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Colon Polyps

Definition


Disease: Colon Polyps Colon Polyps
Category: Digestive diseases
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Disease Definition:

A colon polyp is a small clump of cells that forms on the lining of the colon. Although most colon polyps are harmless, some become cancerous over time. Anyone could develop colon polyps, but the risk is higher when a person is 50 or older, is overweight or a smoker, eats a high-fat, low-fiber diet, or has a personal or family history of colon cancer or colon polyps.
Colon polyps do not usually cause symptoms, this is why experts recommend screening on regular basis. Colon polyps that are found in the early stages could often be removed safely and completely. Screening helps stopping colon cancer from occurring, a common disease that’s usually fatal when it is discovered in later stages.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

A person might not realize they have colon polyps until their doctor discovers it throughout an examination of their bowel. Colon polyps range from smaller than a pea to golf ball sized. Small polyps aren’t likely to result in problems. Yet sometimes, they might have signs and symptoms like:

 

  • Blood in your stool. Blood can appear as red streaks in the stool or make bowel movements look black. However, a change in color doesn’t always indicate a problem, iron supplements and some anti-diarrhea drugs could make stools black, whereas beets and red licorice could turn stools red.

 

  • Rectal bleeding. A bright red blood on toilet paper might be noticed right after the affected person had a bowel movement. This, however,  might be a sign of colon polyps or colon cancer, rectal bleeding could show other conditions, like hemorrhoids or minor tears (fissures) in the anus. The patient should discuss any rectal bleeding with the doctor.

 

  • Pain or obstruction. Occasionally, an extended colon polyp might partially obstruct their bowel, contributing to crampy abdominal pain, vomiting, nausea and severe constipation.

 

  • Constipation, diarrhea or narrowing of the stool. Though a change in bowel habits that lingers longer than a week might mean the presence of an extended colon polyp, it could also result from a number of other conditions.


A doctor should be consulted when someone is having the following symptoms:

 

  • Blood in the stool
  • Abdominal pain
  • A change in the bowel habits that lingers longer than a week

 

A person should be screened on regular basis for polyps if:

  • They age 50 or older
  • They have risk factors, like a family history of colon cancer. Sometimes, people who have an increased risk should start screening on regular basis much earlier than age 50

Causes:

The digestive tract stretches from the mouth to the anus. As food travels along this 30-feet (9-meters) passageway, nutrients are broken down into a form that could be absorbed by the body and used to build cells and produce energy. The last part of the digestive tract is a long muscular tube known as the large intestine. The colon is the upper 4 to 6 feet (1 to 2 meters) of the large intestine; the rectum makes up the lower 8 to 10 inches (20 to 25 centimeters). The colon’s primal function is absorbing water, salt and other minerals from colon contents. The rectum stores waste until it is ruled out from the body.


Why polyps form

Most of the polyps aren’t cancerous (malignant). However, like most cancers, polyps are the outcome of abnormal cell development. Healthy cells grow and divide in an orderly way, a procedure that’s managed by two broad groups of genes. Mutations in any of these genes could result in cells to keep on dividing even when new cells aren’t required. This unregulated development, in the colon and rectum could result in polyps. Some of these polyps might become malignant through a long period of time.


Polyps could grow anywhere in the large intestine. They could be small or large and flat (sessile) or mushroom shaped and attached to a stalk (pedunculated). Flat or large polyps are much more likely to become malignant than small and mushroom-shaped ones. Generally, the larger a polyp, the more the likelihood of cancer.


There are three primal types of colon polyps:

 

  • Adenomatous. Nearly all malignant polyps are adenomatous. About two-thirds of all polyps fall under this category. Even though only a small percentage of these polyps in fact become cancerous.

 

  • Hyperplastic. Most persistent polyps are hyperplastic. These polyps take place most frequently in left (descending) colon and rectum. Often less than 0.5 centimeters (5 millimeters) in size, they’re very rarely malignant.

 

  • Inflammatory. These polyps might follow a bout of ulcerative colitis or Crohn’s disease of the colon. Even though the polyps themselves are not a significant threat, having ulcerative colitis or Crohn’s disease of the colon raises the overall risk of colon cancer.


A number of factors might lead to the formation of colon cancer and polyps. They include:

 

  • Age. Most of the people suffering from colon cancer are 50 of age or older. Their risk generally begins rising around age 40.
  • Family history. A person’s more likely to develop colon polyps or cancer when they have a parent, sibling or child with them. If several family members have them, they’re at a higher risk. Sometimes, this connection isn’t hereditary or genetic. For instance, cancers within the same family might come out from shared exposure to a cancer-causing substance (carcinogen) in the environment or from similar diet or lifestyle factors.
  • Inflammatory intestinal conditions.  Long-standing inflammatory diseases of the colon, like ulcerative colitis and Crohn’s disease, could raise the individual’s risk.
  • A sedentary lifestyle. When a person’s inactive, they’re more likely to grow colon cancer. Because when they’re inactive, waste persists in their colon longer.
  • Smoking and alcohol. Smoking significantly raises the risk of colon polyps and cancer. Smokers are 20 % more likely to develop colon cancer than are nonsmokers. Additionally, excessive drinking of alcohol, specifically beer, raises the likelihood of developing colon polyps. If a person smokes and drinks, the risk increases even more.
  • Race. Black or Ashkenazi Jew of Eastern European descents are at an increased risk of developing colon cancer.
  • Weight. An obese person is at a higher risk of several forms of cancer, including colon cancer.

