polyps

Colon polyps: description

Intestinal polyps are mucosal structures that protrude into the cavity of the intestine. They may sit flat on the intestinal lining, be attached to it by a style, or assume a “shaggy” form. Polyps are very common in the colon and rectum (rectum). They may consist of different tissues, but have mostly formed from glandular tissue of the intestinal mucosa. In this case, polyps are called adenomas. Adenomas are benign structures, but can turn into malignant cancerous tissue.

After the age of 70, almost half of all people in Germany carry at least one polyp in the intestine. One distinguishes a single polyp from diseases with several colon polyps. In a so-called polyposis there are over 100 polyps in the intestine. Symptoms are mostly diarrhea and abdominal cramps.

Intestinal polyps: symptoms

Initially, polyps in the intestine usually cause no symptoms. But sometimes polyps can bleed. The affected person often notices this by a reddish discolored stool. If it bleeds permanently from the polyp, symptoms of anemia such as dizziness and weakness may occur. Some polyps produce mucus. Those affected then have a slimy bowel movement. Slime production can cause water, salts (electrolytes) and proteins to be lost. Diarrhea and abdominal cramps are common symptoms. However, intestinal polyps also cause blockages in some cases.

Intestinal polyps: causes and risk factors

Intestinal polyps are much more prevalent in the Western world than in Asian countries, for example. Therefore, it is believed that the western lifestyle promotes the development of intestinal polyps. This includes the very greasy and sugar-rich food, high alcohol consumption and nicotine. Lack of exercise should also play a role in the development of intestinal polyps. Furthermore, genetic factors are considered to have a great influence.

The colon mucosa is renewed regularly. Old mucosal cells are broken down and new cells multiply. They form a new mucous membrane. When propagating but small errors (mutations) can arise in the genetic material. Certain mutations may alter the growth characteristics of mucosal cells. For example, they multiply uncontrollably. This causes intestinal polyps. If intestinal polyps persist for a very long time, a bowel cancer can develop from their already damaged cells. Therefore, intestinal polyps should be removed preventively.

Intestinal polyps: genetic factors

Sometimes, the tendency to form polyps in the gut can be inherited. In this case, certain genes that have a defect are passed on to the offspring. It then grow much earlier in life polyps. The risk of developing colon cancer is increased.

Intestinal polyps in familial adenomatous polyposis (FAP)

In the rare familial adenomatous polyposis (FAP) polyps with mucosal glands (adenomatous intestinal polyps) grow throughout the intestine. It is a gene mutation that can be passed on. Those affected are usually still in their teens at this time and often have no complaints. Symptoms such as abdominal pain, diarrhea, weight loss, flatulence or bloody-slimy bowel movements only become apparent over the years. After a few years, colon cancer often develops from the intestinal polyps. In addition, irregular tooth structures, changes in ocular pigmentation, and occasionally polyps in the stomach and tumors in bones occur in this disease. The risk of developing thyroid cancer is slightly increased. People who have relatives with this condition should have their bowels checked regularly. It is also possible to test the relatives for the FAP gene mutation.

MUTYH-associated polyposis (MAP)

In MAP, too, an inherited genetic defect is the cause of early and common colon polyps. The disease is milder than the FAP and the polyps develop later in life. Parents can carry the mutant gene without being ill. If father and mother in each case pass on a mutated gene, there is the danger that the offspring get sick.

Cronkhite-Canada syndrome

In the Cronkhite-Canada syndrome, intestinal polyps occur throughout the gastrointestinal tract. In addition, brownish spots appear on the skin. Fingernails and toenails can change their structure, the head hairs fail. The syndrome usually occurs after the age of fifty. The problem is severe diarrhea, which swamp the electrolytes and proteins out of the body. Unlike other genetic polyps, there is no higher risk of colorectal cancer here.

