CA: A Cancer Journal for Clinicians, Vol 9, 15-23, Copyright
© 1959 by American Cancer Society
Adenomatous Polyps of the Rectum and Colon
Curtice Rosser M.D.1 and
Robert A. McGregor M.D.1
1 The Division of Proctology, University of Texas, Southwestern Medical School, Dallas, Texas.
With this review in mind we have formulated what we believe to be a sound and logical approach to the management of adenomatous polyps of the rectum and the colon consistent with our present knowledge of this disease process.
1. All polyps of the rectum and colon should be removed.
2. Adenomatous polyps, including villous papillomas, below the peritoneal reflection may be excised locally by snare or biopsy forceps and electrodesiccated. If invasive carcinoma is found in the base of any polyp, a cancer operation should be performed.
3. For adenomatous polyps above the peritoneal reflection, total exploration with coloscopy should be carried out. Pedunculated adenomas should be excised. If possible, frozen sections of the pedicle should be obtained and, if invasive carcinoma is found, immediate resection should be carried out. The same is true if invasive carcinoma is found in the permanent sections, that is, subsequent resection should be performed.
4. Broad-based, large, suspicious tumors above the peritoneal reflection should be treated primarily as cancer.
5. Segmental resection should be performed for small clusters of adenomas or several adenomas in the same area.
6. Postoperatively all patients should be followed closely for the remainder of their lives with routine proctosigmoidoscopic examinations and radiographic studies of the colon.
