Introduction to adenomatous polyps

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An adenomatous polyp, also known as an adenoma, is a neoplastic growth ( abnormal growth) that can form in the lining of the colon . These neoplasms are quite common, accounting for about 70% of all colon polyps . About one-third to one-half of all people will develop one or more adenomatous polyps in their lifetime. Most of these growths are benign (benign) and do not cause symptoms. There are many causes of colon polyps, including genetics, age, ethnicity, and smoking.

Because most colon adenomas are asymptomatic, they can only be diagnosed during a colonoscopy (colon cancer screening test). Once a polyp (or polyps) is found, it may or may not be treated with a procedure called a polypectomy , depending on factors such as the size of the growth and its location. Only about 5% or less of adenomas progress to cancer in a period of 7 to 10 years.

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Symptoms

Adenomatous polyps do not cause symptoms unless they progress to colon cancer . Still, there may not be any signs of a problem until cancer develops. This is why colon cancer screening is so important.

  • Abdominal pain : Most polyps do not cause pain until they are large enough to cause a blockage in the colon.
  • Anemia – A bleeding polyp, even if it only causes a small amount of blood loss that is not visible in the stool, can lead to anemia.
  • Stool Discoloration – Stool comes in a variety of colors and can vary based on diet or supplements. Blood in the stool can make it dark or black. Discoloration of stool that cannot be related to food or medication should be evaluated by a doctor. Black tarry stools may contain blood and should be considered by a doctor.
  • Constipation or diarrhea : Most people experience constipation or diarrhea from time to time. However, if these symptoms last for more than a few days, they may be due to a more serious cause. A large polyp can block the inside of the colon and cause constipation or diarrhea.
  • Rectal bleeding : Polyps can be a source of rectal bleeding. Blood that appears in stool / feces, on toilet paper, or alone in a toilet without a chair can appear for a number of reasons. A common cause of blood in the stool is hemorrhoids , but this should always be investigated by a doctor, as there are more serious causes.

Bleeding from the rectum without pain is a common symptom of a polyp.

Causes

Adenomatous polyps can form anywhere in the colon. There is currently no known way to prevent the complete overgrowth of polyps, although some of the known risk factors can be changed and avoided.

Genetic mutations may be responsible for the formation of some polyps because these mutations cause cells to divide in an unregulated manner. This type of cell division can cause polyps to keep growing.

While there is no way to determine the specific cause of polyps, there are several things that can increase your risk of developing polyps and colorectal cancer:

  • Age : Polyps are more common in older people, especially those over the age of 50.
  • Inflammation : Diseases of the digestive system that cause inflammation, such as inflammatory bowel disease ( Crohn 's disease and ulcerative colitis ), can contribute to the formation of polyps.
  • Drinking alcohol : Drinking alcoholic beverages can increase your risk of colon cancer.
  • Race and Ethnicity : African Americans and people of Eastern European Jewish descent may be at increased risk for colon cancer.
  • Family history : Having a close relative who has developed colon polyps or colon cancer is a risk factor for developing polyps.
  • Personal history : The presence of adenomatous polyps in the past exposes a person to an increased risk of new polyps.
  • Smoking : Smoking cigarettes can increase your risk of developing polyps.
  • Type 2 diabetes : The risk of developing colon polyps may be increased in people who are diagnosed with type 2 diabetes and have poor control of the disease.

Diagnostics

Polyps are found during various colorectal cancer screenings. It is important for people to get regular colorectal cancer screenings as recommended by a doctor.

Updated Guidelines for Colon Cancer Screening

The US government and professional body screening guidelines were updated in 2021 to begin screening earlier, at age 45, for all moderate-risk adults, and even younger for those with risk factors. risk. This change was based on an increase in the incidence of colon cancer among adults under 50 years of age and on the understanding that early detection of the disease is essential for effective treatment.

When polyps are found during the exam, they can be removed, preventing them from growing and becoming cancerous.

Colonoscopy

A colonoscopy uses a long tube with a lamp and camera on the end to look inside the colon and look for abnormalities such as polyps. Patients prepare in advance for a colonoscopy using strong laxatives to remove all stool from the colon and are sedated during the test.

The advantage of this test is that if a polyp is found, the tissue can be removed and sent for analysis. During a colonoscopy, biopsies are also taken, which can be analyzed to see if there are important characteristics of the cells in the colon.

