Sunday, March 9, 2008
Back in town
Back from a much needed vacation. I get a little strung out this time of year, seasonal affective disorder I suppose. Wife and I went to the Island of Kauai (part of the Hawaiian Islands) for a week. An absolutely breathtaking trip. We hiked part of the Kalalau Trail along the Na Pali coast and were both just awestruck. I definitely recommend it. Of course, the karma gods evened things out by dumping two feet of snow on Cleveland over the weekend; always nice to spend three hours shoveling just to get your car back in the garage.
On another note, I noticed an interesting study discussing the significance of "flat lesions" with regards to colorectal cancer. These are lesions that are, well, flat, as opposed to the pedunculated appearance of colorectal polyps. The study's main finding was that flat lesions are 10 times more likely to harbor malignancy compared to polypoid lesions, irrespective of size. What's worrisome is that these lesions are very difficult to identify on routine screening colonoscopy or even virtual colonoscopy. Moreover, even if identified, removing them endoscopically with adequate clean margins can be challenging. What is the long term significance? Hard to say until better data comes back. The days of GI specialists and surgeons lining up 8-10 quickie scopes for a day may be over; the time necessary to slowly pore over the entire mucosal surface looking for these suckers may preclude such behavior. I like the idea of having these lesions biopsied and tattoed and proceeding with laparoscopic resections if any dysplasia seen on path. We will see.....