2 precancerous polyps need help interpreting pathology

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gameboy88
Posts: 3
Joined: Sat Dec 24, 2022 3:10 pm
Facebook Username: Jasraj Dhaliwal

2 precancerous polyps need help interpreting pathology

Postby gameboy88 » Sat Jan 07, 2023 9:20 am

25 year old male with 2 sessile serrated polyps

So I had a colonscopy done 2 weeks ago to remove a Sessile Serrated Polyp (10mm). Doc also found another 12mm Sessile Sertated one which was missed in my first colonscopy back in July (these polyps are supposedly very hard to identify)

As for why my polyps weren't removed in the first one in July, it's because that was carried out by a nurse endoscopist and he wanted a second opinion of a specialist GI on whether I actually had polyps (as sessile serrated lesions are very hard to identify he wasn't sure so he took pics).

Doc confirmed it was a SSL and that it looked very benign and not serious but wanted to remove anyway. So the second colonscopy was done 2 weeks ago in which they removed the two sessile serrated polyps. Doc said they looked fine and not serious and that these polyps can become potentially serious years down the road. Seemed completely unconcerned and very sure of himself

Anyway frustratingly I haven't got my pathology back for those polyps yet even though the colonscopy was on the 21st December. I take comfort in that if it was really bad I guess they would have told me asap.

But I was able to get the pathology for the first colonscopy I did in July in which they took a bunch of samples:

Results below:

https://imgur.com/a/W6JPOYh

So my two sessile serrated polyps were in the ascending colon. And the two tissue samples of mucosa they took from the ascending colon came back as "normal mucosa". Does this pretty much rule out colon cancer? From what I've read, if its stage 0 cancer the mucosa would show up as abnormal. But the mucosa of where my polyps were was normal.

Would be a relief but not pleased about having precancerous polyps.

roadrunner
Posts: 347
Joined: Sun Jan 12, 2020 8:46 pm

Re: 2 precancerous polyps need help interpreting pathology

Postby roadrunner » Sat Jan 07, 2023 5:09 pm

I didn’t dive into the pathology, but based solely on your description and your doctors’ communications, it seems that it might be worth asking your surgeon/GI: (1) is he/she confident that all SSPs were found; (2) is he/she confident that the resections were complete (both can be issues with these polyps); and (3) what should be your surveillance schedule (the article below seems to suggest 3 years if I have the facts right. It should be noted, however, that the authors appear to be suggesting that more frequent surveillance may be justified depending on specific circumstances.)

[Edited to add: I did look at the report. I see nothing of concern in it, but—perhaps obviously—you need to get the pathology on the resected polyps to know what you’re dealing with. Nothing jumps out of your narrative as high risk/concern for carcinoma, but the pathology will have specific information that you will need to consider, including for necessary follow-ups. I agree that generally bad path reports are expedited, but that is not anything to rely on.]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077296/
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)

gameboy88
Posts: 3
Joined: Sat Dec 24, 2022 3:10 pm
Facebook Username: Jasraj Dhaliwal

Re: 2 precancerous polyps need help interpreting pathology

Postby gameboy88 » Wed Jan 11, 2023 2:05 pm

roadrunner wrote:I didn’t dive into the pathology, but based solely on your description and your doctors’ communications, it seems that it might be worth asking your surgeon/GI: (1) is he/she confident that all SSPs were found; (2) is he/she confident that the resections were complete (both can be issues with these polyps); and (3) what should be your surveillance schedule (the article below seems to suggest 3 years if I have the facts right. It should be noted, however, that the authors appear to be suggesting that more frequent surveillance may be justified depending on specific circumstances.)

[Edited to add: I did look at the report. I see nothing of concern in it, but—perhaps obviously—you need to get the pathology on the resected polyps to know what you’re dealing with. Nothing jumps out of your narrative as high risk/concern for carcinoma, but the pathology will have specific information that you will need to consider, including for necessary follow-ups. I agree that generally bad path reports are expedited, but that is not anything to rely on.]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077296/


Thank you for your response.

