Dear OncoLink "Ask The Experts,"
I am 38-year-old woman in excellent health. I have eaten fiber since age 15 every night (bran cereal). I am a long distance runner since age 14. I recently had a villous adenoma removed and remnants cauterized at initial removal 07/01. There was also a small polyp removed. I had the adenoma cauterized again in Nov. and I'm going back in May 2002. My mother died of breast cancer, age 66, my father had polyps. Will the villous adenoma ever come back or does cauterization kill it at the site? What caused it since I have no risk factors (I am tall)?
How often should it be checked? Am I at risk for more of these villous adenoma at other sites or colon cancer? The cells on top had changed. My Dr. said it would be cancer in a year if not removed but cells underneath ok. What behavior modification can I do? I eat pretty healthy.
Thank you for any information. (This was an extremely fortuitous discovery.)
Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor responds:
Although we understand some of the reasons polyps and colon cancer develop, we often are surprised and feel that it is all random and fortuitous.
If your polyp was completely removed, it should not recur. The issue with a larger polyp is whether it has been removed completely. I assume that is the reason you have had several follow-up colonoscopies. When you are completely clear, you can probably have a colonoscopy every 3 years. Once you have had a couple clear colonoscopies without polyps, you may be able to expand the interval to 5 years.
You are already doing most of the behavioral preventative strategies. You might want to add a vitamin with at least 400 ug of Folic acid daily. Although there is some evidence that drugs like aspirin or some of the other pain medications may help prevent colon cancer, there still is not good enough evidence to routinely recommend this. However, it is something you and your physician could discuss. It isn't clear whether the risks outweigh the benefits. You do have an increased risk with your father's history of colon polyps. Your mother's history of breast cancer may play some role, but that is not clear. As with any disease, there will always be people that develop a disease despite doing all the right things. OncoLink has joined forces with the National Colorectal Research Alliance to help their scientists study the risk factors associated with colorectal cancer and identify potential preventive and treatment therapies. You and your family may be interested in taking our survey. This confidential survey was developed by cancer experts as an interactive way to help our leading scientists study families with a history of colorectal cancer.