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Forum Name: Colon and Rectal Cancers

Question: Low grade dysplasia

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 johno - Thu Mar 17, 2005 4:20 pm

I'm 55 years old and was diagnosed with ulcerative colitis 5 years ago. I had my most recent flare in November 2004 and had to go into hospital since the prednisone did not stop the flare. I had my annual colonoscopy 2 weeks ago and the Doctor took a lot of biopsies. The Pathologist found low grade dysplasia in the transverse colon and the Gastroenterologist wants me to have the colon removed.

My first question is, do I have any alternatives to surgery? He wants me to meet with the surgeon as soon as possible and my second question is do I have move this quickly? I will do what I have to do but I feel like this is moving really fast and it concerns me to make this kind of decision that quickly. I am considering a second opinion but I thought I would try this board first.
 Dr. Safaa Mahmoud - Thu Jul 13, 2006 7:12 pm

User avatar Dear johno,

More than 5 percent of patients with ulcerative colitis are at risk to develop colon cancer.

The risk of cancer is directly related to the disease duration and to the anatomical extent of the disease. For example, when the lesions affect the entire colon there is about 32 times increased risk than normal.

The presence of Dysplasia is an additional risk factor for colon cancer and the management in these cases depends on the detailed histological diagnosis as follows:

High grade dysplasia in the colon of patients with ulcerative colitis is an absolute indication for total colectomy.

Low grade dysplasia (LGD ) in a flat lesion in the colon of patients with long lasting ulcerative colitis is a strong indication for colectomy in many studies. Some studies, advised total proctocolectomy to all patients with flat LGD.

These lesions indicate a concurrent or a future colon cancer.

Low grade dysplasia in a mass lesion, that
does not represent a typical sporadic adenoma or
symptomatic stricture, or
is not easy to bypass during endoscopy,
is another indication for surgical consideration.

Indications for colectomy include also, patients who did not respond to maximum medical treatment and those of severe colitis.

You physician who is more aware by your medical history and the details of the results of your investigations, would provide you a better understanding for the reasons of this treatment decision. You can also discuss with the surgeon in more details the medical aspects of your disease before doing the surgery.

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