Polyps of the Gastrointestinal Tract

Overview

A gastrointestinal tract polyp (Colorectal polyp) is a fleshy growth that develops on the colon or rectum lining. Colorectal polyps that go untreated can turn into colorectal cancer.

Colorectal polyps are frequently categorized according to their behavior (i.e. benign vs. malignant) or etiology (e.g. as a consequence of inflammatory bowel disease). They might be benign (such as a hyperplastic polyp), pre-malignant (such as a tubular adenoma), or malignant (such as colorectal adenocarcinoma).

Polyps seldom cause symptoms. Symptoms that may be present include: blood in the feces, changes in bowel habits and fatigue as a result of blood loss over time.

Polyps are frequent in adults over 40, and they normally develop slowly. Polyps have the potential to grow into colon cancer, which is why they are routinely removed during a colonoscopy.

Having a colon cancer screening is the greatest approach to detect polyps and have them removed before they become malignant. Colonoscopy screening is safe, effective, and recommended by medical experts.

To remove colon polyps, physicians often employ specific equipment during a colonoscopy or flexible sigmoidoscopy. After removing the polyp, physicians send it to be tested for malignancy. A pathologist will review the test findings and provide you a report. Almost all polyps can be removed surgically.

What Causes Gastrointestinal Polyps?

Causes Gastrointestinal Polyps

Healthy cells divide and grow in a regular pattern. Certain gene mutations can cause cells to divide even when new cells are not required. Polyps can arise as a result of uncontrolled growth in the colon and rectum. Polyps can form anywhere in the large intestine.

Polyps are classified into two types: nonneoplastic and neoplastic. Hyperplastic polyps, inflammatory polyps, and hamartomatous polyps are examples of nonneoplastic polyps. Nonneoplastic polyps do not usually develop into cancer.

Adenomas and serrated polyps are examples of neoplastic polyps. If let to grow, these polyps have the potential to develop into cancer. Adenomas are the most common kind of colon polyp. Serrated polyps, depending on their size and location in the colon, might also develop cancer. The bigger the polyp, the higher the risk of cancer, especially with neoplastic polyps.

Risk Factors

Gastrointestinal Disorders

Because of age or family history, some people are more likely than others to develop polyps in their colon. Among these risk factors are:

Over 50 years' old.
A familial history of polyps or a personal history of polyps.
A history of colon cancer in the family.
A personal history of uterine or ovarian cancer.
Being of African-American descent.

Other lifestyle variables that increase the risk of colon polyps include:

A diet heavy in fat.
Cigarette smoking history.
A history of drinking alcohol.
A sedentary way of life.
Obesity.

There is no one technique to avoid getting colon polyps, but maintaining a better lifestyle that includes eating well, exercising, and avoiding smoking or drinking may help. Calcium, folic acid supplements, and a low-dose aspirin taken daily may also help prevent the formation of polyps.

Polyps can form in younger persons, even teens, because of some rare hereditary disorders. People with hereditary non-polyposis colon cancer -HNPCC [also known as Lynch syndrome], Peutz-Jeghers syndrome, and familial adenomatous polyposis (FAP) are more likely to develop colon cancer.

Hereditary Gastrointestinal Polyp Disorders

Gastrointestinal Polyp Disorders

Rarely, people inherit genetic alterations that lead to the formation of colon polyps. If you have one of these genetic mutations, you are far more likely to develop colon cancer. Early identification and screening can help prevent the development or spread of many malignancies.

The following hereditary conditions produce colon polyps:

Lynch syndrome. It's also known as hereditary nonpolyposis colorectal cancer, is a kind of colorectal cancer that runs in families. People with Lynch syndrome have fewer colon polyps, but those polyps can quickly become cancerous. Lynch syndrome is the most frequent kind of hereditary colon cancer, and it is also linked to breast, stomach, small intestine, urinary system, and ovaries malignancies.
Familial adenomatous polyposis (FAP). It is an uncommon disorder in which hundreds or even thousands of polyps form in the lining of your colon beginning in your adolescence. If the polyps are not removed, your chances of developing colon cancer are approximately 100%, generally before the age of 40.

Genetic testing can assist in determining your risk of FAP. Familial adenomatous polyposis (FAP) is a hereditary cancer condition caused by the APC gene on chromosomes. The gene is expressed 100% of the time in those who have the mutation, and it is autosomal dominant. 10% to 20% of individuals have no family history and develop the condition due to a spontaneous germline mutation.

The average age of a newly diagnosed patient is 29 years old, while the average age of a newly detected colorectal cancer patient is 39 years old. Colorectal cancer screening at a younger age is suggested, and treatment and prevention include surgical, including excision of diseased tissues.

