surgical

1. BENIGN TUMORS OF
LARGE INTESTINE
By: Ismah Haron
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2. Adenomatous Polyps
• Asymptomatic
• Association of symptoms and risk of malignancy with
increasing of size; colonic bleeding, diarrhea, mucus
discharged
• Colonoscopy; sessile, pedunculated or mixed
• HPE; Tubular, tubulovillous or villous type
• Resection (e.g. adenoma > 5 mm)
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1. http://www.aboutcancer.com/rectal_polyps2.htm 2. http://www.ajronline.org/content/189/1/35/F3.expansion.html
3. http://avantis.thirdeyecolonoscopy.com/tag/colonoscopy/ 4. http://www.endoatlas.com/co_bt_11.html
Sessile adenomatous polyps
Pedunculated adenomatous polyps

4. 4
Norman S. William, et al. Bailey and Love’s Short Practice of Surgery
Familial Adenomatous Polyposis (FAP)

5. Familial Adenomatous Polyposis (FAP)
• Asymptomatic or
• Symptomatic
- Diarrhea, passage of blood and mucus, abdominal pain, LOW
• Family history
• Colonoscopy, biopsy, genetic testing
- Presence of >100 colorectal adenoma
- Gene APC
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6. • Treatment
- Risk of colorectal carcinoma
- Surgery at age 17 to 18 y/o or symptomatic or multiple polyps
develop
- Colectomy + ileorectal anatomosis or
- Restorative protocolectomy + ileoanal anastomosis
- Follow up
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7. • Screening policy
- At-risk family members are offered genetic testing in their early
teens
- At-risk members of the family should be examined at the age of 10
to 12 years, repeated every year
- Most of those who are going to get polyps will have them at 20
years, and these require operation
- If there are no polyps at 20 years, continue with 5-yearly
examination until age 50 years; if there are still no polyps, there is
probably no inherited gene
- Examination of blood relatives, including cousins, nephews and
nieces, is essential, and a family tree should be constructed and a
register of affected families maintained
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8. Hereditary Non-polyposis Colorectal Cancer
(HNPCC) or Lynch’s Syndrome
• Asymptomatic
• Diagnosis; Genetic testing or Amsterdam criteria II
- ≥3 family members with HNPCC related ca
- 2 successive affected generation
- ≥1 of HNPCC related ca diagnosed <50 y/o
- Exclusion of FAP
• MLH1, MSH2 genes, colonoscopy, HPE
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http://www.creighton.edu/fileadmin/user/Admin/pr_mednews/10_2004.html
Henry T. Lynch

9. • Risk of colorectal ca, ca of endometrium, stomach, ovary,
small intestine
• Treatment*
- Surgery + postoperative surveillance
· Subtotal colectomy with ileorectal anastomosis
· Total colectomy ileoanal pull-through
· Total colectomy with ileostomy
- Prophylactic hysterectomy, bilateral salphigo-oophorectomy
∙ Age >50 y/o with HNPCC
- Chemoprevention (e.g. folic acid, calcium, vitamin C, vitamin E)
- Exercise and diet
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*http://emedicine.medscape.com/article/188613-overview

10. THANK YOU
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REFERENCES:
1. Norman S. William, et al. Bailey and Love’s Short Practice of
Surgery.
2. Grey McLatchie, et al. Oxford Handbook of Clinical Surgery.
3. P. Youssefi, et al. Mind Maps in Surgery.