I got the path back. Both polyps had no dysplasia or cancer. Return in 3 years.

I've read about every piece of medical literature I can find on sessile serated polyps and from what I've read, these polyps turn into cancer much more slowly than tubular adenomas. The sequence from no dysplasia to low grade to high to carcinoma is 15-20 years. And the average size of these polyps tends to be larger (avg for SSP without dysplasia is 10mm). So maybe that's why doc wasn't concerned with size.

I'm relieved but I'm not exactly pleased of having two precancerous polyps at 25. Not sure why my doc wasnt concerned given my age. He treated it like any other typical benign polyp.

roadrunner
Posts: 347
Joined: Sun Jan 12, 2020 8:46 pm

Re: 2 precancerous polyps need help interpreting pathology

Postby roadrunner » Wed Jan 11, 2023 10:31 pm

Glad to hear the results were good! I understand the concern given your age, but perhaps it’s a blessing in disguise. It likely will result in better surveillance until that is demonstrated to be unnecessary. That is definitely better than not knowing if something is going on.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)

Rock_Robster
Posts: 742
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: 2 precancerous polyps need help interpreting pathology

Postby Rock_Robster » Thu Jan 12, 2023 7:27 am

roadrunner wrote:Glad to hear the results were good! I understand the concern given your age, but perhaps it’s a blessing in disguise. It likely will result in better surveillance until that is demonstrated to be unnecessary. That is definitely better than not knowing if something is going on.

I agree this is like best case scenario under the circumstances. You now have a solid case for enhanced surveillance, without having to deal with an established cancer. Long may your scopes be clear!
40M Australia
2018 Dx RC 12cm high
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA: Nov-18: 14 > 2
Jun-22: 5
Sep: 10
Nov: 19
Dec/Jan-23: 17-19
11/18 FOLFOX
3/19 Liver resect
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resect
NED
11/21 Liver met, PALN, sub-cm lung mets
3-4/22 Lymphadenectomy, liver SBRT
9/22 Liver met, PALN
10/22 PALN SBRT
11/22 Liver mets, nodes, peri nodules. Xeloda+Avastin
1/23 Liver/lungs stable. Lymph/peri undetectable

gameboy88
Posts: 3
Joined: Sat Dec 24, 2022 3:10 pm
Facebook Username: Jasraj Dhaliwal

Re: 2 precancerous polyps need help interpreting pathology

Postby gameboy88 » Sat Jan 14, 2023 5:37 am

roadrunner wrote:Glad to hear the results were good! I understand the concern given your age, but perhaps it’s a blessing in disguise. It likely will result in better surveillance until that is demonstrated to be unnecessary. That is definitely better than not knowing if something is going on.


I just received my pathology report and I'm very confused. It says that I had two HYPERLASTIC polyps removed, not sessile serrated polyps. It also says they were 8mm and 10mm respectively, opposed to 1cm and 1.2cm. No dysplasia seen etc.

From what I know, hyperlastic polyps are not the same as sessile serrated ones?

weisssoccermom
Posts: 5984
Joined: Thu May 10, 2007 2:32 pm
Location: Pacific NW

Re: 2 precancerous polyps need help interpreting pathology

Postby weisssoccermom » Sat Jan 14, 2023 2:55 pm

You are correct.....hyperplastic and serrated polyps are NOT the same. In addition, hyperplastic polyps almost never become cancerous. I've had 1 or 2 removed in the last 16 years. My colorectal surgeon who does my scopes doesn't see the need in sending them to pathology but I insist...if nothing else, for peace of mind.
Dx 6/22/2006 IIA rectal cancer
6 wks rad/Xeloda -finished 9/06
1st attempt transanal excision 11/06
11/17/06 XELOX 1 cycle
5 months Xeloda only Dec '06 - April '07
10+ blood clots, 1 DVT 1/07
transanal excision 4/20/07 path-NO CANCER CELLS!
NED now and forever!
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