What are the varieties?
Most polyps are non-cancerous, or benign. However, some polyps can develop into cancer. Polyps smaller than pea-size are not generally dangerous. Even so, when they find them, Doctors routinely remove polyps and test them. Larger polyps may already be malignant or could become malignant in the future. There are three broad categories:

Ordinary Polyp – Most polyps develop in people between the ages of 40 and 60. There may be only one or two and they can take ten years or more after forming to develop into a malignancy. There is a hereditary link, so if your parents or siblings have polyps, you are at an increased risk of developing them yourself.
Hereditary Familial Polyposis – This is a true hereditary condition in which the entire colon is marked with hundreds or thousands of polyps. They can start forming as young as ten years of age. This condition is not common, but nearly every Familial Polyposis patient will eventually develop colon cancer. The only reliable preventive treatment is a colectomy, or removal of the colon.
Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer) – This disorder involves the formation of large numbers of polyps and carries a high risk of cancer. Although still a rare disorder, it occurs more often than familial polyposis but less often than ordinary polyps. There is a strong tendency for polyps to occur in close family members such as sisters, brothers, aunts, uncles and children. More polyps are seen developing at an early age and cancer is seen at earlier ages as well, often starting in the twenties. In some families there is also an increased incidence of breast, ovarian, and other cancers, so it is important for all close blood relatives to be monitored.
Who is likely to get polyps?
Anyone can get polyps, but certain people are more likely to form polyps than others. You may have a greater chance of getting polyps if you:

are age 50 or older
have a family member who has had polyps
have a family member who has had cancer of the large intestine
have a high intake of fatty foods
use tobacco
drink alcohol
are sedentary
are overweight.
What are the symptoms of colon polyps?
The majority of small polyps do not cause symptoms. Often, people do not know they have a polyp until the doctor discovers it during a routine checkup or while testing them for something else. But some people do have symptoms such as:

Rectal bleeding. You might notice blood on your underwear or on toilet paper after a bowel movement.
Constipation or diarrhea that lasts longer than seven days.
Blood in the stool. Blood can make stool look black, or it can appear as red streaks in the stool. Consult your doctor if you have noticed these symptoms.
How are colon polyps diagnosed?
Several tests can be used to check for polyps:

Digital rectal exam. The doctor checks your rectum, the last part of the large intestine, to see if it feels normal. This test would find rectal polyps only.
Barium enema. A liquid containing barium is placed into your rectum and x rays of your large intestine are taken. Barium allows physicians to see a contrast between normal and abnormal shapes in the colon. On x rays, the normal space inside your intestine looks white, while Polyps appear dark, making them easy to detect.
Sigmoidoscopy. With this test, the doctor can view the inside of your large intestine. The doctor puts a thin flexible tube (sigmoidoscope) into your rectum. It has a light and a miniature video camera in it, allowing the doctor to view the last third of your large intestine, where most common polyps occur.
Colonoscopy. This test is like sigmoidoscopy, but involves probing further into the intestines, allowing the doctor to view the entire colon. This test generally requires sedation.
What is the conventional treatment of colon polyps?
Removal of the polyp is the conventional treatment. When the polyps are small, the doctor can actually remove the polyp during a sigmoidoscopy or colonoscopy. For larger or multiple polyps, the doctor may decide to operate through the abdomen. Polyps are biopsied to test for cancer. If you have a history of polyps, the doctor may recommend regular testing.

What therapies does Dr. Weil recommend for colon polyps?
With regard to preventing colon cancer, early detection is key to winning the battle. Once you reach the age of 50, the following tests should be done routinely:

A fecal occult blood test (to test for blood in the feces) annually, or more often if any problems have been encountered.
A flexible sigmoidoscopy every 5 years if normal, or
A colonoscopy (if normal, every 10 years), or
A barium enema every 5 to 10 years if normal and
A digital rectal exam at the same time the sigmoidoscopy, colonoscopy or barium enema is performed (up to 10 percent of tumors can be detected by this low-tech test). Screenings should be initiated earlier than age 50 if there is a family history of colon cancer or polyps.
Nutrition and supplements for colon polyps:

