Role of colonoscopy in the treatment of malignant polyps Pathology of malignant colorectal polyps Assessing the risk of residual disease post-polypectomy.

Slides:



Advertisements
Similar presentations
EQUIP Training session 2
Advertisements

T1 colonic carcinoma – Is endoscopic resection sufficient? HC Yip JHGR 21/7/2012.
Polyps – Where do they come from and what do you do with them?!
Management of Malignant Polyps Santhat Nivatvongs, MD Colon and Rectal Surgery Mayo Clinic Rochester Minnesota U.S.A.
Multimodality Therapy of Rectal Cancer Robert D. Madoff, MD University of Minnesota.
Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE
Endoscopic Mucosal Resection (EMR)
Endoscopic Mucosal Resection Dr. Howard Mertz Clinical Assistant Professor Vanderbilt University Saint Thomas Hospital Nashville TN.
Colorectal NSSG Audit Day - Polyp Cancers Northumbria Healthcare NHS Trust Sarah Mills.
Management of large rectal adenoma Dr. Hester YS Cheung Department of surgery Pamela Youde Nethersole Eastern Hospital.
AJCC TNM Staging 7th Edition Colon Case #1
The Adenoma/Carcinoma Sequence in the Colon
Assessment of Adenomas Geraint Williams Pathology Department Cardiff University.
COLORECTAL CARCINOMA Bernard M. Jaffe, MD Professor of Surgery Emeritus.
Management of Difficult Colonic Lesions
Malignant colonic polyp: endoscopic treatment updates
Joint Hospital Surgical Grand Round 19 June 2004.
Reporting and Management of Early stage Colorectal Cancer Frank Carey Dundee.
Colorectal cancer Khayal AlKhayal MD,FRCSC
Management of early rectal carcinoma Joint Hospital Surgical Grand Round Jeren Lim United Christian Hospital.
Treatment of Early Malignant Rectal Polyp
THE SIGNIFICANCE OF HISTOLOGICAL SUBSTAGING IN CURATIVE RESECTED T3 COLORECTAL CANCER Karl Mrak & Jörg Tschmelitsch Department of Surgery, Barmherzige.
Not for reproduction IT Infrastructure NHS BCSP Julietta Patnick November 2007.
TREATMENT OF LARGE AND GIANT COLORECTAL POLYPS IN THE REAL WORLD UEGW, PARIS, 2007 Association pour le Dépistage du Cancer colorectal dans le Haut-Rhin.
Colorectal carcinoma Dr.Mohammadzadeh.
Colorectal cancer Khayal AlKhayal MD,FRCSC Assistant professor of Surgery Consultant Colorectal surgeon 9/11/2015Shwartz.
CONFIDENTIAL PillCam ™ COLON PillCam™ COLON has received a CE Mark, but is not cleared for marketing or available for commercial distribution in the USA.
Slides last updated: March 2015 CRC: STAGING. How colorectal cancer (CRC) is staged 1 Stage describes the extent of cancer, and is one of the most important.
Common small and large intestinal surgical diseases Part II
Dr Poonam Valand, Foundation Year Two Dr Anjan Dhar, Consultant Gastroenterologist COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST Early gastric cancer.
Colon Cancer. Epidemiology 3 rd most common cancer in males and females. Accounts for 11% of cancer deaths. In 2000, 130,200 cases (colon and rectum).
Handling difficult cases and possible referral service Professor Neil A Shepherd Gloucester, UK NHSBCSP Pathology Day, London, November 21, 2007.
Moderators: David Cort, MD Alex Denes, MD Panelists: Stephen Swisher, MD, PhD Edward Lin, MD.
COLON CANCER A MAJOR ISSUE IN ALASKA. A common malignancy 200,000 cases in the U. S. in ,000 cases in the U. S. in 2008 Greater than 50 new cases.
Colorectal Cancer. Colorectal cancer - statistics Leading causes of cancer death in the US Male Female Lung – 31% Lung – 25% Prostate – 11% Breast – 11%
Endoscopic Mucosal Resection of Large Colon Polyps Chris Hamerski, MD Director of Luminal Oncology Interventional Endoscopy Services California Pacific.
