Intestinal polyps

Intestinal polyps are small benign (non-carcinogenic) formations on the inner wall of the colon and rectum (rectum).

They often occur in the elderly. Usually they cause neither symptoms nor metastases.

Anatomical background
The last part of the digestive tract is a long muscular tube called the colon.
The colon forms the largest section of the colon in the left lower abdomen.
The colon is formed from 4 parts: ascending colon (ascending colon), transverse colon (C. transversum), descending colon (C. descendens) and finally the sigmoid colon (C. sigmoideum).
The rectum and anus form the last part of the intestine. The main function of the colon is the absorption of water and mineral salt from the thick darmin content.
The rectum retains the waste products until excretion from the body as feces.


What are the causes of intestinal polyps?

Most polyps are not carcinogenic (malignant). However, like most tumors, polyps are the result of abnormal cell growth.
The healthy cells grow and divide in an orderly manner, a process controlled by two large groups of genes.

Mutations of these genes can lead to further cell proliferation even if no new cells are needed. In the colon and rectum, this unregulated growth can lead to the formation of polyps. After a long time, some of these polyps can become a colon tumor.
Polyps can form anywhere in the colon. They can be large or small, flat (sessil) or mushroom-shaped and connected with a shaft (petiolate).
In general, the larger a polyp is, the higher the risk of cancer.

Classification and typologies of colonic polyps

Adenomatous polyps
The most important type of polyp in the colon is the adenomatous or neoplastic polyp.
The adenomatous polyps begin as a benign mass, but during their development they can become invasive and carcinogenic.
For this reason, great efforts are made to identify, remove and study such polyps, thus preventing carcinogenic modification.
Most adenomatous polyps are petiolate, so they have a foot similar to a tree trunk.
Some polyps are sessile or flat with a velvety appearance. They spread with a thin layer over the intestinal wall. These polyps are called shaggy adenomas.
In general, the larger a polyp, the more likely a malignant or cancerous mutation is.

Hyperplastic polyps Hyperplastic polyps
are very common but tend to be small. These vegetating (growing in the intestine) formations are flat and shiny, but are not neoplastic, nor do they become carcinous.
Therefore, patients with hyperplastic polyps can be calmed down and do not require further controls.

Serrated polyps These are polyps that have the characteristics of hyperplastic polyps
. However, they are potentially malignant and must be removed if they have been detected in a colonoscopy.
They are usually found in the appendix and ascending colon.
They are difficult to detect and you have to be extra careful to identify them.
The removal of these polyps is curative.

Inflammatory polyps or pseudopolyps
Chronic inflammation in the colon, usually due to Crohn’s disease or ulcerative colitis that has existed for years, can cause scarring.
These have the appearance of polyps, but in fact they are caused by the inflammation. Inflammatory polyps are benign and not potentially cancerous.
The removal may be necessary to carry out a check.

Hamartomatous polyps
hamartomas consist of normal tissue. Hamartomatous polyps are benign and tumor-like malformations and usually occur in children. That is why they are often referred to as juvenile polyps.
A special type of hamartomatous polyp is found in Peutz-Jeghers syndrome, often associated with skin patches or hyperpigmentation of the lips.
The polyps in Peutz-Jeghers syndrome can bleed when trying to remove them. They also cause abdominal pain.
Polyps in Peutz-Jeghers syndrome occur in all intestines, not just the colon, and there is a possible risk of cancer. Therapy may be necessary and is usually carried out in a specialized gastroenterological center.

What are the risk factors for colorectal cancer?

Anyone can develop colorectal cancer, but it is much more common in people over the age of 50.

The risk factors for colorectal cancer include:
• familial accumulation of colorectal cancer or polyps
• diet low in fiber and lots of red and processed meats
• inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• obesity • smoking • alcohol abuse

• lack of exercise

What are the symptoms of colon polyps?

Most people with colonic polyps have no symptoms. They often don’t even know about it until a doctor discovers them during a routine check-up or during an examination for other problems.
Other people, on the other hand, have symptoms such as:

• Bleeding from the anus. The anus is the opening at the end of the digestive tract from which the stool exits. You can observe blood on the wash or on the toilet paper after defecation. One should talk to the doctor to clarify whether it is hemorrhoids.
• The polyps cause pain in the abdomen.
• Constipation or diarrhea that lasts for more than a week.
• Blood in the stool. The blood may stain the stool black or appear as red lines on the feces.

