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Recurrence Possible Even With Favourable Features After Colonoscopy Polyp Excision: Presented at NCCN

By Ed Susman

HOLLYWOOD, FL -- March 20, 2007 -- Despite negative margins and removal of a single cancerous polyp during colonoscopy, doctors should advise patients that there is still a chance that the cancer could return, according to newly-released guidelines.

The updated guidelines for colon cancer released by the 20-member institutions of the National Comprehensive Cancer Network (NCCN) specifically pointed out the critical footnotes to the treatment algorithm.

"Even in the case of T1 tumours, there is a possibility that the cancer will return and we have to convey that to our patients," said Paul Engstrom, MD, senior vice president for extramural research, Fox Chase Partners, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States.

The footnote applies to patients who have undergone colonoscopy and the examination resulted in isolating a polyp with invasive cancer. If that polyp was a single specimen, completely removed, with favourable histology and clear margins, the guidelines suggest either observation or colectomy.

But the observation choice comes with this caution: "Observation may be considered, with the understanding that there is an added 10% to 15% risk of lymph node metastases."

Dr. Engstrom also noted that the 2007 guidelines also add a schedule for colonoscopy that brings the NCCN treatment algorithm in line with clinical practice in Europe.

Patients who have an abnormal colonoscopy should have a repeat procedure 1 year later. If that examination is negative then the next colonoscopy can be put off for 3 years and then, if it remains negative, the examination should be repeated every 5 years.

If there is no preoperative colonoscopy due to an obstructing lesion, then follow-up colonoscopy should be performed every 3 to 6 months.

In his presentation on March 15^th at the 12^th annual NCCN Conference on Clinical Practice Guidelines and Quality Health Care, Dr. Engstrom said the new guidelines removed the use of photon emission tomography (PET) as a routine surveillance aid. PET scans, however, are considered useful if doctors are planning to perform surgery for removal of a single metastasis. In that case the scan could determine if there are other metastases which might make performing the surgery moot.


[Presentation title: Update: Colon and Rectal Cancer Guidelines.]

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