Eat very little, if any, red meat. Regular consumption of red meat results in an increased risk of developing colon cancer compared to eating no red meat at all.
Eat generous amounts of vegetables. Green leafy vegetables, especially, have been linked to lower risk of colon cancer.
Eat plenty of fiber from a variety of foods (from beans to whole grains to fruit). Although recent studies about which specific foods provide the most benefit have not been conclusive – especially when it comes to primary prevention of colon cancer – most physicians, researchers and nutritionists recommend a largely plant-based diet with lots of fiber.
Limit alcohol. Studies suggest that the more alcohol you drink, the higher your risk of developing colon cancer.
Make green tea your beverage of choice. Green tea consumption is linked with lower incidence of many kinds of cancer.
Consider taking aspirin therapy. Research suggests that taking a daily low-dose aspirin over a period of years can cut colon cancer risk by as much as half.
Take a multivitamin containing folic acid and vitamin D.
Keep blood sugar and insulin levels low. Insulin resistance, especially when linked to excessive abdominal body fat, is associated with an increased risk of colon cancer.
Eat small, balanced meals frequently and watch your intake of carbohydrates (sugars and starches), especially those with a high glycemic index.?
How can colon polyps be prevented?
Doctors do not know of any one sure way to prevent polyps. But you might be able to lower your risk of getting them if you:

eat more fruits and vegetables and less fatty food
do not smoke
avoid alcohol
exercise every day
lose weight if you are overweight.
Eating more calcium and folate can also lower your risk of getting polyps. Some foods that are rich in calcium are milk, cheese, and broccoli. Some foods that are rich in folate are chickpeas, kidney beans, and spinach.

Some types of polyps (called adenomas) have the potential to become cancerous while others (hyperplastic or inflammatory polyps) have virtually no chance of becoming cancerous.

When discussing colon polyps, the following points should be considered:

• Polyps are common (they occur in 30 to 50 percent of adults)
• Not all polyps will become cancer
• It takes many years for a polyp to become cancerous
• Polyps can be completely and safely removed

The best course of action when a polyp is found depends upon the number, type, size, and location of the polyp. People who have an adenoma removed will require a follow up examination; new polyps may develop over time that need to be removed.

COLON POLYP CAUSES

Polyps are very common in men and women of all races who live in industrialized countries, suggesting that dietary and environmental factors play a role in their development.

Lifestyle — Although the exact causes are not completely understood, lifestyle risk factors include the following:

• A high fat diet
• A diet high in red meat
• A low fiber diet
• Cigarette smoking
• Obesity

On the other hand, use of aspirin and other NSAIDs and a high calcium diet may protect against the development of colon cancer. (See “Patient information: Colon and rectal cancer screening (Beyond the Basics)”.)

Aging — Colorectal cancer is uncommon before age 40. Ninety percent of cases occur after age 50, with men somewhat more likely to develop polyps than women; therefore, colon cancer screening is usually recommended starting at age 50 for both sexes. It takes approximately 10 years for a small polyp to develop into cancer.

Family history and genetics — Polyps and colon cancer tend to run in families, suggesting that genetic factors are also important in their development.

Any history of colon polyps or colon cancer in the family should be discussed with a healthcare provider, particularly if cancer developed at an early age, in close relatives, or in multiple family members. As a general rule, screening for colon cancer begins at an earlier age in people with a family history of cancer or polyps.

Rare genetic diseases can cause high rates of colorectal cancer relatively early in adult life. Familial adenomatous polyposis (FAP) and MUTYH-associated polyposis cause multiple colon polyps. Another, hereditary nonpolyposis colon cancer (HNPCC) or Lynch syndrome, increases the risk of colon cancer, but does not cause a large number of polyps. Testing for these genes may be recommended for families with high rates of cancer, but is not generally recommended for other groups.

TYPES OF COLON POLYPS

The most common types of polyps are hyperplastic and adenomatous polyps. Other types of polyps can also be found in the colon, although these are far less common and are not discussed here.

Hyperplastic polyps — Hyperplastic polyps are usually small, located in the end-portion of the colon (the rectum and sigmoid colon), have no potential to become malignant, and are not worrisome (figure 1). It is not always possible to distinguish a hyperplastic polyp from an adenomatous polyp based upon appearance during colonoscopy, which means that hyperplastic polyps are often removed or biopsied to allow microscopic examination.

Adenomatous polyps — Two-thirds of colon polyps are adenomas. Most of these polyps do not develop into cancer, although they have the potential to become cancerous. Adenomas are classified by their size, general appearance, and their specific features as seen under the microscope.

As a general rule, the larger the adenoma, the more likely it is to eventually become a cancer. As a result, large polyps (larger than 5 millimeters, about 3/8 inch) are usually removed completely to prevent cancer and for microscopic examination to guide follow-up testing.

