I have been diagnosed with familial polyposis. My biopsy report came back and the polyps were high-grade dysplasia. What does that mean? Do I need to see a surgeon instead of keeping on having colonoscopies?

W.

Familial adenomatous polyposis (FAP) is a genetic disease in which people develop hundreds to thousands of colonic polyps starting in their teenage years. These polyps are of the adenomatous type, which means they have the potential to transform into colon cancer. The sheer numbers of adenomatous polyps in FAP ultimately leads to colon cancer in virtually all patients by the time they have reached their 40s. Thus, the therapy for FAP patients ultimately will involve surgical removal of the colon.

The timing of this operation depends on several factors. Since FAP usually appears in young people, certain lifestyle issues must be considered. It may take a while to accept the idea of having your colon removed. Also, there may not be a large number of polyps present at the time of diagnosis, and a decision may be made to closely monitor the subsequent growth.

Colonoscopy is the method of choice for monitoring the growth and numbers of the polyps in FAP patients. Biopsy or removal of the largest polyps or the most suspicious-looking ones may also be done at colonoscopy. By definition, all adenomatous polyps have elements of dysplasia (abnormal cell growth). Dysplasia is a precursor to cancer and is graded from mild to severe. It is almost certain that a patient with FAP will eventually develop severe dysplasia in a polyp -- indicating the transformation to cancer is very near.

Recently, a drug was approved for the medical treatment of patients with FAP. This drug, celecoxib (Celebrex) is an anti-inflammatory drug that inhibits an enzyme known as cyclooxygenase 2 (COX-2). Colon polyps produce large amounts of COX-2. Studies have shown that celecoxib and other COX-2 inhibitors can slow the growth of polyps and even reduce the number of polyps in patients with FAP. However, it must be stressed that COX-2 inhibitors are not a cure for FAP, or even a substitute for eventual surgical removal of the colon in patents with FAP. You should discuss your biopsy findings and treatment options with your gastroenterologist before deciding what steps to take next.