COLON POLYPS
Colon polyps are important because they may become or maybe already malignant (cancerous). They are also important because based on their size, number, and microscopic anatomy (histology); they can predict which patients are more likely to develop more polyps and colon cancer.
What are colon polyps?
A colon polyp is a small clump of cells that form on the colon's lining (large intestine). Most colon polyps are harmless, but over time some colon polyps can develop into colon cancer. Colon cancer is often fatal when found in its later stages. More than one polyp may be present.
Anyone can develop colon polyps.
Colon polyps often don't cause symptoms. It's important to have regular screening tests, such as colonoscopy, because colon polyps found in the early stages can usually be removed safely and completely. The best prevention for colon cancer is regular screening for polyps.
What are the symptoms of colon polyps?
Most colon polyps do not show any symptoms. Doctors may find them while running routine tests or trying to diagnose another condition. However, when symptoms do occur, they may include:
Bleeding from the rectum blood may show up on underwear or toilet paper after a bowel movement. This can be a sign of colon polyps or cancer, or other conditions, such as hemorrhoids or minor tears in your anus.
Change in bowel habits. Constipation or diarrhea that lasts longer than a week may indicate the presence of a large colon polyp. But many other conditions can also cause changes in bowel habits.
Change in stool color. Blood can show up as red streaks in your stool or make stool appear black. Foods, medications, and supplements may also cause a color change.
Mucus discharge
Pain, nausea, or vomiting (rare). A large colon polyp can partially obstruct your bowel, leading to crampy abdominal pain, nausea, and vomiting.
Iron deficiency anemia. Bleeding from polyps can occur slowly over time, without visible blood in your stool. Chronic bleeding robs your body of the iron needed to produce the substance that allows red blood cells to carry oxygen to your body (hemoglobin). The result is iron-deficiency anemia, which can make you feel tired and short of breath.
When to see a doctor?
See your doctor if you experience:
Abdominal pain
Blood in your stool
A change in your bowel habits that lasts longer than a week
You should be screened regularly for polyps if:
You're age 50 or older.
You have risk factors, such as a family history of colon cancer. Some high-risk individuals should begin regular screening much earlier than age 50.
What causes colon polyps, and who gets them?
The cause of polyps is unknown. Healthy cells grow and divide in an orderly way. Mutations in certain genes can cause cells to continue dividing even when new cells aren't needed. In the colon and rectum, this unregulated growth can cause polyps to form. Polyps can develop anywhere in your large intestine. In general, the larger a polyp, the greater the likelihood of cancer.
What are the risk factors?
Risk factors for polyp include:
Age: They are found in about 15 to 20% of the adult population. In general, they are more common in people over the age of 50, and doctors suggest that patients get tested for colon polyps.
People with a history of polyps or colon cancer may be more likely to develop more polyps. You also have an increased chance of getting polyps if you had ovarian or uterine cancer before 50.
Smoking and drinking alcohol
Not exercising, being overweight
Inflammatory intestinal conditions, such as ulcerative colitis and Crohn's disease.
Family history. You're more likely to develop colon polyps or cancer if you have a parent, sibling, or child with them. If many family members have them, your risk is even greater. In some people, this connection isn't hereditary.
Race. African-Americans are at higher risk of developing colon cancer.
Type 2 diabetes that isn't well-controlled.
Hereditary polyp disorders
Rarely, people inherit genetic mutations that cause colon polyps to form. If you have one of these genetic mutations, you are at a much higher risk of developing colorectal cancer. Screening and early detection can help prevent the development or spread of these cancers.
What are the complications of polyps?
Some colon polyps may become cancerous. The earlier polyps are removed, the less likely it is that they will become malignant.
What happens if you have a colon polyp?
When a colon polyp is found, a doctor will remove it and test it for cancer. Most polyps are removed during a colonoscopy.
How does a doctor find colon polyps?
There are several ways a doctor can find colon polyps. They include:
Colonoscopy
Sigmoidoscopy
Computerized tomography (CT)
Barium enema—Procedure in which barium is inserted into the rectum, and the large intestines are X-rayed.
How are polyps treated?
Your doctor is likely to remove all polyps discovered. The options for removal include:
Removal during screening. Most polyps can be removed with biopsy forceps or a wire loop that snares the polyp.
Minimally invasive surgery. Polyps that are too large or can't be reached safely during screening are usually removed using minimally invasive surgery.
Colon and rectum removal. If you have a rare inherited syndrome, such as FAP, you may need surgery to remove your colon and rectum (total proctocolectomy).
Are there risks to polyp removal?
Polyp removal (or polypectomy) during a colonoscopy is a routine outpatient procedure. Possible but uncommon complications include bleeding from the removal site and perforation (a hole) in the colon, which only occurs in approximately one in 1,000 procedures. Bleeding from the polypectomy site can be immediate or delayed for several days, but persistent bleeding can almost always be stopped by treatment during the procedure. Perforations usually require surgery to repair.
Follow-up care
If you have had an adenomatous polyp or a serrated polyp, you are at an increased risk of colon cancer. The level of risk depends on the size, number, and characteristics of the removed adenomatous polyps.
How can you help prevent colon polyps?
Although the cause of colon polyps is not known, you may be able to reduce the risk of developing polyps if you:
Avoid alcohol and tobacco
Lose any extra weight
Eat more fruits and vegetables
Avoid fatty foods
Eat more calcium (such as milk, cheese, broccoli)
Take a low dose of aspirin every day-this might help prevent polyps
March 17, 2021
HUNG M. DO, MD, Ph.D