Current Role of Partial Cystectomy: Are we scarifying patient ’ s survival Dr Eric Li Department of Surgery Pamela Youde Nethersole hospital.
Colon Cancer. Multihit Concept Clinical Information Clinical Information 1. Patient identification a. Name b. Identification number c. Age (birth date)
Datum/Vortragsthema Local resection of Rectum tumors Peter M. Markus Elisabeth Hospital Essen Germany.
Evaluation Of Colonic Polyps Kathia E. Rosado Orozco MD GI and Liver Pathologist Hato Rey Pathology Associates.
Prognosis of colon cancer compared with rectal cancer. Where lies the difference? Bjørn S. Nedrebø Stavanger University Hospital.
The role of Endoscopy in Gastric Cancer Fergal Donnellan Gastroenterologist VGH.
Interesting case. OD yo man with irretrievable rectal TVA on screening colonoscopy, prior transanal excision 8 cm from anal verge Pmhx: hypothyroidism,
MALIGNANT POLYPS DURING THE FIRST THREE SCREENING ROUNDS ( ) FOR COLON-RECTAL CANCER (CRC) IN A NORTH-EASTERN SANITARY DISTRICT (ULSS-1 VENETO).
Do all colorectal polyps require pathological examination? Aim To assess whether it is possible to omit the pathological examination of some polyps without.
Role of MRI in Primary Rectal Cancer Staging and Management
(A) Surveillance colonoscopies for detecting dysplasia and preventing colorectal carcinoma. (B) Management of visible lesions at endoscopy. A visible lesion.
Case 1 현 O 훈 (M/34). Diagnosis : Stomach, distal gastrectomy: Signet ring cell carcinoma 1) Location: Angle 2) Tumor gross type: Early.
Kyung Hee University, Seoul, Korea Conference LGI Conference Presented by Byeong-Joo Noh Supervised by Youn-Wha Kim Kyung Hee University, Seoul, Korea.
The Malignant Polyp Handout Version Hans Elzinga, MD Program Director- Advanced Procedures in Family Medicine Fellowship Salud Family Health Center-Longmont,
Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification R1 김진숙 / Prof. 장재영.
Should Elderly Patients Undergo Additional Surgery After Non-Curative Endoscopic Resection for Early Gastric Cancer? Long-Term Comparative Outcomes R3.
Cancer: Staging and Grading What is meant by the term “biopsy”? How do tumors behave differently from one another ? Examples of the stages of cancer and.
Measurement of SM invasion depth by ‘Committee of Management for sm Carcinoma Project’ of the Japanese Society for Cancer of the Colon and Rectum J Gastroenterol.
Staging of rectal cancer by EUS: depth of infiltration in T3 cancers is important Christian Jürgensen, MD, Andreas Teubner, MD, Jörg-Olaf Habeck, MD, Friederike.
Significance of Neoplastic Involvement of Margins Obtained by Endoscopic Mucosal Resection in Barrett’s Esophagus Ganapathy A. Prasad, M.D. Navtej S. Buttar,
Department of General Surgery, Upper Gastrointestinal Unit,
Dr.Amit Gupta Associate Professor Dept. of Surgery
Jasper Vleugels PhD-student AMC
Contribution by Prof. Dr. B.L.A.M. Weusten
معيارهاي ارزشيابي برنامه ثبت سرطان دانشگاهي ارسال به موقع اطلاعات (هر سه ماه)(2) گردآوري از لحاظ پيدا كردن موارد جديد سرطاني از منابع ذيل: - ثبت.
Wide Field Endoscopic Resection for Advanced Colonic Mucosal Neoplasia: Current Status and Future Directions  Bronte A. Holt, Michael J. Bourke  Clinical.
Nonpolypoid (Flat and Depressed) Colorectal Neoplasms
Polyps of the Colon and Rectum
Endoscopic Management of Nonpolypoid Colorectal Lesions in Colonic IBD
STOMACH CANCER BY DR: ALI ALWAILY/MD.
Endoscopic Management of Nonpolypoid Colorectal Lesions in Colonic IBD
AGA Technical Review on the Diagnosis and Management of Colorectal Neoplasia in Inflammatory Bowel Disease  Francis A. Farraye, Robert D. Odze, Jayne.
Changes in TNM 8 To be used from
Presentation transcript:

