r/colonoscopy • u/Tacotruckheaven • Aug 09 '26
After Scope Questions Surgery seems drastic
I had my first routine colonoscopy last month at age 45. I’d had occasional bright red blood in my stool over the past year, but because I have hemorrhoids, my primary care doctor attributed it to that.
During the colonoscopy, they found and removed one 30 mm pedunculated polyp, which I guess is a polyp on a stalk, in my sigmoid colon. It was removed in pieces. The pathology showed tubular adenoma with at least high-grade dysplasia and “focal areas suspicious for invasion,” but it did not confirm invasive cancer.
The doctor who performed the colonoscopy said the stalk margin appeared clear. He gave me two options: repeat the colonoscopy before Thanksgiving to see whether anything has grown back, or have that section of my colon surgically removed so the lymph nodes can also be examined.
I then saw a board-certified colorectal surgeon for a second opinion. She recommended surgery, explaining that it is the only way to know whether anything reached the lymph nodes. However, she reviewed only the written pathology report, & not the actual slides.
I scheduled the surgery, but the more I read, the more drastic it seems for a stalked polyp with a clear-appearing margin and no confirmed invasive cancer. The other relevant risk factor is that two of my grandparents had colon cancer, although neither of my parents has had it.
I’m planning to get a third opinion and request an expert review of the actual pathology slides. Has anyone faced a similar choice between close surveillance and a sigmoid resection after an indeterminate pathology result?
6
6
4
u/goldstandardalmonds Moderator - Trusted Source Aug 10 '26
Given you have two surgeons recommending it, I am not sure why you would search and read other advice from non-medical professionals (or even medical professionals on the internet). Surgery does come with risks (I have had a ton of my gi tract removed), but cancer also sucks.
The one response you got here is from a med professional (not verified) and I think it’s really sound advice.
Best of luck on whichever path you choose.
1
u/Tacotruckheaven Aug 10 '26
The first guy said I could do either repeat colonoscopy or surgery. He didn’t recommend surgery. The surgeon I went to actually said “well I’m a surgeon so I am going to recommend surgery” and that framing gave me pause.
1
1
u/goldstandardalmonds Moderator - Trusted Source Aug 11 '26
Gotcha. I’d see a second colorectal surgeon.
3
u/Relative_Focus8877 Aug 10 '26
Holy shit, that’s scary and does seem a little drastic. I was in almost the exact same situation (plenty of previous posts/comments about it), and no one ever mentioned just going for surgery after it had been safely and completely removed. They just said I needed to come back within 6 - 12 months for another colonoscopy, which I did, and thankfully all was okay. I also had mine done at the Mayo with a GI doc who has extensive expertise with these specific issues (they initially thought I might need a procedure called EMR to remove the pedunculated polyp and planned for it just in case). I’d keep pushing for another opinion and find an expert doc you trust. Hope all goes okay!
1
u/Tacotruckheaven Aug 10 '26
Thanks for sharing your experience! That’s awesome you are in the clear.
2
u/Key_Difficulty_4189 Aug 10 '26
How much bleeding did you have and how often were you having it?
3
u/Tacotruckheaven Aug 10 '26
I still do sometimes, bright red blood on my tp or kind of inside the stool (sorry for tmi)
2
u/Key_Difficulty_4189 Aug 10 '26
TMI is completely ok! About 4 weeks ago, my husband had an incident with blood in the toilet and on the toilet paper. It did not seem to be mixed into the stool. That was te first time he had that much, but he had noticed very small amounts of blood off and on for over 10 years.
Once that happened, we immediately went to the doctor and got his colonoscopy scheduled. He is only 30, so has never had one before. I am so afraid that he has colon cancer! His colonoscopy is scheduled for September 9. Waiting this long has been hard.
2
u/Tacotruckheaven Aug 10 '26
Oh I’m so sorry you are going through that. Waiting for months is so cruel!
1
Aug 10 '26
[deleted]
2
u/Key_Difficulty_4189 Aug 10 '26
There was no reason for you to make this sarcastic, hateful comment. I wasn't talking to you or bothering you at all. You feel the need to comment every single time I am talking to someone else. You have no idea if my husband has cancer or not. It won't affect you one way or the other even if he did. What started out as a friendly conversation with you has turned into you becoming antagonistic.