 

Inherited gene mutations

Genetic mutation is another risk factor for colon polyps. A small percentage of colon cancers results from gene mutations. Some of these cancers are autosomal dominant, meaning they require inheriting only one defective gene from either one of their parents. A person might have a 50 % chance of inheriting the mutation, in case one of their parents has the mutated gene. Not everyone with a mutated gene develops caner, although inheriting a defective gene greatly increases their risk.

  • Familial adenomatous polyposis (FAP). This is a rare hereditary disorder that results in developing hundreds, even thousands, of polyps in the lining of the colon starting throughout their teenage years. If these remain untreated, a person’s risk of growing colon cancer is nearly 100 %, often before age 40. The encouraging news about FAP is that in some cases, genetic testing could help determine whether they’re at risk of the disease or not. Additionally, people suffering from FAP are at risk of cancers of the small intestine, specifically in the duodenum.

 

  • Gardner's syndrome. A variant of FAP that is a less common syndrome. This condition results in polyps to grow througtout a person’s colon and small intestine. In addition, they might grow noncancerous tumors in other portions of the body, including the skin (sebaceous cysts and lipomas), bone (osteomas) and abdomen (desmoids).

 

  • MYH-associated polyposis (MAP). This inherited disease is similar to FAP. People suffering from MAP usually grow multiple adenomatous polyps and colon cancer at a young age, like in their 20s. This is a newly found disease and there’s more that needs to be learned about it. Genetic testing could help determine whether they’re at risk of MAP that results from mutations in the MYH gene.

 

  • Lynch syndrome. Also called hereditary nonpolyposis colorectal cancer (HNPCC) is the most common type of inherited colon cancer. People suffering from lynch syndrome seem to grow relatively few colon polyps, but those polyps could rapidly become malignant. Or, people suffering from lynch syndrome might have tumors in other organs, including the breast, small intestine, stomach, urinary tract, ovary in addition to the colon.

 

  • Peutz-Jeghers syndrome (PJS). This genetic condition often starts with freckles growing all over the body, including the lips, feet and gums. Then benign polyps grow throughout the intestines. These polyps might become malignant, so people suffering from this condition have a higher risk of colon cancer.

Complications

Complications:

Some polyps might become cancerous (malignant), meaning a person could grow colon cancer. The earlier polyps are removed, the less likely it is that they will become malignant.

Treatments:

Even though some forms of colon polyps are far more likely to become malignant than are others, a pathologist often must examine polyp tissue under a microscope to determine whether it is potentially cancerous. That is why the doctor is likely to remove all polyps discovered throughout a bowel examination.


Snare

Most of polyps can be removed during colonoscopy or sigmoidoscopy by snaring them with a wire loop that simultaneously cuts the stalk of the polyp and cauterizes it to prevent bleeding. Some small polyps might be cauterized or burned with an electrical current. Risks of polyp removal (polypectomy) include bleeding and perforation of the colon.


Surgery

Extended polyps that can’t be reached safely or snared are often surgically removed, usually using laparoscopic methods. That is the surgeon performs the procedure through several small incisions in the abdominal wall, using instruments with attached cameras that display the colon on a video monitor. Laparoscopic surgery might cause a faster and less painful recovery than does traditional surgery using a single large incision. Once the part of a patient’s colon containing the polyp is removed, the polyp can’t reoccur, but there’s a moderate chance of developing new polyps in other areas of the colon in the future. Which is why follow-up care is extremely essential.


Endoscopic mucosal resection

Endoscopic mucosal resection (EMR) is performed in some specialized medical centers to remove extended polyps with a colonoscope. For this newer method a liquid, like saline, is injected under the polyp to elevate and isolate the polyp from surrounding tissue, which makes it easier to remove a larger polyp. With this operation, patients can avoid surgery, but complication rates might be higher.


Colon and rectum removal

In cases of rare, inherited syndromes, like familial adenomatous polyposis (FAP), the surgeon might perform a procedure to remove the whole colon and rectum (total proctocolectomy). Later on, in an operation known as ileal pouch-anal anastomosis, a pouch is constructed from the end of the small intestine (ileum) attaching directly to the anus. This permits the affected person to expel waste naturally, even though they might have many watery bowel movements a day.
 

Prognosis:

Not Available

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