High grade dysplasia - need advice

[dale1959]

I am a 50 yr old male. My colonoscopy on 3/25/10 found a sessile polyp in the right ascending colon near to the connection of the small intestine. CAT scan on 3/31/10 showed no problems with liver or other organs. Had a followup visit with the GI doctor on 4/14/10 and was told the pathology came back as high grade dysplasia. GI doctor recommends removing 1/2 of large intestine and reconnecting the small to what is left. I am not comfortable with the surgeon/hospital that was recommended. I have asked to be referred to another surgeon/hosptial but will have to wait until 4/26/10 just to see the surgeon for a consult. My question is am I putting myself at great risk by waiting another week to see the surgeon of choice? Any opinions / advice are welcome.

[shmurciakova]

No, I don't think you are putting yourself at risk. The polyp was removed and it takes years and years for the cancer to develop in the first place, which is why another week isn't going to make any difference imo. I think it is wise to get a surgeon whom you feel comfortable with and can help to put your mind at ease, however, this operation is the standard procedure when a cancerous polyp is found. We have all been through this surgery and there are lots of people who can help you along the way. After the surgery they will know more and what treatment, if any, you will need. Here's hoping you are at a very early stage!
Was this just your routine 50 year old colonoscopy? The reason I ask is because my husband is 45 and after what I have been through I am tending on trying to see if he can get his first scope sooner rather than waiting till 50...
-Susan H.

[SkiFletch]

Totally agree, waiting a week will make no difference in your surgery, outcome, or prognosis. Remember, the stuff we deal with on this site on a regular basis really takes nearly a decade from first polyp formation to later stage complications. A week is a drop in the bucket

High grade displasia means the cells in the portion that was biopsied are growing at a rate higher than normal and are likely to become cancerous. Remember, pathology is definitely plenty of parts art as well as science and it's possible your pathology is wrong, in either direction. You might be dealing with more of a low grade displasia, or even the very beginnings of a well differentiated carcinoma. I know one of our members here, seamonkey (hope you don't mind me throwing you under the bus seamonke ) was in your same boat a few months ago, had a right hemi-colectomy (removal of part of the large intestine), and the surgical pathology came back as stage IIa carcinoma. Alas, surgery is the way to go with this.

The good news is that it's really not a bad surgery, as much as it sounds scary, I've had it myself. My intestinal life is pretty much the same now as it was then, so try not to fear it. Definitely worth getting another oppinion though if you werent comfortable with your first one. Good luck

[seamonkey]

I know one of our members here, seamonkey (hope you don't mind me throwing you under the bus seamonke ) was in your same boat a few months ago, had a right hemi-colectomy (removal of part of the large intestine), and the surgical pathology came back as stage IIa carcinoma. Alas, surgery is the way to go with this.

Yes, that was me. Similar to you Dale my GI doctor found a sessile polyp although it was in the sigmoid colon. Had a CT scan and X-ray in between discovery and removal and both were negative. The original biopsy came back as a high grade displaysia. He recommended removal as soon as possible. I met with both a general surgeon and a laparoscopic colorectal surgeon. I was comfortable with both and chose the general surgeon because he had performed hundreds of resections (including two the week prior to me seeing him) and he had performed a resection on my daughter's small intestine when she was very young. Had 12 inches of my large intestine removed two weeks post discovery with an open surgery and the pathology came back a stage 2A cancer. (I no way am I implying this will happen to you, sometimes things just happen and it happened to me, but then again a stage 2A prognosis is pretty good, relatively speaking). I would find a surgeon who has a lot of experience at the operation and choose someone you are comfortable with and trust. Don't be afraid to ask a lot of questions and seek second and third opinions. Above all I would definitely have surgery to remove the polyp. A week or two while you find the right surgeon probably wouldn't matter, but don't push it back as a matter of convienience. Above all, good luck to you and I have my fingers and toes crossed that it remains a high grade dysplasia.

[garbovatwin]

The thing about high grade dysplasia is that even if he removed the polyp with margins, there is absolutely no guarantee they removed it all. High grade dysplasia, as I am sure you know, is a precursor to malignancy, with no set time frame for when it will change into one. Many researchers and surgeons believe that it is already creating changes leading to malignancy. The only way to insure it is gone is to perform a resection.

A second opinion is a good idea, hopefully one from a GI surgeon.

j

[Confused]

After 32 years of well managed UC, I have been diagnosed with high grade dysplasia in the upper colon. I have seen 2 internal medicine specialists and boapsy reviewed by 2 different pathologists. The recommendations were to have the colon removed, a consult with a surgeon also confirmed the diagnosis. Recommended an ileostomy, and plans are to perform a total colectomy with ileoanal reservoir.

Since the is no cancer, are there less invasive procedures that could be performed and still reduce the risk of cancer in the future? Thank you.

[jscho]

After 32 years of well managed UC, I have been diagnosed with high grade dysplasia in the upper colon. I have seen 2 internal medicine specialists and boapsy reviewed by 2 different pathologists. The recommendations were to have the colon removed, a consult with a surgeon also confirmed the diagnosis. Recommended an ileostomy, and plans are to perform a total colectomy with ileoanal reservoir.

Confused, last summer I had a subtotal colectomy with ileorectal anastomosis due to two dysplasia associated lesions (dalms, in the GI parlance). This followed a right hemicolectomy in 2009 for stage III cancer in the cecum. I opted for the anastomosis to avoid an ileostomy, and this was possible due to a relatively healthy rectum. The anastomosis site preserves 15 cm of rectum, which is enough to preserve good function in my case. I'm happy with the results, though for some people the quality of life is better with an ileostomy. One drawback is that I still need to have sigmoidoscopies for surveillance every so often, but they are much easier than full colonoscopies.

I had complications from the surgery (developed an abscess), which is another potential drawback as well. The risk of leaks at the anastomosis is non-neglible.

This procedure may be an option for you as well.

Best,
Jeremy

[pwebber123]

hi Me too, Had the results of colonoscopy with High Grade Dysplasia its located 4 cm up the rectum from anal opening I'm not sure how much margin is needed to reconnect with removal of the area of concern no other indication of cancer was noted in the bowel. I don't have insurance for hospital or surg. due to cancelation following a heart attack and pacemaker placement had to pay cash to get colonoscopy done and I'm broke . I feel like if I'm lucky enough to find a surgeon to do this next needed surg. I can't have much say in any part of what he wants to do. I've been a nurse for over 40 yrs. hard to believe this is how retirement ended up. Sorry to vent . Thanks for being here so I could.