Birt-Hogg-Dube syndrome

In the Birt-Hogg-Dube syndrome, numerous colon polyps occur in the large intestine, which can very often develop into colon cancer. In addition, tumors of the skin, kidneys and lungs occur.

Hamartomatous polyposis syndromes

A hamartomatous syndrome may be associated with tumors in almost all areas of the body. If intestinal polyps develop as part of such a syndrome, the risk of colorectal cancer is increased. Most often, the disease occurs at a young age. For example, the so-called Peutz-Jeghers syndrome is diagnosed at about the age of 35, because the polyps often lead to intestinal obstruction. The disease is associated with a high risk of pancreatic cancer or ovarian cancer.

Colon polyps: examinations and diagnosis

In the case of stool complaints or in the context of colorectal cancer screening, a doctor for gastroenterology should be consulted. In most cases, it is desirable to come to the doctor with an “empty stomach”, as the abdominal organs can be better assessed. The doctor will first ask some questions to get clues about the gut health of his patient:

• Do you suffer from constipation, diarrhea or irregular bowel movements?
• Have you noticed that your stool is bloody or slimy?
• Are there any intestinal diseases in your family?
• Have you lost weight in the past few weeks and months?

Following is the physical examination. With the stethoscope, the doctor can hear bowel sounds. Then he gropes his stomach for possible hardening. With an ultrasound device intestinal polyps can be displayed in the rectum.

Colonoscopy (colonoscopy)

Since one can only assess a very small section of the intestine with an ultrasound examination, a colonoscopy is usually performed. On the day before the examination usually a laxative must be taken. A flexible tube with camera (colonoscope) is inserted into the intestine and advanced. If a polyp is discovered in the intestine, it can be removed directly. Subsequently, the tissue is examined in the laboratory.

Abdominal MRI

Polyps in the small intestine can sometimes be visualized in a so-called magnetic resonance imaging (MRI). An MRI makes many individual sectional images of the intestine. You have to lie in a tube for about twenty minutes. Using various magnetic resonance a computer then calculates the images of the intestine.

Video capsule endoscopy

In video capsule endoscopy, a small capsule is swallowed with a camera. As she wanders through the digestive tract, she takes pictures of the intestinal mucosa. If the capsule has passed through the entire intestine, it is excreted with the stool. These can then be evaluated on the computer. Since this study is very time consuming and expensive, it is not performed on every ordinary colon polyp.

prevention

Since colon polyps and colon cancer are not rare diseases, a colonoscopy is offered as a precautionary measure for every person in Germany from the age of fifty and paid by the health insurance companies. Every ten years the colonoscopy should be repeated. In case of complaints or an increased risk for intestinal diseases, it is more often performed.

A so-called hemoccult test is also a precaution. This is determined by means of a test strip, if blood is in the stool. The test is repeated once a year as part of colorectal cancer screening.

Intestinal polyps: treatment

Since a bowel polyp can pass into cancer, it should be removed once discovered. Smaller intestinal polyps can be removed in a colonoscopy. Larger polyps sometimes need to be removed through the abdominal wall during surgery. In rare cases, a whole piece of intestine is removed. People with genetic polyposis who are at high risk for colorectal cancer sometimes remove the colon as a precautionary measure.

Colon polyps: disease course and prognosis

A polyp is actually a benign intestinal tumor. However, if it persists for a long time, it can develop into a colon cancer and become dangerous. On average, it takes five to ten years for adenoma to develop from an adenoma. The larger the size of the polyps, the greater the risk that intestinal polyps will become cancerous.

After polyp removal, there is a risk of bleeding from the ablation site. Therefore, you should look after the bowel movement and perform regular hemoccult tests. Sometimes you have to stay in the hospital for one day after being removed for observation. After the treatment, a colonoscopy is performed again after half a year, then every 3 years.

A western lifestyle with high-fat and high-sugar diet, alcohol and nicotine seems to be the cause of polyps to favor. Therefore, a balanced diet should be respected and alcohol and nicotine are enjoyed only moderately.