Colon Cancer Confused for Benign Polyp

This case involves the care of a fifty-two-year-old male patient who underwent a routine colonoscopy. In 2007, the colonoscopy revealed a two-centimeter sessile mass in the sigmoid colon. The mass was biopsied and the pathology report revealed a tubular adenoma. The plan was to reschedule the patient for a polypectomy if the path report was negative. No follow-up was conducted by the treating GI physician until 2013. Several years later, the patient presented back to the GI doctor after experiencing several months of GI symptoms. Another colonoscopy was performed that revealed a suspected sigmoid cancer, which was confirmed by biopsy. The patient underwent a left hemicolectomy and a six centimeter, moderately differentiated adenocarcinoma, classified as T3NO, was removed. One year after his operation, the patient developed metastatic disease that had spread to the lungs.

Question(s) For Expert Witness

1. What is the follow-up protocol after the removal of colonic polyps?

Expert Witness Response E-001727

Most gastroenterologists now advocate repeat colonoscopy for five years following complete removal of a low-risk adenomatous polyp (as defined histologically). Colonoscopy is repeated in three years if the polyp has higher-risk features. Repeat colonoscopy may be advised in three to twelve months if the adequacy of polyp removal is a matter of substantial doubt. If no colonic polyps are found at the initial examination, follow-up colonoscopy at approximately five year intervals is recommended.