Tubulovillous adenoma and LAR

[Cocopuff]

Hello All,

I am new here and have been reading through old threads for a couple of days. I had my first colonoscopy 6 days ago performed by a board-certified GI doctor. She found a 5cm tumor located 15-20 cm from the anal verge (so border of sigmoid colon and rectum?). 3 fragments were removed to be biopsed. Two other polyps were removed from the cecum (3 mm) and descending colon (2 mm).

She told me she was concerned that the tumor was malignant and that I needed to have a resection done. The next day I had a CT w/ contrast of my chest/abdomen/pelvis and met with a general surgeon. CEA was 1.6. "2 to 3mm hypodensities in liver, probably small cysts"

the pathology came back as tubular adenoma for the two small polyps. The tumor pathology is as follows:

there are fragments of colonic mucosa showing well-formed villous projections, increased numbers of glands, glandular crowding and mucin depletion. The glands are lined by enlarged cells with hyperchromatic nuclei showing pseudostratification. No high grade dsyplasia is identified. No malignancy is seen.

Surgeon and GI have both said that "no malignant cells were identified" but that I'm not out of the woods and they won't know for certain until after the resection.

I have a second opinion with a board-certified colo-rectal surgeon at the University of Pennsylvania in two days. But I am very anxious and fearful that it is cancer even with the negative pathology report. Also, trying to determine if a Low anterior resection is necessary. I'm 39, no environmental risk factors, negative for Lynch. strong family history of polyps.

thank you for reading and any insight or guidance on how to interpret this pathology and whether a resection is appropriate.

[O Stoma Mia]

Here is a link to an old post that you can read before your second-opinion meeting this week. it has some information on tubulovillous adenomas

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60733&p=480975#p480975

Here are some other old threads in the villous / tubulovillous area:

old threads

The average colon is about 1.5 m long. Lengths of the various parts are:

* Ascending colon: 25 cm
* Transverse colon: 45 cm
* Descending colon: 15 cm
* Sigmoid colon: 40 cm
* Rectum: 12 cm
* Anal canal: 5 cm
* Anal verge: 0

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[O Stoma Mia]

There are a few other questions you could ask in your meeting with the surgeon tomorrow.

• "T" value of the tumor. Is the tumor a T1, T2, T3, or T4 tumor? This can make a difference for which procedure would the best for removing it.
  
• Should they be planning to do an MRI of the tumor area to see just how far the tumor has grown into the colon wall?
• If the tumor is in the upper rectum area and rests only in the superficial layers of the colon, they might be able to do a Transanal Endoscopic Microsurgical Excision, which is far less invasive than a LAR.
  https://colorectalsurgery.wustl.edu/Patient-Care/Transanal-Endoscopic-Microsurgical-Excision/
  There are surgeons in Pennsylvania who can do this kind of minimally invasive surgery, e.g.
  https://www.doximity.com/cv/james-mccormick-do-slash-1
• What type of polyps were found -- sessile (flat), or pedunculated(raised)? Is the 5cm "tumor" actually just a large sessile polyp that has not yet become cancerous?