Malignant polyps — Polyps that contain pre-cancerous or cancerous cells are known as malignant polyps. The optimal treatment for malignant polyps depends upon the extent of the cancer (when examined with a microscope) and other individual factors. (See “Approach to the patient with colonic polyps”.)

COLON POLYP DIAGNOSIS

Polyps usually do not cause symptoms but may be detected during a colon cancer screening examination (such as flexible sigmoidoscopy or colonoscopy) (picture 1) or after a positive fecal occult blood test. Polyps can also be detected on a barium enema x-ray, although small polyps are more difficult to see with x-ray.

Colonoscopy is the best way to evaluate the colon because it allows the physician to see the entire lining of the colon and remove any polyps that are found. During colonoscopy, a physician inserts a very thin flexible tube with a light source and small camera into the anus. The tube is advanced through the entire length of the large intestine (colon). (See“Patient information: Colonoscopy (Beyond the Basics)”.)

The inside of the colon is a tube-like structure with a flat surface with curved folds. A polyp appears as a lump that protrudes into the inside of the colon (picture 1). The tissue covering a polyp may look the same as normal colon tissue, or, there may be tissue changes ranging from subtle color changes to ulceration and bleeding. Some polyps are flat (“sessile”) and others extend out on a stalk (“pedunculated”).

Colonoscopy is also the best test for the follow-up examination of polyps. Virtual colonoscopy using CT technology is another test used to detect polyps.

COLON POLYP REMOVAL

Colorectal cancer is preventable if precancerous polyps (ie, adenomas) are detected and removed before they become malignant (cancerous). Over time, small polyps can change their structure and become cancerous. Polyps are usually removed when they are found on colonoscopy, which eliminates the chance for that polyp to become cancerous.

Procedure — The medical term for removing polyps is polypectomy. Most polypectomies can be performed through a colonoscope. Small polyps can be removed with an instrument that is inserted through the colonoscope and snips off small pieces of tissue. Larger polyps are usually removed by placing a noose, or snare, around the polyp base and burning through it with electric cautery (figure 2). The cautery also helps to stop bleeding after the polyp is removed.

Polyp removal is not painful because the lining of the colon does not have the ability to feel pain. In addition, a sedative medication is given before the colonoscopy to prevent pain caused by stretching of the colon. Rarely, a polyp will be too large to remove during colonoscopy, which means that a surgical procedure will be needed at a later time.

Complications — Polypectomy is safe although it has a few potential risks and complications. The most common complications are bleeding and perforation (creating a hole in the colon). Fortunately, this occurs infrequently (one in 1000 patients having colonoscopy). Bleeding can usually be controlled during colonoscopy by cauterizing (applying heat) to the bleeding site; surgery is sometimes required for perforation.

After polyp removal — Medications that can increase bleeding, including aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve), should be avoided for approximately two weeks after polypectomy. Acetaminophen (Tylenol) is safe to take. People who require anticoagulant medications such as warfarin (Coumadin) should discuss how and when to resume this medication with their clinician.

Patients should discuss the results of the tissue analysis when they are available, within a few weeks after the procedure, to decide if and when a follow-up examination is needed.

COLON POLYP PREVENTION

Follow-up examination — People with adenomatous polyps have an increased risk of developing more polyps, which are likely to be adenomatous. There is a 25 to 30 percent chance that adenomas will be present on a repeat colonoscopy done three years after the initial polypectomy. Some of these polyps may have been present during the original examination, but were too small to detect. Other new polyps may also have developed.

After polyps are removed, repeat colonoscopy is recommended, usually three to five years after the initial colonoscopy. However, this time interval depends upon several factors:

• Microscopic characteristics of the polyp.
• Number and size of the polyps.
• Ability to see the colon during the colonoscopy. A bowel preparation is needed before colonoscopy to remove all traces of feces (stool). If the bowel prep was not completed, feces may remain in the colon, making it more difficult to see small to moderate size polyps. In this situation, follow up colonoscopy may be recommended sooner than three to five years later.
• Whether it was possible to examine the entire colon.

Persons who undergo screening (and re-screening) for colon cancer are much less likely to die from colon cancer. Thus, following screening guidelines is important in the prevention of colon cancer.

Preventing colon cancer — Guidelines issued by one of the major medical societies in the United States (the American College of Gastroenterology) suggest the following to prevent polyps from recurring:

• Eat a diet that is low in fat and high in fruits, vegetables, and fiber
• Maintain a normal body weight
• Avoid smoking and excessive alcohol use

(See “Patient information: Diet and health (Beyond the Basics)” and “Patient information: Quitting smoking (Beyond the Basics)”.)

