Expert: Claes-Gustaf Nordquist, M.D. - 8/1/2008

Question
I was recently diagnosed with a "tubular adenoma" of the rectum (adenomatous polyp)that was "positive for focal cytologic high grade dysplasia." Polyp APPEARS to be completely excised. Which worries me. The biopsy specimen showed an increased number of glands with glandular crowding and mucin depletion is present. The glands are lined by enlarged, hyperchromatic cells showing pseudostratification. There is a focus with some glands having nuclear pseudostratification which extends through their entire thickness with nuclei reaching the luminal surfaces. I was told that I technically have cancer and should treat it as such. They said I need a sigmoidoscopy every six months and colonoscopy every year. What are the chances of me having another growth? Are these tumors an indication of malignancy? What is the current usual treatment for someone with my diagnosis? Do I need to consult an oncologist-gastroenterologist or will my regular GI M.D. be able to just do frequent 'screenings'? I am not sure what all the medical terminology means and would appreciate it if you can tell me a little more about my diagnosis. I am very concerned about my condition and am trying to understand all this medical jargon. Thank you for your time and help. Tom

Answer
Well I do not agree that this is the same as if you indeed had cancer. What you had was "severe high grade dysplasia" which technically is a precursor to cancer BUT NOT yet cancer! But it is true that this indicates that you have a tendency of developing polyps that in turn can turn cancerous. So I fully agree that you should follow the suggested scheme. Any GI specialist should be able to do it! In order to fully explain all the medical terminology I would have to gice you a crash course in pathology which is somewhat too much to do here. But I do hope my advice here has been clear enough!