You’ve made it through the dreaded prep, you’ve probably dozed through the colonoscopy itself, you’re awake again and headed for a nice breakfast . . . now what?
Depending on what was found during the colonoscopy, your doctor will recommend how soon you need to following up with another colonoscopy. Guidelines, based on the risk for a new adenoma or cancer, recommend:
- Patients with no polyps or with small hyperplastic polyps don’t need to return for another colonoscopy for 10 years.
- Low-risk: 1 or 2 adenomatous polyps less than 1 centimeter (10 millimeters) in size should be followed up with colonoscopy in 5 to 10 years.
- High-risk: 3 to 10 adenomas, any adenoma 1 centimeter or bigger, or any adenoma with villous features or high-grade dysplasis needs in 3 years. If there are no further multiple, large or high-risk adenomas at that time, follow up can extend to 5 years.
- Patients with more than 10 adenomas found during one test should be reexamined with colonoscopy at a shorter than 3 year interval, depending on their doctor’s clinical judgment. With their doctors, they should consider the possibility of inherited colorectal cancer mutation such as FAP (familial adenomatous polyposis) or AFAP (attenuated familial adenomatous polyposis.)
- If sessile or flat polyps were removed piecemeal during the colonoscopy, a follow-up exam should be scheduled within 2 to 6 months to be sure that they were completely removed. Further follow-up depends on the doctor’s judgment.
- Patients with a family history that may indicate Lynch syndrome (hereditary non-polyposis colorectal cancer) need shorter intervals between colonoscopies, even if they are normal each time, because of the speed that their polyps cancer can develop into cancer.
These consensus guidelines were developed by the American Cancer Society in collaboration with the US Multi-Society Task Force on Colorectal Cancer in 2006. In publishing them, they wrote:
Adoption of these guidelines nationally can have a dramatic impact on shifting available resources from intensive surveillance to screening. It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps.
If suspicious lesions were found and biopsied during your colonoscopy, the gastroenterologist will refer you to a surgeon or other physician for further immediate follow-up.
Where Can You Go for More Information
Guidelines for Colonoscopy Surveillance after Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society were published by the American Cancer Society in 2006. The consensus team was headed by Sidney Winawer, MD.
Ann Zauber PhD, discusses high risk patients for adenomas and colorectal cancer, during a webcast of her presentation at the American Association for Cancer Research Frontiers in Cancer Prevention Research conference in 2007.