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Colon cancer surveillance after adenomas — ABIM Board MCQ

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HardHematology/OncologyColon cancer surveillance after adenomasABIM Board

A 59-year-old man undergoes high-quality colonoscopy with piecemeal endoscopic mucosal resection of a 30-mm tubular adenoma. Pathology shows no high-grade dysplasia, and the endoscopist believes all visible tissue was removed. When should the first surveillance colonoscopy occur?

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Correct answer: B — Schedule the first surveillance colonoscopy approximately six months after resection

The best answer is “Schedule the first surveillance colonoscopy approximately six months after resection”. Piecemeal resection of a lesion larger than 20 mm carries a meaningful residual and recurrence risk independent of high-grade dysplasia. The recommended first surveillance examination is approximately six months, followed by additional staged surveillance. The endoscopist’s impression of complete visible removal does not justify a standard low-risk interval.

Reference: US Multi-Society Task Force: Follow-up After Colonoscopy and Polypectomy: https://pmc.ncbi.nlm.nih.gov/articles/PMC7672705/