4cm polyp! Freaking out

[alphagam]

I had a 4-5 cm polypoid mass very near my anus at colonoscopy. The GI gave me a probable treatment plan of chemo/radiation, surgery and a permanent colostomy . Biopsy was inconclusive. Went for a second opinion. That dr scheduled me for a surgical procedure to get better pathology. When he got in there, TEMS procedure, he found that the tumor was only in the lining and removed the whole thing. Scared my husband to death that I was in surgery for two hours longer than estimated. I went home very shortly thereafter (about 2.5 hrs) Pathology came back two days later, Stage 0, in situ Cancer. No treatment necessary. It will be 4 years in March. Have another colonoscopy then, but in the intervening years NED based on colonoscopies, PET scans, physical exams as it was SO close to anus.

[Skoliv]

Went to a new doctor just to have him look at the pictures and have a second opinion. He also thinks it looks like no cancer or pre-cancerous/stage 0, and said something about the base of the polyp looking clean, which is a really good sign. He said many times that I was going to be ok. I feel better now. Will try to play that in my mind as many times as possible. He also said that I was probably looking at what caused my uncles death in a much earlier stage, which made me cry my eyes out. Anyway, point is I will try and survive (physically and mentally) this possible 2nd cancer in less than 30 years of life. I do feel blessed to have found this now and not later, but it is still hard to believe . I will keep you posted on the pathology report, but I am feeling hopefully today.

[Cb75]

Glad to hear you have found some peace of mind. It's always best to be cautious. xo

cb

[skypup]

Just a thought: it might help your anxiety issues to now spend time consciously feeling compassion for those who do not have your fortunate circumstance. And let me say loud and clear--good for you for getting onto this before it became a big problem!

[Regan]

Great message skypuppy.... I second every word for you!!!!
So glad for you to have checked it out before monster took over.

[Skoliv]

Just a thought: it might help your anxiety issues to now spend time consciously feeling compassion for those who do not have your fortunate circumstance. And let me say loud and clear--good for you for getting onto this before it became a big problem!

I am sorry, again, if I said anything that upset you. I know anxiety issues may seem silly for those who are suffering "real problems", but unfortunately it is not so simple to resolve. Trust me, I feel compassion for those who are not in my position (still am not sure what position that is), and pray for all those hit by this nasty disease that has killed so many of my loved ones. I will now try to stay away from this forum for a while, I don't know if it helps or gets me even more worked up. Thanks to all those who shared their stories with me. I will keep you posted on biopsy results.

[Pathfindergrl28]

skoliv, did you get an answer on what type of polyp you have yet? I am new here and this is my first post. Been hanging out here a few days & finally joined the forum. I'm 34/F from east coast, USA. I was seeing some blood & mucous in my stool on and off the last few months, so I made an appointment with a GI specialist 3 hours from my home in a city area. He said I should have an immediate colonoscopy to see what was going on. I had the colonoscopy this past Monday. So glad I did. He said I have mild diverticulitis, hemorrhoids, and a 1.2 cm polyp in the sigmoid colon. He didn't feel it was cancerous at this time, but sent it to pathology for more information. I am nervously awaiting the results. I also suffer from health anxiety (ironically I'm an LPN). I take Vistaril for anxiety attacks. I also have genetic high BP which I take medication for. I have had a couple other health scares in the past, and wasn't expecting the doctor to tell me I had a growth in my sigmoid colon this past Monday. I felt blessed he didn't feel it was cancer yet, but I am still nervous, and all of this is new to me. I am married, and a mom of two young children. I have been with my husband 15 1/2 years. My husband's first wife (they were together 2 1/2 years) had colon cancer. She passed away at age 24 (fortunately they did not have children). Her doctors thought hers was genetic my husband told me. I hate my husband is going through all of this again. I am praying my results are benign, but now know that I am high risk for CC now if this does turn out to be an adenoma. My GI doctor wants my family checked for them as well. My heart goes out to those facing or about to face this horrible disease. My prayers go out to everyone on here.

[orcasres]

GI's see a lot of cancer. They usually know as soon as they see it. So while I am sure you are nervous until you get the final result, it will probably be benign; they have to send everything to pathology just to be sure. My husband has had ulcerative colitis for 40 years and has a colonoscopy every two to three years and almost always has one or more polyps removed with no cancer. Ironically I am the one that got CC.

It is important that you did have the colonoscopy and that they removed the polyp. Not all polyps become cancer, but nearly all cancer starts as a polyp and is usually slow growing. Making sure that your family gets scoped at the recommended time is a great idea. Especially if you have parents that have chosen not to be scoped at age 50. If the polyp should be cancerous, you will be given appropriate recommendations for monitoring of other family members.

