1) Colonic polyps can be neoplastic or non-neoplastic, with adenomatous polyps being precursors for colon cancer. Larger and villous polyps carry higher cancer risk. 2) Management of polyps depends on size, histology, and risk factors. Low-risk polyps can be removed endoscopically, while malignant or high-risk polyps may require surgery based on factors like margins, invasion, and differentiation. 3) Studies have shown poor differentiation, vascular/lymphatic invasion, and margins less than 2mm to be histologic risk factors associated with residual disease and poorer outcomes, necessitating surgery for high-risk malignant polyps.

1. Neoplastic Colonic Polyps Dr. Saud Al-Subaie Department of Surgery Amiri Hospital Monday 17/04/2006

3. Polyp- Cancer Sequence

5. Epidemiology 10.5% (100 %) Weighted chance 40 % 10 % Villous adenoma 22% 15 % Tubulovillous 5% 75% Tubular adenoma % Malignant Prevalence TYPE

6. Size and % of Ca 54% 10% 10% Villous 45% 9% 4% Tubulo-villous 34% 10% 1 % Tubular > 2cm 1-2 cm < 1cm

7. Endoscopic appearance

10. Etiology of Ca

11. Etiology (FAP)

13. Management

17. Adenoma With Ca Adenoma With Ca

20. Haggitt Highest Invasion of submucosa, not the muscularis propria, sessile polyp 4 Moderate Invasion of the (MM)& polyp stalk 3 Low Invasion of the (MM) & polyp neck 2 None Invasion of the (MM) & polyp head 1 None No invasion of the muscularis mucosa (MM), carcinoma in situ 0 Risk of LN mets Histologic description level

33. “ Colon cancer can only be found if looked for. And it can only be cured if found early.”

34. THANK YOU