Regional Gastrointestinal Consultants

Colorectal Polyps

Colorectal Polyps

Colorectal Polyps

Overview

A colorectal “polyp”, also known as other names: polyps of the colon and rectum, or large bowel, is a small finger-like or flat lump growing from the lining of the colon. There are many types of polyps, some of which are rare. The two most common types are adenomas and hyperplastic polyps.

The most important colorectal polyp is the adenoma, a small benign tumor growing to about 2 cm in size. Colonic adenomas are common, occurring in more than 20% of the population, and in the majority of patients there is no ill effect on health. They are more common with increasing age. There is good evidence that colonic adenomas are the early stage of colorectal cancer, although only a very small percentage of adenomas undergo malignant change and this process is very slow (e.g. five to 15 years). The larger the polyp, the greater the probability that the polyp will have undergone malignant change and contain cancer (adenocarcinoma).

Hyperplastic (or metaplastic) polyps are usually small, pale curved elevations of the colon lining. These are very common. Although hyperplastic polyps themselves do not turn into colorectal cancer, occasionally hyperplastic polyps (those which are large and multiple) will contain adenomas, known as mixed hyperplastic adenomatous polyps. In these polyps, development of cancer may occur but it is very rare.

Symptoms

Most patients with colonic polyps have no symptoms, and often polyps are detected at the time of investigation for unrelated symptoms. Where symptoms occur, these are usually bleeding and sometimes pass mucous (especially large villous adenomas). Colonic polyps usually do not cause abdominal pain, diarrhea, or constipation.

Treatment

Colonoscopy is the preferred technique for diagnosis of colonic polyps because of its accuracy and because the polyp can usually be removed at the time of the procedure. A barium enema X-ray is an alternative, but is not as reliable. Colonoscopy may also fail to detect polyps depending on their size and location, quality of the bowel preparation, and the thoroughness of the colonoscopies.

Excision of colonic adenomas (polypectomy) and subsequent surveillance has been shown to reduce the long-term risk of colorectal cancer. In general, colonic polyps should be excised (cut out) in total rather that biopsied. Polyps are usually excised at colonoscopy by diathermy (heat) using a snare around the polyp base or by using a ‘hot’ biopsy forceps. All or part of the polyp is removed for examination by a pathologist. This allows the type of polyp to be determined and the presence of precancerous or cancerous change to be assessed. The risks of polypectomy should be discussed prior to the procedure.

A technically unsatisfactory colonoscopy, or inability to remove all visible polyps, will require a repeat examination. If there are multiple or large (> 1 cm) adenomas, it is common practice to re-examine the colon after 3 years (provided all adenomas were excised at the initial examination). Thereafter, colonoscopy should be repeated after 5 years. If one small (< 3 mm) colonic adenoma is completely excised at the first examination, and tissue obtained confirming complete excision with no cancer or precancerous change, a repeat colonoscopy at 5 years is usually adequate, although some experts advise a colonoscopy at 3 years if there is also a family history of colorectal cancer. If no further polyps are seen at the time of a satisfactory repeat examination, the colonoscopy may then be repeated in 5 years. There is no need to continue these examinations beyond about age 75 - 80 years. Recommendations about screening intervals vary even amongst experts and the above intervals are guidelines. In patients with hyperplastic polyps there is usually no need to repeat the colonoscopy.

IMPORTANT HEALTH NOTE

We recommend that people experiencing gastrointestinal symptoms do not attempt self-treatment. With many medications being available over the counter, and numerous do-it-yourself online unqualified remedy recommendation, it is natural to consider treating yourself but we highly recommend against this.

If you are experiencing gastrointestinal symptoms you may have a more significant issue than you would expect from the sometimes muted or infrequent symptom you may be experiencing. It is important to keep in mind that is you are having gastrointestinal symptoms or concerns it is best see a doctor to have those symptoms diagnosed and any conditions treated. Also, it is worth noting, that if health conditions do exist, the earlier they are diagnosed and treated, the greater the probability will be to successfully eliminate or manage a present condition, in fact successful outcomes will increase significantly with early detection.

If you have gastrointestinal concerns or are experiencing any gastrointestinal symptoms, please contact us promptly to schedule a consultation with a physician.


DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way, does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a best in class physician regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today at (215) 321-4700 to schedule a consultation.