Role of colonoscopy in the treatment of malignant polyps Pathology of malignant colorectal polyps Assessing the risk of residual disease post-polypectomy Surgical salvage of the high-risk polyp Staging & non-endoscopic surveillance of malignant polyp

Endoscopist BEFORE Histopathologist Predict polyp histology by morphology – OPTICAL Bx Aim for en bloc resection – AVOID piece-meal

Endoscopist BEFORE Histopathologist Endoscopy reporting Site – Right Vs left colon (splenic flexure) Size – >35mm – 75% of carcinoma Pedunculated / Sessile - Villous 15% risk of Ca Morphology – irregular, ulcer, hard, broad stalk Paris classification of appearance Kudo classification of pit pattern Laterally spreading lesion Non-lifting sign One-piece / PiecemealCompleteness of excision Benign / Malignant

Histopathologist Malignant Colorectal Polyp is a lesion in which neoplastic cells have invaded through the muscularis mucosae into the submucosa. pT1 adenocarcinoma is defined as invasion into the submucosa but not into the muscularis propria Carcinoma in situ / intramucosal carcinoma - OBSOLETE (High Grade Dysplasia)

Histopathologist Degree of differentiation Size – microscopic assessment is most accurate Level of invasion into polyp – Haggitt & Kikuchi

Histopathologist Depth of invasion into submucosa HaggittKikuchi

Histopathologist Degree of differentiation Size – microscopic assessment is most accurate Level of invasion into polyp – Haggitt & Kikuchi Resection margin ≤ 1mm is an involved margin LVI, tumour budding, cribriform histology

Histopathologist 2 nd opinion due to interobserver variability Degree of differentiation LVI

Estimation of risk of residual disease Malignant polyp – Colorectal MDT Estimate the risk of residual disease Technique of resection Resection margin Degree of differentiation Depth of invasion – Haggitt and Kikuchi LVI

Estimation of risk of residual disease Surgery should be considered, provided that the patient is fit enough to undergo such surgery where resection margin is deemed to be involved (< 1 mm) Haggitt Level 4 or Kikuchi sm3 Kikuchi sm1 or sm2 with adverse histology Poorly differentiated – is unusual Colon Vs Rectum differences

Estimation of risk of residual disease Surgery should be considered, provided that the patient is fit enough to undergo such surgery where resection margin is deemed to be involved (< 1 mm) Haggitt Level 4 or Kikuchi sm3 Kikuchi sm1 or sm2 with adverse histology Poorly differentiated – is unusual Lymphovascular invasion Tumour budding Cribriform Mucinous In isolation NOT High risk

Estimation of risk of residual disease

Surgical decision making in high-risk polyps Fitness Life expectancy Impact of morbidity Mortality Patient wishes Surgery if predicted op mortality (CR-POSSUM) < risk of residual disease It should be remembered that even in ‘high-risk polyps’, it is more likely that the resected specimen will NOT contain any evidence of residual disease at the polypectomy site or in draining lymph nodes.

Staging and surveillance - TNM T – Little data on use of MRI or EUS for residual disease N – MRI or EUS unreliable (Not accurate enough to judge whether a visible lymph node does NOT contain cancer) M – CTCAP

Staging and surveillance - TNM Endorectal US should be performed on all rectal polyp tumours prior to transanal or surgical excision (good practice BUT no good evidence)