sphincter remains: Pathology: no lymph node,
    Tumor downgraded from Possible T3 to T2
    Feb. - April Chemo:5 FU and Oxilaplatin:6 infusions over 14 weeks
    9.4.14 ColonoscopyClear,CT Clear
    Dec.14 Follow up BlWk +,CEA .9
    Mar.15Follow up BlWk +,CEA .6
    June.15 Follow up BlWk +,CEA .7
    Sept2015Followup BlWk + CEA .7 CTScanClear NED
    Dec2015SurgicalHerniaRepair
    Sept2016Followup BlWk + CEA .7 CTScanClear NED
    Sept-Oct2017Followup All clear NED
    Sept-Oct2018CTScan+Clear Bldwk+
    Mar2019Bldwk+NED
    Continue ColoRectal Support Group monthly

  6. #6
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    Quote Originally Posted by Doug K View Post
    I think you are offering good advice for this situation. On further thought, five year time line seems long to me, maybe one or two years, if clean, then five? Just a thought.

    doug
    Hi Doug,

    My concern is what the OP said concerning his treatment plan and the impressions of the polyp by his doctor. If in fact the doctor really believes the polyp is cancerous, no doctor would say come back in 5 years for another colonoscopy. The doctor would say probably he got all of it out but will have to wait on pathology to see if any cancer cells are in the stalk of the polyp. If there is, then this would necessitate the need to have further intervention such as a resection to remove that area of the colon to ensure there are no cancer cells there along with any possible lymph nodes. Depending on the pathology outcome, would also dictate if a CT scan would be warranted.

    My colonoscopy schedule was shortened to one and two years of follow up because of my cancer history. 5 years after discovery of a supposed cancerous polyp is ridiculous.

  7. #7
    Super Moderator Top User po18guy's Avatar
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    Truthfully, it does not matter how many hundreds or thousands of polyps a doctor removes. Only a pathologist - and no one else - may diagnose cancer. And then, only after in-depth examination and testing of the biopsy sample.

    To "pre-worry" a patient by declaring cancer seems irresponsible to me. And 5 years?

    I would find another doctor.
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  8. #8
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    I'm late to this conversation but would agree with the advice to either switch entirely to another doc or at least get a second opinion from one.

    I've spent a good portion of my life on an aggressive screening regime for colon cancer -- colonoscopies every two years -- due to a bad history of the disease on my father's side of the family.

    I think my doc is very good. He's found a few polyps over the years, one of them fairly large, and has on occasion commented to me that based on the size and look he didn't expect pathology to report a problem. He hasn't been wrong yet. But as has been noted, and I've always understood, only the lab can make a conclusive determination.

    But to blithely tell you, pre-pathology, that the polyp was cancerous and oh by the way come back in five years -- that strikes me as downright bizarre.
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