Colon Disorders and

Surveillance

Prof. Shorena Chumburidze

 Colon Disorders and Surveillance
Diverticular
 Diverticulosis

 Diverticulitis

Functional
 Constipation

Malignant
 Colon cancer

 Hereditary non- polyposis syndrome

 Familial adenomatous polyposis (FAP)

 Juvenile polyposis

 Other: Gardner’s syndrom, Peutz-Jegher’s syndrome,

Turcot’s syndrome
 Diverticulosis
 Diverticulosis is an outpouching of the colonic
mucosa

 These pouches are usually very small (5 to 10

millimeters) in diameter but can be larger

 Extremely prevalent in countries w/ “ Western”

diets

 Generally asymptomatic, rarely LLQ pain, never

fever, in most cases incidental finding on
colonoscopy
 Diverticulosis
 Should advise pt and make note

 Tx: No acute therapy is necessary.

 Educate pt about increasing fiber in diet.

 Over-the-counter drug (OTC),

( bulking agents
(Psyllium) can be useful

 Major complication is diverticulitis

 Diverticulitis
 Infection of a colonic diverticulum;

 Often occurs from blockage due to non- digestive food

products (corn, gum)

 Sx: LLQ or periumbilical pain, fever

 Dx: Abdominal CT with oral contrast is the best first

step.

 Should also get routine labs, checking for elevated

WBCs.
 Diverticulitis
 Don’t try to perform a colonoscopy and
don’t try to give a barium (or any kind)
enema

 Tx: Admit Ciprofloxacin and metronidazole, along

with a fiber-sufficient diet.

 Advise pts of need for 20-25 g of fiber per day

 Top 8 High-Fiber Foods
• Beans.
• Broccoli.
• Berries.
• Avocados.
• Popcorn.
• Whole Grains.
• Apples.
• Dried Fruits.
 Constipation
 Technically< 3 bowel movements per week, but
generally subjective diagnosis

 Sx: Decreased frequency bowel movements,

“ hard” or “ lumpy” stool staining

 Dx: Clinical grounds

 Causes: Dehydration, sedentary condition, DM,

iron supplementation, drugs, hypothyroidism,
neurologic disorders
 Constipation
 What drugs? Opiates, calcium channel
blockers , anticholinergics, antacids,
sympathomimetics

 Tx: Minimize offending agents, ensure

adequate hydration, psyllium, docusate,
bisacodyl, other laxatives are all fine shot
term, consider getting a TSH/T4

 Dx: Irritable bowel syndrome (will be painful,

>3 months)
 Colon cancer
 Adenocarcinoma; one of the more common
cancers in the US; Lifetime prevalence of around 5-
6%

 Risk slightly increased with red meats, high fat

diet, and smoking

 Risk greatly reduced with proper preventive

measures

 Sx: Depend on location of tumour

 Colon cancer

 Dx: Colonoscopy

 Tx: localized disease is resected;

widespread is chemotherapy, particularly 5-
fluorouracil (5-FU)
 Colon Surveillance

 Routine surveillance colonoscopy are

recommended for all adults beginning at age 50
and continuing every 10 years

 If a polyp is found, the colonoscopy should be

repeated in 3-5 years
 Colon Surveillance

If a pts has a family history of premature colon

cancer (any colon cancer dx before age 50), the pt
should begin routine screening at the age the
relative was diagnosed minus 10 years
 Colon Surveillance

 If a pt has 3 or more relatives dx w/colon

cancer, in 2 or more generations, and at least
one was premature, surveillance should start at
the age of 25 and repeat every 1-2 years
 Overview of colon polyps
 A polyp of the colon refers to a protuberance into
the lumen above the surrounding colonic mucosa.

 Colon polyps are usually asymptomatic but may

ulcerate and bleed, cause tenesmus if in the
rectum, and, when very large, produce intestinal
obstruction !!!