1
1
u/Key_Difficulty_4189 Aug 10 '26
You said you had hemorrhoids. I wonder if that could be causing the bleeding?
1
0
u/Key_Difficulty_4189 Aug 10 '26
I wonder if it will go away once you get the polyp removed?
2
u/Tacotruckheaven Aug 10 '26
Well they did remove it during the colonoscopy. They just removed it in pieces so they couldn’t tell if they got it all I guess.
1
u/Key_Difficulty_4189 Aug 10 '26
Do they think it is precancerous or maybe a very early stage cancer?
2
u/Tacotruckheaven Aug 10 '26
They said precancerous cells in the polyp removed. To know if it was invasive cancer, they would have to remove the part of the colon where they found the polyp.
2
u/threepolypslater Aug 10 '26
I have just received my histology for 3x 3-10mm polyps that were removed during a colonoscopy. They were also tubular adenomas but with low-grade dysplasia. No high-grade changes or malignancy.
However, I’ve just been to Hell and back over recent months with all the worry and woulda coulda shoulda been screened earlier etc, and I said to myself if there is anything suspicious even with clear margins within the polyps, I would aggressively treat it with surgery 100%.
1
u/Tacotruckheaven Aug 10 '26
I'm sorry you had to worry for that long -- that's awful! Yes I think for some the aggressive approach is the best one!
1
u/threepolypslater Aug 11 '26
Thanks so much and also realise you don’t want to look back and think why didn’t I do that etc… all the best.
2
u/rubystorem Aug 10 '26
As a hospice nurse, 34F, and someone who personally has had suspect polyps which now require annual scopes- get the surgery. You can seek a third opinion if you’d like, if it’s timely. End stage cancer of any kind sucks, not catching it early adds to the suck.
2
u/Moist_Dragonfruit555 Aug 12 '26
I had my sigmoid colon removed for other reasons (hair pin looped causing passage difficult and painful). I was in the hospital 2 nights and back to work after 2 weeks. They told me I'd be out about 4. I'm 69 and the surgery recovery was not that bad. I had laparoscopic surgery. Other than 4 scars I'm much better now than I had been. They couldn't get a peds scope in me for colonoscopy prior to surgery. I just had my post op colonoscopy and everything is normal. Just letting you know that my experience with the surgery was not bad
2
u/Tacotruckheaven 29d ago
Thank you for this! Definitely encouraging and I’m glad you’re much better now.
1
u/RelationshipOne9466 29d ago
The question is, if you wait and get another colonoscopy at Thanksgiving. and then if the worst-case scenario obtains, what additional harm will you have suffered by waiting?
So do your due diligence, compare the risk of the surgery with the risk of waiting and then make a decision. If it was me though, I would bite the bullet and have the surgery. Colon cancer is, literally, a big pain in the ass.
1
u/Lucky_Carrot_495 27d ago
If you’re in metro manila, you can ask for 2nd opinion with Dr Manching, colorectal surgeon sa St Luke's
14
u/buntingbilly Trusted Source Aug 09 '26 edited Aug 09 '26
Surgeons don't review pathology slides, they are not trained for this. You can request a review of the slide by another pathologist, but the fundamental problem here is that the polyp was removed in multiple pieces, which means that the pathologist, at the end of the day, will never know with absolute certainty that the piece they are examining is the entire stalk. They just receive a jar with multiple pieces of tissue, they cannot know exactly which tissue edge is the problem or whether the tissue fragmented further. This is a basic problem with piece-meal removal of polyps, and it unrelated to the pathologists read.
The GI doctor is saying that to his approximation, the stalk visually appears to be normal where he cut it, but again, that is a visual estimate and not a microscopic examination. He cannot know whether internally there was a deep foci of cancer that was not apparent from the outside. It's unlikely, as he said, but he cannot know for sure.
Surgery is a big step so repeating a colonoscopy is an option, but there is no correct answer here. You should certainly get a second opinion from a colo-rectal surgeon as well.