This question was answered on Sun 21, Nov 2010 10:09am by Dr.Kokil Mathur

I have been diagnosed at colonoscopy with a colon tumor at the hepatic flexure. It was biopsied and 8 samples taken. The pathology report said

    
Asked by slsama (Male; 61; UNITED STATES; see question; Relevant drugs:none ) on Sun 21, Nov 2010 08:15am
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I have been diagnosed at colonoscopy with a colon tumor at the hepatic flexure. It was biopsied and 8 samples taken. The pathology report said "fragments of villous adenoma". The colonoscopy findings were of a fungating circumferential partially obstructing mass, 3 cm in length, with oozing present. CT scans show no spread. Apparently I have none of the risk factors for this except age. I am 61, never smoked, do not drink alcohol and never used recreational drugs. I am not overweight, and do not take any medications. My father had gastric cancer. I have been told I need surgery and that it should be a right hemicolectomy. This is quite radical compared to just removing the tumor with margins. I get vague reasons about disturbed blood supply to the colon from surgery and getting a proper harvest of lymph nodes "in case" of cancer. I have consulted 3 endoscopic surgeons about having an EMR procedure to remove the tumor, but they referred me back to conventional surgery. So my question is whether or how I should pursue less aggressive surgery in order to preserve the ileocecal valve and the ascending colon where most of the fecal water is reabsorbed. This, of course, is to ensure the absolute best quality of life after surgery. The surgeons play down my concerns but I am not convinced.

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Answer by Dr.Kokil Mathur  on Sun 21, Nov 2010 10:09am:

Hi! I can understand your concern. Villous adenomas are basically polyps of the colon. If the size is less than 1 cm then chances of cancer are almost nil. However if the size is 1 cm or more, then there is 10% chance of developing cancer, this increases slightly if there is a family history of gut cancer, as in your case. Also if adenomas have villous extensions then the risk of cancer increases another further. Hence in your case we are talking of a higher risk of developing cancer in future than in case of simple polyps. In your case I have a feeling that you have many such growths covering a large area of hepatic flexure of colon and this may be appearing as a large tumor. This could be the reason why surgical resection of colon has been advised in your case. Also a large oozing tumor is not a good sign. Though endoscopic laser therapy has been found effective in hepatic flexure growths with or without dysplasia (http://www.ncbi.nlm.nih.gov/pubmed/10202067), you have been to several endoscopic doctors and all are advising conventional surgery and hence I feel that you should accept that as the treatment of choice in your case. Only removing the tumor may not be an option due to position, size, risk of cancer, and villous extensions. Biopsies at times miss the actual cancer portion and if doctors suspect cancer by look of the tumor then a radical surgery is panned. Hope this helps you understand your case to some extent. You can discuss these points with your surgeon. Please feel free to ask anything else you may want to know. Take care!

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Comment by Dr Sanjivani Wanjari on Mon 22, Nov 2010 01:08am:

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