Colon Polyps

Picture of colon cancer.

• The colon is part of the large intestine that extends from the cecum to the rectum.
• Colon polyps most frequently are benign (noncancerous) overgrowths on the surface of the colon.
• Colon polyps in most people do not cause pain.
• When signs and symptoms of colon polyps are present, they include:
  • Rectal bleeding
  • Anemia
  • Diarrhea
  • Constipation
• Some individuals also may experience other symptoms and signs.
• There are three major groups of colonic polyps, hyperplastic, adenomas, and those associated with polyposis syndromes (genetic).
• The causes of colonic polyps are unclear.
• Risk factors (and possible contributors to the cause of colon polyp development) are:
  • Family history
  • Diet
  • Genetics
  • Older age
• Gastroenterologists (doctors specializing in diseases of the digestive tract) usually diagnose and treat colon polyps.
• Doctors diagnose colon polyps with a test for blood in the stool, and other tests and procedures that visualize view the surface of the colon, for example, colonoscopy. During colonoscopy, through a tiny camera, doctors can see colon polyps and take biopsies of tissue to help diagnose polyps, and possibly confirm benign, pre-cancerous, or cancerous polyps.
• Medical treatment of colon polyps is limited to possibly nonsteroidal anti-inflammatory drugs (NSAIDs) and/or aspirin, removal of the polyps by a colonoscope via colonoscopy, or by a surgeon that can cut out (colon resection) various sections of the large bowel, and thereby remove multiple intestinal polyps.

• The colon is part of the large intestine that extends about five feet long from the cecum (located at the end of the small bowel) to the rectum (the rectum is the last 6-8 inches of the large intestine that ends at the anus).
• The colon (also termed the large bowel or large intestine) is comprised of the ascending, transverse, descending, and sigmoid colon, which ends at the rectum.
• The function of the colon is to absorb water and electrolytes from the indigestible foods we eat, accept, and store food remains that were not digested, and then eliminate that solid waste food (stool or feces) from the body.

• Colon polyps usually are benign, slow-growing tumors that arise from the epithelial cells in the large intestine.
• Some colon polyps contain and/or become cancerous tumors (malignant <1%).
• Benign colon polyps do not invade nearby tissue or spread to other parts of the body.
• Colon polyps are commonly present in many individuals and increase in numbers with increasing age.

Most colon polyps (also termed colonic polyps) do not cause pain; however, they may be painful if the bowel is blocked, which causes abdominal cramps and pain.

Most people with colon polyps do not have signs or symptoms; however, in people who do, the most common are:

• Rectal bleeding
• Anemia
• Diarrhea or constipation
• Decreased stool size (caliber)

Other signs and symptoms may include:

• Iron deficiency
• Black stools
• Abdominal pain
• Nausea and/or vomiting
• Intussusception (the colon folds into itself or telescopes)

The cause of colon polyps is unclear, but there are risk factors for developing them.

Colon polyps are usually divided into three groups or types:

1. Hyperplastic colon polyps are benign protrusions, and comprise about 90% of polyps.
2. Adenomas are colon polyps that usually are small, have a small potential for malignancy, and comprise about 10% of polyps. There are three types adenmas, tubular adenoma, tubulovillous adenoma, and villous adenoma.
3. Polyposis syndromes (a group of hereditary conditions that produce among other things, colon polyps) that include:
   • Familial adenomatous polyposis
   • Hereditary nonpolyposis colorectal cancer (HNPCC)/Lynch syndrome
   • Gardner syndrome
   • Turcot syndrome
   • Peutz-Jeghers syndrome
   • MUTHY polyposis
   • Pamilial juvenile polyposis
   • Hyperplastic polyposis
   • Serrated polyposis
   • Hamartomata polyps

Yes, adenomas or adenomatous polyps have the potential to mutate into colon cancer (or sometimes termed colorectal cancer). Because this happens somewhat infrequently, and because of the difficulty of telling the difference between small benign polyps and polyps that may mutate, gastroenterologists often will remove polyps as a precaution when they do endoscopy.

Risk factors for colon polyps include:

• Family history of colon polyps
• Family history of colon cancer
• Diet high in red meats
• Diet high in processed meats
• History of inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Inherited conditions (polyposis syndromes, for example)
• Older age

A gastroenterologist usually diagnosis colon polyps after ordering and performing several diagnostic tests. These tests may include:

• Stool samples tested for blood
• Rectal exam
• Barium enema
• Flexible sigmoidoscopy
• Colonoscopy
• Capsule endoscopy by camera
• Virtual colonoscopy (computer reconstruction of your colon from X-ray scans)
• Detection of mutant, fragmented and/or methylated DNA in the stool
• Biopsy (often done on polyps removed during colonoscopy) can determine benign vs. pre-cancerous or cancerous polyps

Medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) has shown in some studies to decrease the size and number of colon polyps. However, there is no indication that they can prevent cancer development. One study suggests aspirin may reduce recurrent colon polyps.for example:

• aspirin
• ibuprofen (Motrin)
• naproxen (Naprosyn)
• Iidomethacin (Indocin)
• piroxicam (Feldne)
• celecoxib (Celebrex)

Patients with only a few polyps can undergo polypectomy, a procedure that allows removal of the polyps with a colonoscope.

Colonic resection is used if multiple intestinal polyps are associated with syndromes like familial adenomatous polyposis (FAP). Colonic resection should be discussed between you and your gastroenterologist.