Expert: DANIL HAMMOUDI.MD - 10/6/2006

Question
My husband is a heart transplant patient. Had adenocarcinoma of the sigmoid colon in 1999.  Repeat colonoscopy done every 2 years and always having polyp removed. This year they found a flat polyp with high graded dysplasia, doctor removed it, but couldn't remove all of it. Had another colonoscopy in San Francisco and removed two more polyp, one 4mm from the polyp removed Sept.1,2006.  Doctor there says the area looks good and did't remove anymore of it, which I thought that why we did another colonoscopy. They said repeat in 6 months. Our GI doctor thinks he should have a resection done. This is in the transverse colon at 70cm. tubulovillous adenoma with high grade dysplasia. I don't where to go from here, can you help.  

Answer
I think if the total polyp was not removed, it should had a colectomy, with this high grade there is risks for another cancer.
High-grade dysplasia [dysplasia =Dysplasia, or dysplastic changes, are atypical changes in the nuclei of cells (the inside of the cell that contains DNA), the cytoplasm (the portion of the cell surrounding the nuclei), or in the growth pattern of cells. These changes can be subtle or very pronounced. They are considered pre-cancerous changes (increases the risk of developing cancer).]
This is considered the most advanced dysplasia with atypical changes in many of the cells and a very abnormal growth pattern of the glands. In high-grade dysplasia, the growth pattern of the glands, or rows of cells, are distorted or very irregular. Some of the glands are branching or budding. More than 50% of the cells have large spotted nuclei and are frequently dividing.

So, therefore with this high risk , the solution is to have close follow up, or to remove the colon at risk, instead of just removing thosand of polyps and since the high risk still there, colectomy is recommeded in my opinion.
Thanks