Several conditions of the colon can lead to colorectal cancer. What are they and how are they treated?
Adenomatous polyps. These types of polyps are more likely than others to become cancerous. During a screening with sigmoidoscopy or colonoscopy, polyps can be seen and removed. The type of polyp can be determined in a lab.
Here is how adenomatous colon polyps are treated:
- A single polyp found during a flexible sigmoidoscopy exam will usually lead to follow-up colonoscopy to look for other polyps.
- Then, once the colon is "clean" of polyps, experts recommend repeat colonoscopy every 1 to 3 years.
- If follow-up exams continue to be normal, further screening recommendations will be determined by your doctor.
Familial adenomatous polyposis (FAP). There is continued controversy over how to manage patients with FAP. Almost all untreated patients have colorectal cancer by age 40, therefore some surgical treatment is needed. Here's how FAP is usually managed:
- Total colectomy with anastomosis of the ileum with the rectum, unless the rectum has polyps.
- Then follow-up proctoscopy (a scoping test of the rectum) after surgery every 6 months to look for polyps.
- If a person is unwilling to take the risk of developing cancer in the rectum or already has polyps in the rectum, the rectum can be removed (the risk of developing polyps in an uninvolved rectum ranges from 7.5% to 59%). In these cases, an ileal pouch-anal anastomosis surgery is preferred to maintain quality of life.
Inflammatory Bowel Disease. Many people with chronic inflammatory disease of the bowel, such as ulcerative colitis, can be followed with regular colonoscopy to look for signs of colon cancer. If cancer is found, it can be treated appropriately.
Some patients elect to undergo prophylactic colectomy possibly with the creation of an ileal pouch-anal anastomosis to preserve some bowel function.