IMPLICATIONS FOR THE FAMILY

First-degree relatives (a parent, brother, sister, or child) of a person who has been diagnosed with an adenomatous polyp (or colorectal cancer) before the age of 60 years have an increased risk of developing adenomatous polyps and colorectal cancer compared to the general population. Thus, family should be made aware if the person is diagnosed with an adenoma or colon cancer.

While screening for polyps and cancer is recommended for everyone (typically beginning at age 50), those at increased risk should begin screening earlier. The best test for screening in people with an increased risk of cancer is not known, although a sensitive test (such as colonoscopy) is usually recommended.

Relatives can be told the following, based on typical guidelines for screening people with a family history of colorectal cancer:

• People who have one first-degree relative (parent, brother, sister, or child) with colorectal cancer or an advanced type of adenomatous polyps at a young age (before the age of 60 years), or two first-degree relatives diagnosed at any age, should begin screening for colon cancer earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first. Screening usually includes colonoscopy, which should be repeated every five years. (See “Patient information: Colon and rectal cancer screening (Beyond the Basics)”, section on ‘Average risk of colorectal cancer’.)
• People with a second-degree relative (grandparent, aunt, or uncle) or third-degree relative (great-grandparent or cousin) with colorectal cancer should be screened for colon cancer similar to a person with an average risk. (See “Patient information: Colon and rectal cancer screening (Beyond the Basics)”, section on ‘Average risk of colorectal cancer’.)
• Some conditions, such as hereditary nonpolyposis colorectal cancer (Lynch syndrome), familial adenomatous polyposis, MUTYH- associated polyposis, and inflammatory bowel disease (eg, ulcerative colitis, Crohn’s disease) significantly increase the risk of colon polyps or cancer in family members. Colon cancer screening in this group is discussed separately. (See “Patient information: Colon and rectal cancer screening (Beyond the Basics)”, section on ‘Increased risk of colorectal cancer’.)

]]> http://coloncancer.net/?feed=rss2&p=1131 0 http://coloncancer.net/?p=1129 http://coloncancer.net/?p=1129#comments Fri, 10 Jan 2014 00:14:32 +0000 http://coloncancer.net/?p=1129 What are colon polyps?
Colon polyps camera are growths in your large intestine (colon) camera. The cause of most colon polyps is not known, but they are common in adults.

Most colon polyps are not cancer. But some growths can turn into colon cancer. If a colon polyp is the kind that can turn into cancer, it usually takes many years for that to happen.

People over 50 are more likely than younger people to get colon cancer. Experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. People with a higher risk, such as African Americans and people with a strong family history of colon cancer, may need to be tested sooner. Talk to your doctor about when you should be tested. Finding and removing colon polyps can prevent colon cancer.

What are the symptoms?
You can have colon polyps and not know it because they usually don’t cause symptoms. They are usually found during routine screening tests for colon cancer. A screening test looks for signs of a disease when there are no symptoms.

If polyps get large, they can cause symptoms. You may have bleeding from your rectum or a change in your bowel habits. A change in bowel habits includes diarrhea, constipation, going to the bathroom more often or less often than usual, or a change in the way your stool looks.

Most polyps are found during tests for colon cancer. Experts recommend routine colon cancer testing for everyone age 50 and older who has a normal risk for colon cancer. People with a higher risk, such as African Americans and people with a strong family history of colon cancer, may need to be tested sooner. The tests for colon cancer are:

Stool tests. In a fecal occult blood test (FOBT), a fecal immunochemical test (FIT), and a stool DNA test (sDNA), stool samples are checked for signs of cancer.
Colonoscopy. In this test, the doctor inserts a small viewing tube all the way into your colon and looks for polyps. The doctor can also take out any polyps he or she finds.
Flexible sigmoidoscopy. This test is like a colonoscopy, except that the viewing tube is shorter so the doctor can only look at the last part of your colon. Doctors can remove polyps during this test.
Computed tomographic colonography (CTC). This test is also called a virtual colonoscopy. A computer and X-rays make a detailed picture of the colon to help the doctor look for polyps.
Doctors often recommend colonoscopy because it lets them look at the whole colon and remove any polyps they find. If polyps are found during another type of test, you may still need colonoscopy so the doctor can remove the polyps.