Gardner's syndrome. It's a kind of FAP that causes polyps to grow in your colon and small intestine. Noncancerous tumors may also form in other regions of your body, such as your skin, bones, and abdomen.
MUTYH-associated polyposis (MAP). It is a disorder comparable to FAP that is caused by MYH gene mutations. Multiple adenomatous polyps and colon cancer are common in people with MAP. Genetic testing can assist in determining your risk of MAP.
Peutz-Jeghers syndrome. It is a disorder that causes freckles to appear all over the body, including the lips, gums, and feet. Noncancerous polyps then form throughout the intestines. Because these polyps can turn malignant, patients with this condition are at a higher risk of developing colon cancer. Peutz–Jeghers syndrome is an autosomal dominant condition characterized by hamartomatous polyps, which are disorderly growths of intestinal tissues, and hyperpigmentation of the mouth, lips, and fingers.

Extraintestinal cancers such as breast, ovary, cervix, fallopian tubes, thyroid, lung, gallbladder, bile ducts, pancreas, and testicles are also enhanced by the condition. The polyps frequently bleed and may create a blockage, necessitating surgery. Any polyps greater than 1.5 cm should be removed, and patients should be continuously followed and screened for malignancy every two years.

Serrated polyposis syndrome. It is a disorder that causes many serrated adenomatous polyps in the upper section (right side) of the colon. These polyps have the potential to become malignant and thus must be monitored and removed.

Types of Colorectal Polyps

Types of Colorectal Polyps

Colon polyps are classified into four types: adenomatous (tubular adenoma), hyperplastic, inflammatory, and villous adenoma (tubulovillous adenoma). Sessile polyps are those with a flat form, while pedunculated polyps have a long stalk.

Tubular Adenoma or Adenomatous Adenoma: This is the most frequent form of polyp that has the potential to become malignant. This form of polyp will be checked for malignancy if discovered. Anyone who has these polyps will need to be screened on a regular basis to look for new polyps and have them removed.
Hyperplastic polyps: These polyps are common, small, and have a low risk of developing into cancer. Any polyps identified in the colon that are hyperplastic would be removed and evaluated to verify they are not malignant.
Tubulovillous Adenoma or Villous Adenoma: This form of polyp has a significant chance of developing into cancer. They are frequently sessile, making removal more difficult.
Pseudopolyps: Pseudopolyps is most common in persons with inflammatory bowel disease (IBD). These polyps, also known as inflammatory polyps, are distinct from the other three kinds and do not progress to malignancy. They are caused by the persistent inflammation that occurs in the colons of persons with Crohn's disease and ulcerative colitis.

Symptoms & Signs

Rectal bleeding

Because most individuals with colon polyps have no symptoms, you may not realize you have one until your doctor discovers it during a colonoscopy.

However, some persons with colon polyps may have the following symptoms:

Rectal bleeding. This might be a sign of colon polyps, cancer, or other diseases including hemorrhoids or mild anus tears.
The stool's colour has changed. Blood might appear in your stool as crimson streaks or as black spots. Certain meals, drugs, or dietary supplements may also produce a change in hue.
Changes in bowel habits. Constipation or diarrhea that lasts more than a week may signal the existence of a bigger colon polyp or cancer. However, a variety of other illnesses can also induce changes in bowel patterns.
Pain. A big colon polyp might partially obstruct your intestine, causing crampy stomach pain.
Iron deficiency anemia. Polyp bleeding can happen gradually over time, with no obvious blood in your stool. Chronic bleeding depletes your body of the iron required to make the component that permits red blood cells to deliver oxygen to your body. As a result, you may experience tiredness and shortness of breath due to iron deficiency anemia.

Diagnosis of Colorectal Polyps

Diagnosis of Colorectal Polyps

Polyp detection is crucial for preventing colorectal cancer. There are several types of screening exams. During some of them, your doctor may also remove polyps.

Colon polyp screening tests include:

Colonoscopy. You'll go on a clear liquid diet and take a laxative around 1 to 3 days before the test to clean out your intestines. Your doctor will administer medication to keep you conscious during the surgery. To examine the interior of your colon, they use a long, thin, flexible tube with a light and camera at the end. They can also remove the majority of polyps and send them to a lab to be tested for malignancy. This exam takes around 30 minutes.
CT colonography. This procedure, also known as a virtual colonoscopy, combines X-rays and a computer to capture images of your colon from outside your body. During this examination, your doctor will not be able to remove polyps. If they find any, you'll need to get a regular colonoscopy. You'll be awake during this test, but you'll need to perform a particular diet prior to cleaning out your intestines.
Flexible sigmoidoscopy. This test is comparable to a colonoscopy, except it does not require as much intestinal preparation. You can be given medication to help you relax during the surgery. Your doctor inserts a small tube with a light into your abdomen to examine only the lowest section of your colon. If you have a polyp, they can remove it during the exam. It takes roughly 20 minutes.
Stool tests. An FOBT (guaiac-based fecal occult blood test) and a FIT (fecal immunochemical test) check for microscopic amounts of blood in your feces. Stool DNA assays look for gene alterations. For any of these tests, you collect a feces sample at home and either bring it to your doctor's office or mail it to a lab. If the tests reveal any issues, you'll need to have a colonoscopy.
Lower gastrointestinal series. A barium enema is another name for a barium enema. Before this test, the radiologist will fill your large intestine with a chalky liquid called barium, which makes your colon easier to view on an X-ray.

