NCCN Guidelines for Patients® | Colon Cancer - page 38

1
About colon cancer
Genetic counseling | Treatment
NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
36
5
Treatment guide
Stag I (T1) colon cancer
5.1 Stage I (T1) colon cancer
Chart 5.1.1
addresses surgical treatment for polyps
with cancer. It shows whether surgery is needed after
a polypectomy for stage I, T1 tumors.
Surgery for T1 tumors is based on whether the cancer
is likely to return. Cancer that is likely to return is
called high risk. High-risk features include:
• Fragmented specimen – the tumor was
removed in pieces,
• Grade 3 or 4 – the cancer cells don’t look like
the normal cells in which the cancer started,
• Positive surgical margins – cancer was found
in the normal-looking tissue around the tumor,
• Unknown surgical margins – the presence of
cancer in the normal-looking tissue around the
tumor can’t be confirmed,
• Angiolymphatic invasion – the cancer has
spread into the lymph vessels or bloodstream.
The option for high-risk T1 tumors is colectomy with
lymphadenectomy. The options for T1 tumors without
high-risk features are based on whether the polyp
is pedunculated or sessile as shown in
Figure 5.1.
A pedunculated polyp has a stalk and round top. A
sessile polyp doesn’t have a stalk.
If you had a pedunculated polyp, it is likely that all
the cancer was removed. No more treatment is
recommended. You can start follow-up testing. If you
had a sessile polyp, two options are listed. Your doctor
will likely advise for follow-up testing if he or she is
sure that all the cancer was removed. If unsure, a
colectomy with lymphadenectomy or follow-up testing
within a short timeframe will likely be recommended.
Chart 5.1.1 Surgical treatment
Test results
Treatment options
• Pendunculated polyp without high-risk features
• Start follow-up testing
• Sessile polyp without high-risk feature
• Start follow-up testing, or
• Colectomy + lymphadenectomy
• Any tumor with high-risk features
• Colectomy + lymphadenectomy
Illustration Copyright © 2014 Nucleus Medical Media, All rights reserved.
Figure 5.1 Shapes of polyps
1...,28,29,30,31,32,33,34,35,36,37 39,40,41,42,43,44,45,46,47,48,...88
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