In a study published by Dr. David Blumberg, a colon cancer surgeon at the University of Pittsburgh Medical Center.
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Pittsburgh, PA, 10th August, 2009 In a study published by Dr. David Blumberg, a colon cancer surgeon at the University of Pittsburgh Medical Center.
A high percentage of patients undergoing laparoscopic colectomy for presumed benign colon polyps were found to have a colon cancer within the polyp. Dr. Blumberg says this has important implications for colon cancer treatment.
Colon polyps are benign precursors of colon cancer. Most colon polyps are detected by colonoscopy which is recommended in all people by the age of 50 and at age 40 in patients with a family history of colon polyps or colon cancer. The majority of polyps found at colonoscopy can be successfully removed during a colonoscopy. Although many people dread having a colonoscopy, colonoscopy has been shown to save lives by reducing the incidence of colorectal cancer. The procedure is safe and is performed under sedation and usually only takes 15-30 minutes time.
Patients with colon polyps that are too large to be removed via colonoscopy are referred for surgery. In the past, surgeons treating colon polyps performed limited operations only removing a small portion of the colon containing the polyp and not worrying about removing the adjacent lymph nodes. The adjacent lymph nodes are around the colon and are routinely removed in colon cancer because this is how colon cancer spreads. New data indicates that many patients with presumed benign colon polyps undergoing colon resection (colon polyp surgery) actually have a cancer hidden in the polyp. Unfortunately there is no test that can tell 100% whether a colon polyp is benign or has a cancer until the polyp is completely removed at colon resection surgery.
In a study published by Dr. David Blumberg at the University of Pittsburgh Medical Center, 14% of patients undergoing laparoscopic colon surgery for presumed colon polyps had a colon cancer when the pathologist examined the entire colon polyp removed by the surgeon. For this reason, Dr. Blumberg advocates that all patients undergoing colon removal surgery should undergo a complete colorectal cancer surgery operation which means removing all of the potential cancer bearing lymph nodes around the site of the colon polyp. This study was published this June in the journal Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. “We need to ensure that a cancer operation is performed in all patients with colon polyps which mean removing all of the lymph nodes also to ensure that no occult cancer is left behind”.
In the past, patients with colon polyps were also thought to be good initial cases for surgeons gaining laparoscopic colon resection surgery experience prior to doing laparoscopic colon cancer resection surgery. Dr. Blumberg cautions that patients with colon polyps are not the best candidates for laparoscopic colon surgery by novice laparoscopic colon surgeon. Dr. Blumberg recommends that patients with colon polyps should be referred to surgeons that have a high level of expertise in laparoscopic colorectal cancer surgery (laparoscopic hemicolectomy). Dr. Blumberg further found that patients with pre-cancer on biopsy before surgery and polyps on the left side of the colon had the highest risk of having an occult colon cancer (43%). In choosing a surgeon for laparoscopic colectomy, Dr. Blumberg advocates that patients with colon polyps ask their surgeon how many laparoscopic colon operations the surgeon has performed and how many colon cancer operations have been performed laparoscopically. “Make sure to choose an experienced laparoscopic colon surgeon, check out the surgeon’s credentials and find out if the surgeon has published any peer-reviewed papers in the field or keeps an internal audit of his own experience”. The American Society of Colon and Rectal Surgeons advocates that a surgeon performing laparoscopic colon surgery have performed a minimum of 20 laparoscopic colon operations before operating on patients with potentially colon cancer.
The bottom line: Make sure your surgeon does a complete cancer operation even when you have a seemingly benign colon polyp. Clearly it would be a nightmare to be told a week after surgery that your polyp is actually a colon cancer and the surgeon potentially left cancer behind by not removing all of the lymph nodes.
About Dr. David Blumberg:
Dr. Blumberg is a colorectal surgeon who has practiced at the University of Pittsburgh Medical Center and its affiliate Hillman Cancer Center for the past ten years. He is board certified in colon and rectal surgery and also received specialty training in colon cancer surgery at the world renowned Memorial Sloan-Kettering Cancer Center in New York. Dr. Blumberg is recognized as a national expert in the area of colon and rectal cancer and laparoscopic colon surgery. He has written over 40 articles and has lectured at multiple national meetings. His pioneering work in laparoscopic colon surgery was initially brought to media attention with television interviews in 2004. He has been acclaimed by his peers as one of Pittsburgh’s Top Doctors in 2007 and 2008.