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Your Good Health: Flat polyps are harder to remove

If a biopsy shows any sign of cancer, a follow-up colonoscopy and surgery may be necessary
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Dr. Keith Roach

Dear Dr. Roach: I am a 78-year-old man who recently had a colonoscopy and had several polyps removed, but there was also a “flat polyp” that couldn’t be removed. My doctor said that he usually recommends surgery to remove this, but because of my age, as well as my heart (stents, high blood pressure) and kidney problems (they have been stable for years), he was not sure if surgery was the wise choice.

He recommended that I have another colonoscopy with a different doctor who has had luck removing these flat polyps. I would like your opinion as to the best way to treat this. My options are: do nothing, have the operation, or try the colonoscopy with this other doctor. I once read a column of yours that said other problems could arise with colon surgery.

L.F.

This is a problem I have encountered with my own patients, and there isn’t a right answer for everybody.

Flat polyps are harder to remove, but the gastroenterologist is likely to have taken a biopsy of the flat polyp. Part of what’s important to take into account is the biopsy result of the flat polyp, which tends to show more worrisome pathology results. If the result shows severe dysplasia that is close to becoming cancer, then I tend to favour a more aggressive approach. But if the pathology is less concerning, given your age and medical problems, it may be reasonable to get a follow-up colonoscopy.

I had one of my own patients require surgery for this, as the polyp couldn’t be removed even by an expert, and the pathology showed the polyp to be perilously close to cancer.

So, if the pathology result is worrisome, I recommend another colonoscopy before resorting to surgery, but if it’s not so worrisome, I recommend a follow-up in six to 12 months. Because of your medical issues, it’s best not to rush to surgery.

Dear Dr. Roach: My father died from pneumonia at age 76, his father of pneumonia at age 46. At age 60, I had the original pneumonia vaccine and had an injection site reaction with redness and swelling. I am a healthy 75-year-old man, have had every vaccine and COVID shot required, including some exotic ones for travel, and have never had an issue.

My doctor thinks that because of my reaction to the shot 15 years ago, I should not get the current two-dose shots. Considering my family history, I would like to get the shots.

R.Y.

The only pneumonia vaccine that was available 15 years ago was the PPSV23, called Pneumovax, and I’m almost certain that’s what you had. A reaction of redness and swelling at the injection site is common and, especially given your lack of reaction to the other vaccines, would not be a reason to avoid getting the recommended pneumonia vaccine for you, which is the PVC20 (Prevnar). I don’t think you will get the same reaction with this new vaccine as you did with PPSV23.

Most healthy people should get the PCV20 vaccine if it’s available. Those at a higher risk (those with diabetes or chronic heart and lung disease) should get the PPSV23 as well.

In my practice, I have often recommended PCV20 to those who have only received PPSV23. In my opinion, the benefit outweighs the risk, given your history of a fairly mild vaccine reaction and your family history.

Email questions to ToYourGood Health@med.cornell.edu