THE PROPHYLAXIS OF COLORECTAL CANCER THROUGH ENDOSCOPIC POLYPECTOMY

Ana-Maria Mihai1, L. Simion2, M. Alecu 2, Sânziana Ionescu 2, N. D. Straja 1,2

1The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
2Surgical Clinic I, “Professor Doctor Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania.


Corresponding author: Nicolae Dan Straja 
Phone no. 0722 350 308
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Abstract

The evolution of the colorectal cancer (CRC) from a precursor lesion, the adenoma, was reported for the first time decades ago. Today the relationship between a polyp and CRC is widely known, the adenomatous polyp being considered a sequence in the development of this type of malignancy. Early diagnosis, monitoring and, above all, polyp resection represents one of the most efficacious methods in the CRC prophylaxis. The authors made a 4-year analysis (January 2009 - December 2012) of all the patients for whom colonoscopy was performed in the Surgery Clinic 1 of the Bucharest Oncology Institute. Out of all the 1368 colonoscopies, 222 patients had colorectal polyps and for 88.7% of them endoscopic polypectomy was possible. The election of the treatment method in patients with rectocolic polyps has to take into consideration several factors: the macroscopic type (pedunculated or sessile), the number and dimension of the polyp, the histology type and the grade of malignancy. Endoscopic polypectomy is indicated both in the non-malignant polyps and in the “in situ” cancers (with low risk of lymphatic invasion). In all the other cases that could not be removed because of technical or safety limits, the main surgical indication is classic polypectomy. The protocol for further endoscopic follow-up and the main treatment strategy chosen are both done according to the result of the histopathology examination from the resected polyp. The increased frequency and mortality of the colorectal cancer makes this pathology a public health problem. The possibility of prevention offered by an early diagnosis justifies the development of a screening programme for CRC. Colonoscopy plays an important role in controlling this pathology, representing a good method of screening, early diagnosis, treatment and monitoring. The purpose of the study is to emphasize the importance of colonoscopicpolypectomy in the prophylaxis of CRC; to determine the incidence of the colorectal polyps and their malignancy rate; to determine the optimal method of treatment and to establish the optimal monitoring protocol in order to identify the postoperative recurrence of polyps.

Keywords: colorectal cancer, the adenoma, adenomatous polypvol

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