Check this updated consensus by U.S. Multi-Society Task Force on Colorectal Cancer

About 90% of colorectal cancer is derived from adenomatous polyps, so the detection and removal of adenomatous polyps is the most important means of preventing colorectal cancer.

 

However, resection of polyps does not mean polyps shall never grow. Reexamination is required and necessary according to the nature of polyps, size, the number of polyps.

In response to this topic, the U.S. Multi-Society Task Force on Colorectal Cancer has released an undated consensus.

 

In March 2020, the renowned journal Gastroenterology published a new update to the United States guidelines for colorectal cancer.

 The article is publicized on Gastroenterology Volume 158, No. 4, 2020.

This recommendation assumes that a high-quality colonoscopy is performed, which is defined as a thorough examination of the cecum, adequate bowel preparation, examination by a colonoscope physician with a high adenoma detection rate, and careful removal of polyps.

The brief follow-up plan is as follows:

1. People with normal colonoscopy results or patients with 20 hyperplastic polyps less than 10 mm should be monitored within 10 years.

2. Patients with 1 to 2 adenomas less than 10 mm should be monitored by colonoscopy within 7 to 10 years.

3. Patients with 3 to 4 adenomas less than 10 mm should be monitored within 3 to 5 years.

4. Patients with 5 to 10 adenomas, adenomas ≥10 mm, or adenomas with villous components or highly atypical hyperplasia should be monitored within 3 years.

5. Patients with more than 10 adenomas should be monitored within 1 year and genetic test should be considered based on adenoma load, age, and family history.

6. If adenomas ≥20 mm have been performed with piecemeal resection, colonoscopy should be performed within 6 months and again 1 and 3 years later.

 

7. Patients with 1 to 2 sessile serrated polyp (SSP) < 10 mm should be monitored by colonoscopy within 5 to 10 years.

 

8. Patients with 3 to 4 SSP< 10 mm or hyperplastic polyps ≥10 mm should be monitored within 3 to 5 years.

 

9. Patients with 5-10 SSP ≥10 mm, or SSP with atypical hyperplasia or traditional serrated adenoma should be monitored within 3 years.

The 2020 guidelines are more complex than the previous version, but contain a more detailed breakdown of patients, which should help physicians make more individualized recommendations, especially for patients with small polyps.

 

A significant and welcome change is to extend the monitoring interval to 7 to 10 years instead of 5 to 10 years for patients with 1 to 2 adenomas < 10 mm.

 

And for patients with 3 to 4 adenoma < 10 mm, the monitoring interval was extended to 3 to 5 years instead of 3 years.

 

Many endoscopes are likely to be conservative in the face of the new interstitials developed by the guidelines, but reducing the density of surveillance for low-risk lesions is a step in the right direction, especially in institutions that perform high-quality colonoscopy.

 

New evidence suggests that we may be able to achieve further individualization for adenoma < 10 mm; Detection of 1 to 2 small (< 6 mm) adenomas does not appear to be associated with a significantly increased risk of neoplasia. So a 10-year interval is considered.