What Are Colorectal Polyps
Colorectal polyps are fleshy outgrowths arising from the walls of the large intestine; they project into the colon and the rectum.
- Colorectal polyps may be hereditary
- Blood in the stool is the usual symptom
- Diagnosis is confirmed by colonoscopy
- Colorectal polyps can be removed surgically
The polyps, which are small fleshy projections of the intestinal wall found in the colon and rectum, are generally benign growths but they have the potential of developing into malignant tumors. They vary greatly in size and the larger polyps usually turn out to be cancerous. Some polyps may be precancerous with a higher chance of developing into malignant tumors if they are not removed. Some polyps may have a stalk or peduncle; they are usually benign. The polyps that grow without stalks and those consisting of glandular cells (adenomatous) are most likely cancerous. Precancerous adenomatous polyps eventually become adenomas, and among them, the serrated forms are aggressive in their growth.
Hereditary Conditions: Hereditary is a major contributing factor to colorectal polyps. Peutz-Jeghers syndrome and inherited familial adenomatous polyposis are two examples of the hereditary conditions predisposing certain people to colorectal polyps.
In the inherited condition called familial adenomatous polyposis, a large number of polyps develop in the rectum as well as in the large intestine, very early in life. These polyps eventually become malignant, resulting in colorectal cancer even before the person reaches the age of forty years. Those who have this hereditary condition are prone to developing Gardner’s syndrome. They develop noncancerous growths or tumors of different types in various parts of the body such as the skull, jaws and on the skin.
People who have Peutz Jeghers syndrome develop a large number of small polyps all along the digestive tract, starting from the stomach and all the way down to the rectum. Characteristic spots of blue-back color are also present on their limbs and faces and even inside their mouths. These marks on the skin may fade as the youngsters reach puberty but those inside the mouth remain. People who have this syndrome are highly prone to developing cancers elsewhere in the body too. The usual sites include the uterus, ovary, breast, and lungs in addition to parts of the digestive system such as the intestines and the pancreas.
Symptoms and Diagnosis
The colorectal polyps may remain asymptomatic or they may cause symptoms such as bleeding through the anus. When the polyp grows large, it can cause obstruction in the large intestine or the rectum. Abdominal cramps and pain may also be present. Occasionally, a polyp in the rectum with an elongated stalk may protrude out of the anus. Some polyps called villous adenomas, which have projections on them, may cause diarrhea as they keep excreting salts and water. Hypokalemia or low potassium levels in the blood may result from this continuous diarrhea.
Rectal polyps may be detected by the doctor while examining the rectum with a gloved finger. But diagnosis is usually done with a test called sigmoidoscopy, in which the rectum and part of the large intestine are examined with a flexible viewing tube. If polyps are detected in the rectum during a sigmoidoscopy, the large intestine is thoroughly examined by a more comprehensive test called colonoscopy. There is always a higher chance of finding more polyps and some may be cancerous too. During colonoscopy, a biopsy also can be done to detect the presence of cancerous polyps.
Treatment
The colorectal polyps have a very strong tendency to become malignant; hence, doctors prefer to remove all the colorectal polyps as soon as they are detected. They can be removed with a cutting tool attached to the colonoscope. An electrified wire loop may be used to remove pedunculated polyps, but major surgery may be needed to get rid of those polyps which are without stalk.
When malignant polyps are detected, biopsy is done to determine the exact nature of the cancerous growth. The surgically removed polyps are examined under the microscope to see whether the malignancy has affected the stalk of the polyp. If the stalk is affected, the portion of the large intestine where the polyp originated is also removed. Then the intestine is repaired by attaching the two severed sections together.
People who are diagnosed with colorectal polyps should undergo colonoscopy regularly, usually once a year, even after the existing polyps are surgically removed. Since there is a high probability of the condition recurring, the rectum and the large intestine are thoroughly checked for polyps during the test. Alternatively, barium enema test can also be done to get a clearer x-ray picture of the intestine and the rectum.
The treatment for those suffering from familial adenomatous polyposis involves the surgical removal of the large intestine to avoid the risk of the polyps developing into malignant tumors. The small intestine is then surgically attached to the rectum. The rectum is also prone to polyps, but after the removal of the large intestine, the occurrence of rectal polyps is found to be rarer. However, a sigmoidoscopy may have to be conducted at regular intervals of 3 months or 6 months to detect the development of polyps in the rectum. If they are found to be developing again, they are immediately removed. Sometimes, the rectum also may have to be removed if the polyps proliferate there. This situation makes an ileostomy inevitable. An opening is created on the abdominal wall, to which the small intestine is connected; thus forming an alternate route for excretion. A disposable or reusable plastic bag is attached to the opening, via a plastic tube, for the collection of feces.
When people with hereditary adenomatous polyposis were treated with certain NSAIDs, the colorectal polyps subsided, but the effect seemed to be reversible, as the polyps returned when the drug treatment was stopped. Research is still continuing in this direction, to find an effective cure for familial polyposis.
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Yasser Elnahas
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