ABSTRACT
Colorectal carcinoma is common, but screening for this cancer has found less acceptance
with the public than screening for breast, prostate, and cervical cancer. Available
methods include fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FOS), double-contrast
barium enema, colonoscopy, computed tomographic colography, and fecal DNA. Evaluation
of these options demonstrates that colonoscopy at ages 55 and 65 offers the best combination
of reduction in colorectal cancer at the lowest cost. However, when compliance with
screening recommendations is very high, costs are high, and the proportion of cancers
arising from adenomas is low, the combination of FOS and FOBT is most cost effective.
Malignant polyps look friable and irregular and feel hard. Sessile malignant polyps
need to be treated by formal resection. Patients with pedunculated polyps with favorable
histology (clear margin, well or moderately differentiated, no lymphovascular invasion)
can be observed, and those whose polyps show unfavorable histology should have the
polyp-bearing segment of colon resected along with its draining lymph nodes.
KEYWORDS
Colorectal cancer screening - colonoscopy - malignant polyp - histology
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James M ChurchM.D.
Department of Colorectal Surgery, The Cleveland Clinic Foundation
Desk A-30, 9500 Euclid Ave.
Cleveland, OH 44195
Email: churchj@ccf.org