Why do polyps enlarge?

A polyp, or rather a certain type of polyp, adenoma, begins as a small protrusion on the surface of the intestine. The genes tell cells to grow faster, but they have to do it in an orderly manner.
Some polyps remain very small for life, while others grow.
Most polyps remain benign for a lifetime, but in about 1 in 10 cases, it turns into cancer.
Scientists believe that all forms of colorectal cancer begin as benign polyps; the removal of benign polyps can prevent the development of cancer.
You can’t predict how quickly they degenerate.

Diagnosis and treatment of intestinal polyps

If the family doctor suspects colon cancer, the physical examination is carried out first.
That means palpating the abdomen to see if there are any protrusions. After that, the rectal examination is performed.
The patient can contact a gastroenterologist or colorectal surgeon for further examination.

The most important examination is colonoscopy. This procedure is performed using a colonoscope, a thin, flexible tube that is inserted into the intestine through the anus and rectum.
The specialist examines the length of the intestine and if any polyps are detectable, he removes them using the colonoscope.

If a suspicious lump is found, a biopsy is made of it. A tissue particle is removed and sent to the pathology department for histological examination.

Alternative examinations are: Sigmoidoscopy:
This is a procedure similar to colonoscopy, but is only suitable for the length of the sigmoid colon, the last section of colon.

Contrast enema: A radiopaque fluid is injected through the rectum before the person is X-rayed.
Tumors are dark areas surrounded by white barium.
However, sometimes a contrast enema may not reveal a tumor, but even if it does, in any case, a colonoscopy is required to perform a biopsy.

To see if the cancer has spread beyond the intestine, the specialist may order blood tests, an X-ray, and a CT or magnetic resonance imaging.
In some cases, if the cancer is small, it can be removed during colonoscopy. However, most cases are treated surgically and under general anesthesia.
If the cancer has spread beyond the intestine, chemotherapy and/or radiation treatment may be indicated.

Treatment of intestinal polyps

When to operate? How are the polyps removed from the colon?
If the diagnosis of a colon polyp is made, the doctor usually recommends its removal, even if there are no symptoms (asymptomatic course). The removal is done to avoid the (low) risk of developing cancer in the future.

Most colon polyps can be removed during colonoscopy (previously described).
The colonoscope is a tube through which the instruments are passed to remove the polyps. These can be selected by the surgeon.
The surgeon can see a polyp during the colonoscopy and perform the resection.
Usually, surgical removal of a polyp is painless. Once removed, the polyp is sent to a laboratory for microscopic examination.
This is done to ensure that it has been completely removed, to determine the type of polyp and to see if it is benign or shows signs of malignant changes.
The duration of the procedure is between 15 minutes and one and a half hours.

If the polyp is difficult to remove or is very large, the surgeon may recommend the removal of an intestinal section by laparoscopy. This is a less invasive technique that allows the removal of a section of the intestine with 3 small incisions (less than 1 cm) in the abdominal wall.

The doctor recommends any checks at regular intervals.
This may depend on factors such as the size of the polyp, age of the patient, subtype of polyp and laboratory report.
After these factors have been taken into account, some patients will need to undergo routine colonoscopy in the future.

There are no medications or natural remedies through which polyps pass, although an acid-reduced diet is the best natural remedy.

After surgery
After surgical polyp removal (polypectomy), the patient remains in the clinic for 24 to 48 hours.
On the first day, he is not allowed to eat any solid food.

Follow-up measures after the removal of the polyps are important because recurrence occurs in about 30-35% of patients.

Can colonic polyps be prevented?
There is currently no conclusive evidence that a change in diet or supplements can prevent the formation of colonic polyps.
Drug treatments have been shown to be ineffective and are usually not recommended.

What is the prognosis (expectation) in patients with intestinal polyps?

Patients with polyps that can be completely removed can be reassured, because the prognosis is excellent.
Rarely, the polyps can not be removed endoscopically and require surgical intervention.
If the operation is successful and there is no cancerous change, the prognosis is also very good.

The most important aspect for the prognosis is constant monitoring and control by means of colonoscopy in order to detect a new formation of colonic polyps in time in the further life of the patient.

It is impossible to know how quickly they degenerate, but the doctor usually recommends a control colonoscopy after a few years, especially if the polyp was very small.

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