benign tumor of large intestine
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This document summarizes benign tumors of the large intestine, including adenomatous polyps and familial adenomatous polyposis (FAP). Adenomatous polyps are usually asymptomatic but the risk of malignancy increases with size. Colonoscopy is used to examine sessile or pedunculated polyps. FAP is characterized by the presence of over 100 colorectal adenomas and is caused by a mutation in the APC gene. Individuals with FAP undergo colectomy to reduce cancer risk and are screened regularly from a young age. Hereditary non-polyposis colorectal cancer (HNPCC), also called Lynch syndrome, is associated with mutations in MLH1 and MSH
benign tumor of large intestine
- 1. BENIGN TUMORS OF LARGE INTESTINE By: Ismah Haron 1
- 2. Adenomatous Polyps • Asymptomatic • Association of symptoms and risk of malignancy with increasing of size; colonic bleeding, diarrhea, mucus discharged • Colonoscopy; sessile, pedunculated or mixed • HPE; Tubular, tubulovillous or villous type • Resection (e.g. adenoma > 5 mm) 2
- 3. 3 1 2 3 4 1. http://www.aboutcancer.com/rectal_polyps2.htm 2. http://www.ajronline.org/content/189/1/35/F3.expansion.html 3. http://avantis.thirdeyecolonoscopy.com/tag/colonoscopy/ 4. http://www.endoatlas.com/co_bt_11.html Sessile adenomatous polyps Pedunculated adenomatous polyps
- 4. 4 Norman S. William, et al. Bailey and Love’s Short Practice of Surgery Familial Adenomatous Polyposis (FAP)
- 5. Familial Adenomatous Polyposis (FAP) • Asymptomatic or • Symptomatic - Diarrhea, passage of blood and mucus, abdominal pain, LOW • Family history • Colonoscopy, biopsy, genetic testing - Presence of >100 colorectal adenoma - Gene APC 5
- 6. • Treatment - Risk of colorectal carcinoma - Surgery at age 17 to 18 y/o or symptomatic or multiple polyps develop - Colectomy + ileorectal anatomosis or - Restorative protocolectomy + ileoanal anastomosis - Follow up 6
- 7. • Screening policy - At-risk family members are offered genetic testing in their early teens - At-risk members of the family should be examined at the age of 10 to 12 years, repeated every year - Most of those who are going to get polyps will have them at 20 years, and these require operation - If there are no polyps at 20 years, continue with 5-yearly examination until age 50 years; if there are still no polyps, there is probably no inherited gene - Examination of blood relatives, including cousins, nephews and nieces, is essential, and a family tree should be constructed and a register of affected families maintained 7
- 8. Hereditary Non-polyposis Colorectal Cancer (HNPCC) or Lynch’s Syndrome • Asymptomatic • Diagnosis; Genetic testing or Amsterdam criteria II - ≥3 family members with HNPCC related ca - 2 successive affected generation - ≥1 of HNPCC related ca diagnosed <50 y/o - Exclusion of FAP • MLH1, MSH2 genes, colonoscopy, HPE 8 http://www.creighton.edu/fileadmin/user/Admin/pr_mednews/10_2004.html Henry T. Lynch
- 9. • Risk of colorectal ca, ca of endometrium, stomach, ovary, small intestine • Treatment* - Surgery + postoperative surveillance · Subtotal colectomy with ileorectal anastomosis · Total colectomy ileoanal pull-through · Total colectomy with ileostomy - Prophylactic hysterectomy, bilateral salphigo-oophorectomy ∙ Age >50 y/o with HNPCC - Chemoprevention (e.g. folic acid, calcium, vitamin C, vitamin E) - Exercise and diet 9 *http://emedicine.medscape.com/article/188613-overview
- 10. THANK YOU 10 REFERENCES: 1. Norman S. William, et al. Bailey and Love’s Short Practice of Surgery. 2. Grey McLatchie, et al. Oxford Handbook of Clinical Surgery. 3. P. Youssefi, et al. Mind Maps in Surgery.
Editor's Notes
- #2: Adenomatous polyps, hemangioma, papilloma
- #3: Polyps: clinical description of any elevated tumor Single polyp/synchronously in small number Risk of malignancy: tubular 1 cm (10%), villous 2 cm (15%) Rx: polypectomy, biopsy sample, protectomy
- #4: Number 4b: Benign tubular adenoma on a long stalk in the colon of a 41 year-old woman with hematochezia
- #6: Can be sporadic Can also affect stomach, duodenum, small intestine Associated with benign mesodermal tumor (e.g. desmoid tumor, osteoma) or epidermoid cyst/thyroid inflammation (Gardner’s syndrome) If genetic testing –ve or no adenoma by 30 y/o, FAP unlikely Gene APC: adenomatous polyposis coli
- #7: Carcinoma can be after 10-20 years after onset of polyposis Surgery at 17 to 18 y/o if FAP diagnosed at adolescene protocolectomy = remove colon + rectum Restorative… surgery for more severe cases i.e. serious rectal involvement of polyps
- #9: “Nonpolyposis” means that colorectal cancer can occur when only a small number of polyps are present (or polyps are not present at all). Autosomal-dominant syndrome, >proximal colon, 44 y/o
- #10: Observational studies of persons at average risk have suggested that the use of some medications and supplements (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin, estrogens, folic acid, calcium), as well as antioxidants (eg, beta carotene, vitamin C, vitamin E), may prevent the development of colorectal cancer