ASCO GUIDELINES Bundle

Colorectal Cancer Early Detection

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Table 5. People With Positive Pre-Malignant Polyps or Other Abnormal Screening Results Basic/ Limited Enhanced Maximal Pedunculated 3.1 Colonoscopy N/A Colonoscopy should be performed always with therapeutic intent. (Strong Recommendation; Ins); Performed by endoscopist with training in polypectomy. (Strong Recommendation; L) 3.2 Polypectomy (Strong Recommendation; I) Refer to guidelines for special considerations including anti coagulants and coronary stents N/A Lesions should be removed with polypectomy. 3.3 Evaluation of morpholog y (Strong Recommendation; Ins) N/A Large pre-malignant lesions not suitable for endoscopic resection should be referred for surgical resection. 3.4 Mucosal tattooing (Weak Recommendation; Ins) N/A If lesion cannot be removed (in BSG guidelines); if large lesion has a high likelihood of malignancy (informal consensus) may be performed. 3.5 Histolog y/ patholog y (Strong Recommendation; Ins) N/A Removed lesions should be retrieved for histologic exam; confirm negative borders of resection. 3.6 Referral to surgery (Strong Recommendation; Ins) N/A Only patients with lesions that cannot be removed endoscopically should be referred to surgery. Non-Pedunculated 3.7 Colonoscopy N/A Yes always with therapeutic intent; endoscopic resection first line therapy for LNPCP with no suspicion of malignancy. (Intent: Strong Recommendation; Ins; Resection: Strong Recommendation; I) Should be performed by endoscopists with training in large complex polyps. (Weak Recommendation; L) Multidisciplinary team may perform colonoscopies. (Weak Recommendation; Ins) 3.8 Polypectomy (Strong Recommendation; I) Refer to guidelines for special considerations including anti- coagulants and coronary stents N/A Lesions should be removed with polypectomy; removal of lesions is dependent on the low likelihood of malignancy. (Strong Recommendation; I) Possibility of complete resection, refer to BSG/ACGB guidelines. (Strong Recommendation; L)

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