 Colonic polyps may be neoplastic (eg, adenomas)

or non-neoplastic (eg, inflammatory polyps).
 Genetic pre-malignant colon syndromes

Non- polyposis
 Hereditary non-polyposis syndrome

Polyposis
 Familial adenomateous polyposis (FAP)

 Gardner’s syndrome

 Juvenile polyposis

 Peutz-Jegher’s syndrome

 Turcot’s syndrome
 Hereditary non-polyposis syndrome

 Hereditary nonpolyposis colorectal cancer

or Lynch syndrome is an autosomal dominant
genetic condition that has a high risk of colon
cancer as well as other cancers including
endometrial cancer (second most common)
ovary, stomach, small intestine, hepatobiliary
tract, upper urinary tract, brain and skin
 Familial Adenomatous Polyposis (FAP)
 Mutation of APC gene, leading to development of
hundred to thousands of polyps, even in
childhood.

 Sx: Often no sx until the development of colon

cancer, therefore family history is important
(and often present)

 FHx: 75-80 % of pts w/FAP have a family member

dx w/colon cancer at 40 years of age or younger

 APC stands for adenomatous polyposis coli.

 Familial Adenomatous Polyposis (FAP)

 Dx: Flexible sigmoidoscopy beginning at age 12,

repeating every 1-2 year.

 When a polyp is found, proceed to full colonoscopy.

 Greater than 100 polyp is diagnostic and warrants tx

 If pt has been genetically tested for the APC mutation,

tx is warranted at the detection of the first polyp

 Tx: Total colectomy w/ileoanal pull-through

 Familial Adenomatous Polyposis (FAP)
 Familial adenomatous polyposis (FAP). Contrast-enhanced
CT images
Familial Adenomatous Polyposis (FAP)
 Gardner’s syndrome

 Predilection for soft- tissue tumors: lipomas,

osteomas, cysts, fibromas, etc. Gardner’s syndrome
is a variant of Familial Adenomatous Polyposis (FAP)
(

 Osteomas are often seen on the mandible.

 Sx: May present at painless lower GI bleeding, but

is most commonly found incidentally
(osteomas on XR) or because of the multiple
lipomas. Supernumerary teeth (impactions),
epidermal inclusion cyst.
 Gardner’s syndrome

 Dx: Colonoscopy with biopsy

 Tx: Sulindac can induce regression of polyps,

otherwise surgery is an option.

 Colonoscopy every 1-2 years, Manage like FAP

 Gardner’s syndrome
 Note supernumerary teeth in the mandible
Gardner’s syndrome
 Juvenile Polyposis

 Predilection to develop hemartromas (unlike FAP,

which is cancerous adenomas)

 Slightly increased risk for developing colon

cancer, but not much higher than the general
population

 Not often symptomatic, if it does present, it will

most often be a painless lower GI bleed,
particularly in a pediatric pt
 Juvenile Polyposis

 MOST COMMON PEDIATRIC LOWER GI

BLEED!!! (after the age of 1 year)

 Dx will be confirmed when biopsy reveals

hamartoma

 No changes in recommendations for surveillance

Other disorders associated with
colon cancer
 Peutz- Jegher’s syndrome
 Peutz–Jegher’s syndrome is an autosomal
dominant genetic disorder characterized by the
development of benign hamartomatous polyps in
the gastrointestinal tract and hyperpigmented
macules on the lips and oral mucosa (melanosis)
as well as hands and feet.

 Very often presents as a bowel obstruction!

 No tx other than for complications.

 Colon surveillance same as general population.

Peutz- Jegher’s syndrome
Peutz- Jegher’s syndrome
 Turcot’s syndrome

 Turcot syndrome is a condition characterized

by multiple adenomatous colon polyps, an
increased risk of colorectal cancer, and an
increased risk of brain cancer.

 It may be associated with familial

adenomatous polyposis (FAP) or
Lynch syndrome
.
 Cafe-au-lait spots often seen on the pts
 Cafe au lait spot: A flat spot on the
skin that is the color of coffee with milk
(café au lait)