Definition and Overview
Colonic (colon) polyps are overgrowths that develop on the lining of the colon. Depending on the type, they can be precancerous.
Polyps appear in many different forms, numbers, and sizes. Some of them can be very big that they may eventually rupture causing bleeding, although the blood may not be easily detected by the naked eye but only through a lab test known as fecal occult blood (FOB).
Two of the common kinds of colon polyps are:
Adenomatous – Most of the polyps found in the colon are adenomatous, which may be tubular or villous in form. They are also the most dangerous since they are the ones that are more likely to develop into colon cancer.
Hyperplastic – A hyperplastic polyp is almost a direct contrast of the adenomatous since it usually doesn’t cause colon cancer, particularly if the polyp is found in the lower section of the colon. It only becomes a potential problem if it appears in the upper colon, or it looks serrated or flat (sessile).
Causes of Condition
Polyps develop mainly due to genetic mutations. The cells in the body, including those of the colon, go through phases, in which cells mature and then die at the right time. However, if the immature cells do not go through programmed death but instead remain immature and multiply, polyps may then happen.
However, the exact cause of the genetic mutation is often sporadic or with no known or identifiable cause.
In certain cases, the colon polyp development is genetic, familial, or hereditary. A well-known condition is FAP (familial adenomatous polyposis). The possibility of developing colon cancer is high, and it may occur earlier than the general population. Polyps may also resurface often.
Underlying diseases that affect the colon such as ulcerative colitis may also result in the development of polyps while the constant inflammation of the colon may lead to genetic mutations.
- Bleeding of the rectum
- Change of color of the stool
- Diarrhea or constipation that lasts for at least a week
- Abdominal pain
Usually, however, these polyps develop and grow without symptoms.
Who to See and Treatments Available
An internist is qualified to inspect, diagnose, and treat colonic polyps. They typically confirm the presence of polyps through:
Colonoscopy – A flexible tube known as colonoscope is inserted into the colon. The camera attached to it sends live images of the colon and confirms the presence of polyps. If there is a polyp, the internist may remove it during the same procedure.
Sigmoidoscopy – This is a test to determine if there’s polyp in the sigmoid colon, a part of the large intestine that is the closest to the rectum.
Fecal occult blood (FOB) test – This is a simple exam in which the stool sample is analyzed for the presence of blood. Blood presence then warrants further investigation.
Polyps are removed and sent to the lab for analysis to ensure that they are not cancerous.
To manage polyps, the doctor may also recommend:
- Genetic testing to determine if it’s familial
- Removal of the colon if the chances of having colon cancer are very high
- Regular colon cancer screening. According to the Centers for Disease Control and Prevention, people who are 50 years and older should undergo screening every 5 to 10 years. High-risk groups such as those with familial polyps or have gone through colon cancer should be screened more often and at a younger age.
Management of colon inflammatory disease
Cooper K, Squires H, Carroll C, et al. Chemoprevention of colorectal cancer: systematic review and economic evaluation. Health Technol Assess. 2010;14(32):1-206. http://www.ncbi.nlm.nih.gov/pubmed/20594533
Itzkowitz SH, Potack J. Colonic polyps and polyposis syndromes. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 122.
Centers for Disease Control and Prevention