Colon cancer screening, polyp management (core) | Colon cancer screening should start at 45yo for average-risk patients Patients with increased risk, specifically family history of colorectal cancer or polyps, known genetic syndromes, history of radiation to the abdomen or history of inflammatory bowel disease (IBD) need to start colonoscopies sooner | Colonoscopy is the ideal screening modality Other screening options: Flex sig q5y or q10y with annual FOBT FOBT annually FIT annually Stool DNA test q1-3y CT colonography q5y If any of these are positive, the patient should undergo colonoscopy | Preprocedure bowel prep with polyethylene glycol or magnesium citrate | Screening colonoscopy (core): - Position patient in left lateral decubitus with knees bent up - Sedation with propofol or fentanyl/versed - Inspect anal area for any irregularities and perform digital rectal exam - Insert scope - Use air insufflation or water irrigation, advance scope all the way to the cecum - May require transabdominal pressure or repositioning to advance past difficult areas - Withdraw the endoscope while looking for polyps, remove polyps if encountered should have (minimum 6-min withdrawal time) - Retroflex to view proximal rectal vault prior to scope removal Colonoscopy findings and recommended follow-up: No polyps or small (< 10 mm) hyperplastic polyps → repeat in 10 y 1-2 tubular adenomas <10 mm → repeat in 7-10 y 1-2 sessile serrated polyps (SSP) <10 mm → repeat in 5-10y 3-4 SSP <10 mm or hyperplastic polyps ≥ 10 mm → repeat in 3-5 y 3-10 adenomas, adenoma or serrated polyp ≥10 mm, adenoma with villous features or high-grade dysplasia, SSP with dysplasia, or 5-10 SSP → repeat in 3 y > 10 synchronous adenomas → repeat in 1y, consider genetic testing Piecemeal resection of adenoma ≥20 mm → repeat in 6 mo | Complications: |