Colon Cancer Screening

Colon Cancer Screening

Due to rising incidence of colon cancer diagnoses among people under the age of 50, the U.S. Preventive Services Task Force and the American College of Gastroenterology modified their respective clinical guidelines for colon cancer screening to begin at age 45 rather than 50 in Spring 2021.

Those at high risk for colon cancer due to a personal or family history of cancer should begin screening earlier and more regularly than those with no risk factors. People who have inflammatory bowel disease (IBD), particularly those who have had ulcerative colitis, are at an increased risk of developing colon cancer.

Treatment of Gastrointestinal Polyps

Treatment of Gastrointestinal Polyps

Colon polyps are often removed by doctors. They may also recommend lifestyle adjustments to avoid the recurrence of colon polyps.

Colon polyps can be removed by doctors using the following methods:

Colonoscopy. Polypectomy, or polyp removal, can be performed with a cutting instrument or an electrified wire loop on the end of a colonoscope. For smaller polyps, surgeons may inject a liquid behind the polyp to elevate and isolate it from the surrounding region so that it may be removed more easily.

Laparoscopy. The doctor will create a tiny incision in the belly or pelvis and introduce a laparoscope into the colon during a laparoscopy. This method is used to remove polyps that are too big or cannot be eliminated safely by colonoscopy.

Removing the colon and rectum. This treatment, known as a complete proctocolectomy, is only required when a person has a serious disease or cancer. Doctors advocate this alternative for people who have rare genetic disorders including familial adenomatous polyposis (FAP). FAP is a hereditary disorder that causes colon and rectum cancer, and polyp removal may prevent cancer from forming. After removing a polyp, the doctor will send it to a lab for analysis, where experts will look for malignancy.

A pathologist who specializes in tissue analysis will analyze the polyp tissue under a microscope to determine if it is benign or precancerous. The suggested time interval for the next colonoscopy will be based on this information, as well as the number and size of polyps.

To prevent new polyps from growing in those who already have polyps or colon cancer, the doctor may give aspirin and coxibs (COX-2 inhibitors). For people with a family history of colon polyps, genetic counseling is recommended to prevent their development.

Are Gastrointestinal Polyps Preventable?

risk of colon polyps

You can greatly reduce your risk of colon polyps and colorectal cancer by having regular screenings. Certain lifestyle changes also can help:

Adopt good habits. Reduce your fat consumption by eating plenty of fruits, veggies, and healthy grains. Limit your alcohol consumption and discontinue all cigarette usage. Maintain a healthy body weight by staying physically active.
Discuss calcium and vitamin D with your doctor. Calcium supplementation has been found in studies to help reduce the recurrence of colon adenomas. However, it is unclear if calcium has any anti-cancer properties. Other research has suggested that vitamin D may protect against colorectal cancer.
If you are at high risk, think about your options. Consider genetic counseling if you have a family history of colon polyps. If you have a genetic disease that develops colon polyps, you will need frequent colonoscopies beginning in your twenties.

Outlook

Polyps of the gastrointestinal tract Outlook

A polyp is a growth of tissue that extends into the intestines from the lining of the colon and rectum.

Polyps in the colon normally cause no symptoms. Most colon polyps are harmless, but some can develop into cancer. Polyp removal is the most effective technique to treat colon polyps and prevent cancer.

People who have risk factors for colon polyps should get frequent tests, especially if they are over the age of 50.

If a person has polyps, they should follow their doctor's recommendations for regular exams and lifestyle adjustments to help control the problem.

Conclusion

Polyps of the gastrointestinal tract

A colon polyp is a small growth of tissue that extends from the lining of the colon, a part of the large intestine.

Polyps are frequent and become more so as individuals age. Colorectal polyps, or polyps in the colon or rectum, are thought to affect at least 30% of persons in the United States aged 50 and over.

Most polyps in the colon or gut are harmless, but some might progress to cancer. If they do, it might take years for them to develop into cancer.

Doctors can only detect colon polyps with certain tests or procedures, such as a colonoscopy or imaging scan. To determine which test or operation is appropriate for you, your doctor may first collect a medical and family history and do a physical exam.

Colon polyps do not always produce symptoms. Regular screening tests, such as a colonoscopy, are necessary because colon polyps discovered in the early stages may typically be removed safely and completely. Regular polyp detection and excision is the most effective way to avoid colon cancer.