Colon, colorectal or intestinal polyps are small growths that are enclosed within the intestinal mucosa and attached to the surface of the intestine. Colon polyps are mostly benign, however they can become malignant. Polyps that are larger than one centimeter are more likely to develop cancer. Polyp appearance is diversified and may be clinically significant.
Polyps are classified according to morphology in two categories: pedunculated (polyps with a stalk) and sessile (polyps without a stalk). In another classification system, colon polyps are divided in three groups: adenomas, polyposis syndromes, and hyperplastic polyps. Polyposis syndromes are rare, inherited conditions associated with a high risk of colorectal cancer.
Hyperplastic polyps are often benign; however, recent studies show that it can become malignant in cases of hyperplastic polyposis syndrome. Adenomas are more likely to become malignant, therefore posing a higher risk of developing cancer. A particular subtype called villous adenoma has a tendency to be larger and is related with the highest morbidity and mortality rate. Villous adenomas are often found in the rectal area and their morphology resembles a cauliflower.
Colon polyps are more common in males than females and are associated with increasing age from 50 years old and above. Black individuals are at a higher risk of developing cancer-related polyps than whites. In the United States, around 30 percent of the elderly people develop colonic polyps.
The causes or factors associated with the development of colon polyps vary amongst different types or classes. Conditions such as hyperplastic polyposis, cowden disease, turcot syndrome, gardner syndrome, familial juvenile polyposis, familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome have a very strong hereditary component. In general, family history of colon cancer or polyps is a factor associated with development of colon polyps. Other factors include: age, cigarette smoking and alcohol consumption.
Colon polyps are usually asymptomatic and are discovered during routine diagnostic testing. The following symptoms may occur:
Initially, the doctor will evaluate the patient's medical records which includes any history of present illnesses and family history, and is then followed by a physical examination. Digital rectal examination is performed to search for distal rectal polyps. This exam is done by inserting a gloved finger in the anus. The doctor may use guaiac and antibody-based tests to check for presence of occult blood in stools.
Most of the time, a rectal examination hardly detects a polyp which often results in apparent normal findings in the physical examination. Therefore, the doctor may ask for further testing to detect the presence of polyps. These tests include: CT colonography, virtual colonoscopy, sigmoidoscopy, barium enema, and colonoscopy.
Since colon polyps can become malignant and may develop into cancer, the polyps must be removed. The polyps can be removed during colonoscopy or sigmoidoscopy. In some cases when the polyps are becoming highly cancerous, the doctor may propose the removal of a part of the colon called colectomy. Within three to five years a follow-up colonoscopy or sigmoidoscopy must be performed to check if the polyps have come back.
Healthy eating and lifestyle, without cigarette smoking or heavy drinking can have a positive impact in reducing the risk of development or recurrence of colon polyps.
The prognosis for patients with colon polyps is excellent, because there are different diagnostic tests available to detect the presence of polyps and the polyps can be removed to prevent development of cancer.
Prevention is very important especially to people with a family history of colon cancer or colon polyps. According to recommendations of the American Cancer Society, colonoscopy screening should start at least by the age of 50 years old. Avoid smoking and excessive alcohol intake, eat a healthy diet that is low in fat and high in fruits, vegetables and fiber, and maintain a healthy and normal body weight.
In some cases, living with colon polyps can be overwhelming since it has the tendency to develop into cancer. It is important to be informed and to talk with other people about the condition. In order to manage colon polyps, prevent their development or recurrence, it is essential to seek medical help and advice. A doctor will inform and direct you to the most adequate treatment and lifestyle changes.
One of the current colon polyps research goals is to better characterize the condition at the molecular level by identifying and characterizing the mechanisms of the disease. There are also several developments in the diagnostic techniques for colon polyps that may have a great impact on the general outcome of the condition given the importance of early diagnosis for favorable prognosis.