Gastrointestinal surgery: malignant colonic polyp: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: malignant colonic polyp

Sample item

Colonoscopy finds a pedunculated polyp that is removed completely with a long stalk. Histology shows invasive adenocarcinoma confined to the head and upper stalk, well differentiated, no lymphovascular invasion and a clear margin of several millimetres. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Endoscopic surveillance without resection

A completely removed malignant pedunculated polyp with favourable features (well differentiated, no lymphovascular invasion, clear margin) has a low risk of nodal spread, so polypectomy alone with surveillance is adequate. Poor differentiation, lymphovascular invasion or a positive margin would justify colectomy.

Option by option

  • A. Immediate segmental colectomy

    Colectomy is advised when adverse features are present, which are absent here.

  • B. Adjuvant chemotherapy

    Adjuvant chemotherapy is for node-positive disease.

  • C. Pelvic radiotherapy

    Radiotherapy has no role in a completely excised colonic polyp cancer.

  • D. Endoscopic surveillance without resection (correct)

    Correct. Favourable histology after complete excision needs only surveillance.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Endoscopic surveillance without resection. A completely removed malignant pedunculated polyp with favourable features (well differentiated, no lymphovascular invasion, clear margin) has a low risk of nodal spread, so polypectomy alone with surveillance is adequate.

Why is "Immediate segmental colectomy" not the answer?

Colectomy is advised when adverse features are present, which are absent here.

Why is "Adjuvant chemotherapy" not the answer?

Adjuvant chemotherapy is for node-positive disease.

Why is "Pelvic radiotherapy" not the answer?

Radiotherapy has no role in a completely excised colonic polyp cancer.

What concept does this question test?

It tests Gastrointestinal surgery: malignant colonic polyp in General Surgery. Poor differentiation, lymphovascular invasion or a positive margin would justify colectomy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: malignant colonic polyp?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.