A 51-year-old woman comes to the office to discuss colon cancer screening. She has normal bowel movements and has had no hematochezia, melena, or unexpected weight loss. Medical history is significant for hypertension. Her mother developed colon cancer at age 85. The patient does not use tobacco or alcohol. Vital signs are normal. Cardiopulmonary and abdominal examinations are unremarkable. The patient undergoes colonoscopy, during which two small (8 mm) hyperplastic polyps are found and removed. Which of the following is the best next step in management?

Question

A 51-year-old woman comes to the office to discuss colon cancer screening.  She has normal bowel movements and has had no hematochezia, melena, or unexpected weight loss.  Medical history is significant for hypertension.  Her mother developed colon cancer at age 85.  The patient does not use tobacco or alcohol.  Vital signs are normal.  Cardiopulmonary and abdominal examinations are unremarkable.  The patient undergoes colonoscopy, during which two small (8 mm) hyperplastic polyps are found and removed.  Which of the following is the best next step in management?

Quizplus · Accepted Answer

Explanation: This patient has hyperplastic polyps, a non-neoplastic abnormality often found on screening colonoscopy. Hyperplastic polyps are most common in the rectosigmoid colon. Small (<1 cm) hyperplastic polyps do not increase the risk for colon cancer, and therefore patients may continue colorectal screening at the usual intervals: Repeat colonoscopy in 10 years for individuals at otherwise average risk Repeat colonoscopy in 5 years for individuals with a high-risk family history (eg, first-degree relative with colorectal cancer at age <60) This patient's mother was over age 60 at the time of diagnosis, which would not appreciably increase the patient's risk; a 10-year screening interval is appropriate. (Choice A) More frequent screening (<10 years) is indicated for patients with adenomatous polyps, with the specific interval dependent on the size and number. Hyperplastic polyps do not change the normal screening frequency. (Choice C) Abdominal CT scan is an appropriate staging measure for patients with a new diagnosis of colorectal cancer. It is not required in evaluation of either neoplastic (eg, adenoma) or non-neoplastic (eg, hyperplastic) polyps. (Choice D) Periodic fecal occult blood testing is an appropriate screening modality for individuals at average risk for colorectal cancer. It is typically performed at 1-year (not 6-month) intervals. This patient just had a colonoscopy with low-risk findings; additional screening tests will not be necessary for several years. (Choice E) Mismatch repair genetic analysis can diagnose Lynch syndrome, which should be suspected in individuals with a strong family history (eg, ≥3 relatives involving multiple generations) of colon cancer, endometrial cancer, and/or ovarian cancer. This individual's family history is not extensive enough to warrant genetic testing. Educational objective: Hyperplastic polyps are a non-neoplastic abnormality commonly found on screening colonoscopy. Small hyperplastic polyps do not increase the risk for colon cancer, and patients may continue colorectal screening at the usual intervals (eg, repeat colonoscopy in 10 years for individuals at otherwise average risk).

A 51-Year-Old Woman Comes to the Office to Discuss Colon