Types of polyps and risk of degeneration
Polyps vary in structure, and this is what determines the danger. Hyperplastic polyps are small and almost never develop into cancer. Adenomatous - tubular, tubulovillous and villous - are classified as precancerous: the larger the polyp and the more villous component it contains, the higher the risk. Jagged formations also require attention. A separate group is hereditary polyposis, in which there are tens or hundreds of polyps, and the risk of cancer is very high without treatment.
- Hyperplastic - minimal risk
- Tubular adenomas - moderate risk
- Villous adenomas - high risk of degeneration
- Jagged formations - require removal
- Inflammatory pseudopolyps in colitis
- Familial adenomatous polyposis and Lynch syndrome
Causes and risk factors
Polyps form when the normal renewal of mucosal cells is disrupted. With age, the likelihood of this increases, so screening for colorectal cancer begins at 45 years of age, and earlier if there is a family history. Excess weight, inactivity, smoking, regular alcohol consumption, the predominance of red and processed meat with a lack of vegetables and whole grains contribute to the formation of polyps. A separate factor is chronic inflammatory bowel diseases.
- Age over 45 years
- Polyps or colon cancer in close relatives
- Hereditary polyposis syndromes
- Overweight and sedentary lifestyle
- Smoking and alcohol
- Diet high in red meat and low in fiber
- Ulcerative colitis and Crohn's disease
Symptoms
Small polyps do not appear in any way - this is their main danger. Large formations can be injured by feces and produce blood or mucus in the stool. A polyp on a long stalk in the lower parts sometimes falls out of the anus when straining. Villous adenomas produce a lot of mucus, which leads to frequent loose stools. If the blood loss is small but constant, the only symptom is iron deficiency anemia with weakness and shortness of breath.
- Most often there are no complaints
- Blood or mucus in the stool
- False urges and foreign body sensation
- Unstable chair
- Prolapse of polyp during defecation
- Anemia due to prolonged occult blood loss
Diagnostics
Examination by a proctologist and digital examination can identify polyps of the lower ampullary region, but endoscopy is needed for a full assessment. Sigmoidoscopy examines the rectum and sigmoid colon, and colonoscopy examines the entire large intestine, which is fundamentally important: polyps are often multiple and located at different levels. Any removed formation must be examined histologically. A stool occult blood test is used as a screening test, but a positive result always requires a colonoscopy.
- Digital rectal examination
- Sigmoidoscopy
- Colonoscopy of the entire colon
- Histological examination of the removed polyp
- Fecal occult blood test as a screening
- Complete blood count to detect anemia
Removal and monitoring
The standard of treatment is endoscopic polypectomy: the polyp is removed with a snare or forceps directly during a colonoscopy, often in the same appointment when it was discovered. Large formations are removed in parts or by mucosal resection. Open surgery is rarely needed - for very large polyps and suspected malignant growth. After removal, histology is required: it determines whether the intervention is sufficient and when to carry out control. The observation interval is usually from one to five years.
- Endoscopic polypectomy during colonoscopy
- Resection of the mucosa for large polyps
- Surgical removal in rare cases
- Histological examination of each polyp
- Control colonoscopy as recommended by a doctor
- More fiber, smoking cessation, weight control