Try to relax until the results are in.

Lois

[Pathfindergrl28]

Hi, thanks for your reply. I got a letter from my GI doctor today. His letter said that he removed a tubulovillous adenoma in my sigmoid colon. His letter said he removed it completely, & to follow up in 3 years. I know this is one of the more dangerous colon polyps, and is rare in my age group (I'm 34). He forgot to send the path report with the letter, so I'm confused. Does the fact I have to follow up in 3 years mean it's benign? Or is it precancerous since its tubulovillous? Are all tubulovillous adenomas precancerous? I plan to contact his office for the path report & plan to follow up with him soon. I think I would prefer a colonoscopy in a year or two as well over 3 years. I'm definitely going to make sure my parents and sister are screened for these polyps as well.

[me2]

Hi, thanks for your reply. I got a letter from my GI doctor today. His letter said that he removed a tubulovillous adenoma in my sigmoid colon. His letter said he removed it completely, & to follow up in 3 years. I know this is one of the more dangerous colon polyps, and is rare in my age group (I'm 34). He forgot to send the path report with the letter, so I'm confused. Does the fact I have to follow up in 3 years mean it's benign?

It's benign, which just means it's not yet cancerous. Size (> 1cm) and histology (villous features) mean you're making adenomas more likely likely to be problematic so you get a 3 year follow-up not 5-10 as people with 3 or fewer polyps and less troubling structure.

Or is it precancerous since its tubulovillous? Are all tubulovillous adenomas precancerous?

"pre-cancerous" isn't a well-defined term.

Polyps can be hyperplastic which means they're normal cells which are growing quickly but lack malignant potential, or neoplastic when they've started to loose differentiation. Neoplastic polyps, also called adenomas, are glandular tissue which is no longer normal. On average 10% of adenomas eventually become cancerous, although factors like histology (tubular villous increases the odds to 20%) and size make the odds wore.

I plan to contact his office for the path report & plan to follow up with him soon. I think I would prefer a colonoscopy in a year or two as well over 3 years. I'm definitely going to make sure my parents and sister are screened for these polyps as well.

It takes 2-5 years for an adenoma to degenerate into an advanced adenoma, then another 2-5 years for it to become an early cancer where polypectomy is often considered curative and the pathologists may call it "advanced dysplasia" so they don't upset people or steer them towards unnecessarily aggressive treatment. A 3-year surveillance interval covers that.

[Pathfindergrl28]

Oh ok, thank you so much for your detailed reply. It has put my mind at ease some. All of this is new to me & it's confusing. I'm an LPN, however we just touched briefly on colon cancer in nursing school, didn't really get in to the pathology aspect of it. This is a wonderful forum. I am so glad I found it, and it's so nice to have such caring, educated people on here as well.

[Pathfindergrl28]

One other question I forgot to ask the other day was, does benign mean there's no dysplasia at all in a polyp?

[Skoliv]

Ok, so mine was cancer after all. Tubular adenocarcinoma with High grade displasia. But apperently margins are free of cancer cells according to path report. I am devastated and relieved at the same time. What should I do now? I talked to my doc on the phone, he said another colonoscopy in 3 months and take it from there. Do you agree? Please tell me everything is going be ok! Any stories like mine out there?!

[Bev G]

I don't think high grade dysplasia is cancer. Did your doctor say he/she was diagnosing you with cancer? It seems like a follow-up colonoscopy is a good idea. Good luck to you.

[me2]

I don't think high grade dysplasia is cancer.

For practical purposes it's not because the offending cells remain in the mucosal layer which lacks lymph and blood vessels that would allow it to spread.

Being pedantic some doctors would describe things differently, although "cancer lite" is a more appropriate classification with surgical intervention unnecessary.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896747/

Cancerous polyps are classified into non-invasive high grade neoplasia (NHGN), when the cancer has not reached the muscularis mucosa, and malignant polyps, classed as T1, when they have invaded the submucosa. NHGN is considered cured with polypectomy, while the prognosis for malignant polyps depends on various morphological and histological factors.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418538/

Thus, intramucosal carcinoma is preferably called high grade dysplasia (discussed later) by pathologists in order to avoid unnecessary surgical intervention. In the American Joint Committee on Cancer (AJCC) Cancer Staging Manual (9), mucosal invasion is classified as carcinoma in situ (Tis). Nevertheless, the term of intramucosal carcinoma may still be used by some pathologists.

http://www.gastrocentro.unicamp.br/endo/colon/malignant_polyps.pdf

The older term carcinoma-in-situ has now been replaced by the term high-grade dysplasia, which also includes severe dysplasia. The pathology diagnosis of high-grade dysplasia also has no clinical significance in terms of the initial management of the patient.