Sigmoidoscopy

Flexible sigmoidoscopy is done by inserting a tube with a lumen and camera on the end into the rectum and examining the last section of the colon, which is the sigmoid colon.

The limitation of this test is that only the sigmoid portion can be seen, which means that the doctor will not visualize the rest of the colon. Polyps lower in the colon cannot be seen or removed.

This test can be performed with or without preparation and with or without sedation.

Stool tests

The stool test will be used to look in the stool for signs of colon polyps and / or cancer. One of those tests, a fecal occult blood test, looks for blood in the stool that cannot be seen with the naked eye (called occult blood), which may come from a bleeding polyp. The stool DNA test, also known as FIT (stool immunochemical test) -DNA, is a test that analyzes stool for genetic material from a colon cancer or polyp.

Virtual colonoscopy

Virtual colonoscopy , also sometimes called CT colonography, is done using images of the colon. This test is less invasive than a regular colonoscopy, but colon prep is necessary to remove stool from the intestine.

A thin tube of about 2 inches is inserted into the rectum and a series of images are taken with a CT (large donut-shaped imaging machine) scanner.

Watch out

If an adenomatous polyp is found, it will most likely be removed to prevent it from growing and increasing the risk of cancer. If a polyp is found during a colonoscopy, it can be removed during this test. The removal of a polyp is called a polypectomy.

Some polyps are more difficult to remove, especially if they are larger or flat, are located behind a flap or fold, or have other features that make it difficult to remove during colonoscopy.

Polypectomy

Most polyps are removed with a polypectomy. Special instruments are used in the colonoscope during the colonoscopy to remove polyps, including a wire loop. The trap can be used to grab the polyp at the base and remove it.

This can sometimes lead to bleeding, but it is painless, and in most cases, the bleeding will go away. Serious complications after polypectomy are rare. Your doctor will tell you what to expect after a polypectomy and what symptoms require further monitoring.

Laparoscopic surgery

If the polyp is too large to remove during colonoscopy, laparoscopic surgery may be required to access it. It is also sometimes called "minimally invasive" surgery.

During laparoscopic surgery, small incisions are made in the abdomen (compared to large incisions in traditional surgery) to access the area where the polyp is located. Because the incisions are small, scars are minimized and patients recover faster than with open surgery.

Once the polyp is removed, the tissue will be sent to a pathologist for examination. The pathologist will examine the tissue under a microscope. This is an important part of the process because if the polyp tissue is cancerous, other treatments or additional tests may be required.

Follow up

Once the adenomatous polyp is found and removed, the next step is to discuss further follow-up with your doctor. Adenomatous polyps are a risk factor for cancer. The level of risk will depend on several factors, including the number of polyps, their size, their characteristics, and the information in the pathology report.

In most cases, follow-up after removal of the adenomatous polyp will include recommendations for detection after a specified period. Your doctor will determine the interval based on recommendations and other factors, such as individual cancer risk.

An approximate follow-up screening schedule after the detection of one or more adenomatous polyps may be as follows:

  • One or two small polyps : recolonoscopy in 5-10 years.
  • More than two small polyps or large polyps : repeat colonoscopy after three years
  • More than 10 polyps : repeat colonoscopy after three years
  • Large polyps that are difficult to remove : repeat colonoscopy after six months
  • Incomplete colonoscopy due to poor preparation or other reasons : the doctor will make an individual recommendation

Get the word of drug information

There is little you can do to prevent the formation and growth of polyps. Some risk factors, such as age, cannot be changed, but a healthy lifestyle can help reduce the risk of colon cancer .

Colonoscopy is considered the gold standard for colon cancer detection because not only can the entire colon be visualized, but polyps can be removed if found. Removing a polyp means that it cannot continue to grow and become cancerous. Adenomatous polyps are believed to be precursors to colon cancer, so although they grow slowly, it is important to find and remove them.

Follow-up after these types of polyps are found is also important for early detection and removal of any new polyp that may arise. Colonoscopy with removal of polyps is well tolerated by most people and has no complications .

Talk to your doctor if you have any concerns about your risk for polyps or colorectal cancer, or if you have questions about when and how often to get tested. Blood in the stool is never normal and is always a reason to see a doctor.

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