What Is a Polyp, and How Should Colorectal Polyps Be Treated?

A polypis tissue growth from a body surface, usually in organ cavities. Polyps occur most often in the colon and rectum, ear canal and cervix.

Large bowel (colon and rectal) cancersbegin when some benign adenomas and polyps become malignant over time. Larger or multiple polyps have greater cancer risk. Through screening methods such as colonoscopy, polyps can be detected early and colorectal cancer incidence reduced.

Colorectal polypsdevelop slowly from the innermost bowel layer, the mucosa, with low cancer risk (< 1%). Nevertheless, they are common and increase with age. They significantly predispose to colorectal cancer and should be removed when detected.

Symptoms and signs of colorectal polyps

The large bowel consists of colon and rectum . The colon is the first, longer section, approximately 1.5 meters; the rectum is the 15 cm section near the anus.

Most colon polyps cause no signs or symptoms. Rectal bleeding is the commonest symptom. Prolonged bleeding can cause iron-deficiency anemia. Other findings, including diarrhea and constipation, generally involve reduced stool thickness (pencil-thin stools).

• Occult blood may be present in stool in a small proportion of patients.
• Rectal polyps may be detected by manual examination.
• Villous adenomas of the rectum and distal colon may cause severe diarrhea with fluid and electrolyte loss.

Polyp Diagnosis

Fecal occult blood test

In colonic polyps with a diameter exceeding 10 millimeters, fecal occult blood testing may be positive in 20-40%. However, this test may also be positive in other conditions causing gastrointestinal bleeding.

Sigmoidoscopy:

It examines the distal bowel through the anus with an endoscope and is ideal for screening rectal and distal colonic polyps. Intensive cleansing the night before is unnecessary; an enema beforehand can suffice. It cannot image the entire large bowel.

Colonoscopy:

Colonoscopyis the best method for detecting polyps, biopsy and/or complete removal. It correctly detects large colonic polyps at rates up to 90%.

Polyp Treatment

Polypectomy:

Pedunculated or sessile polyps may be completely removed during colonoscopy.

Colonic resection:

Familial adenomatous polyposis produces numerous bowel polyps; surgical removal of the entire large bowel is the best option.

Colonic resection is also recommended for high-grade dysplasia or dysplasia-associated lesions in patients with long-standing ulcerative colitis.

Surgical removal of part of the bowel is recommended for large sessile polyps that cannot be removed colonoscopically or have recurred.

Colorectal polyps carry a low cancer risk. Colonoscopy detects them accurately and permits removal. After age 50, everyone should undergo colonoscopy at least 1 time, repeated every 10 years. With family history of polyps or colorectal cancer, screening should begin earlier and follow physician-recommended intervals.