Colon polyps

DEFINITION

ulcerative colitis or Crohn's

disease of the colon
increases your overall risk
of colon cancer.

A colon polyp is a small clump of cells

that forms on the lining of the colon.
Most colon polyps are harmless. But
over time, some colon polyps can
develop into colon cancer, which is
often fatal when found in its later
stages.
Colon polyps often don't cause
symptoms. It's important to have
regular screening tests, such as
colonoscopy, because colon polyps
found in the early stages can usually
be removed safely and completely.
The best prevention for colon cancer
is regular screening for polyps.

Colon polyps often cause no

symptoms. You might not know you
have a polyp until your doctor finds it
during an examination of your bowel.
But some people with colon polyps
experience:

Types

SYMPTOMS

Adenomatous. About twothirds of all polyps are

adenomatous. Only a small
percentage of them actually
become cancerous. But
nearly all malignant polyps
are adenomatous.
Serrated. Depending on
their size and location in the
colon, serrated polyps may
become cancerous. Small
serrated polyps in the lower
colon, also known as
hyperplastic polyps, are
rarely malignant. Larger
serrated polyps which are
typically flat (sessile),
difficult to detect and
located in the upper colon
are precancerous.
Inflammatory. These polyps
may follow a bout of
ulcerative colitis or Crohn's
disease of the colon.
Although the polyps
themselves are not a
significant threat, having

Rectal bleeding. This can be

a sign of colon polyps or
cancer or other conditions,
such as hemorrhoids or
minor tears in your anus.

Change in stool color. Blood

can show up as red streaks
in your stool or make stool
appear black. A change in
color may also be caused by
foods, medications and
supplements.

Change in bowel habits.

Constipation or diarrhea
that lasts longer than a
week may indicate the
presence of a large colon
polyp. But a number of
other conditions can also
cause changes in bowel
habits.

Pain, nausea or vomiting. A

large colon polyp can
partially obstruct your
bowel, leading to crampy

abdominal pain, nausea and

vomiting.

Iron deficiency anemia.

Bleeding from polyps can
occur slowly over time,
without visible blood in your
stool. Chronic bleeding robs
your body of the iron
needed to produce the
substance that allows red
blood cells to carry oxygen
to your body (hemoglobin).
The result is iron deficiency
anemia, which can make you
feel tired and short of
breath.

Hereditary polyp disorders

Hereditary disorders that cause colon
polyps include:

When to see a doctor

See your doctor if you experience:

Abdominal pain
Blood in your stool
A change in your bowel
habits that lasts longer than
a week

RISK FACTORS
Factors that may contribute to the
formation of colon polyps or cancer
include:

Age. Most people with colon

polyps are 50 or older.
Inflammatory intestinal
conditions, such as
ulcerative colitis and
Crohn's disease.Family
history. You're more likely to
develop colon polyps or
cancer if you have a parent,
sibling or child with them. If
many family members have

them, your risk is even

greater. In some people, this
connection isn't hereditary.
Tobacco and alcohol use.
Obesity and lack of exercise.
Race. African-Americans are
at higher risk of developing
colon cancer.
Type 2 diabetes that isn't
well-controlled.

Lynch syndrome, also called

hereditary nonpolyposis
colorectal cancer. People
with Lynch syndrome tend
to develop relatively few
colon polyps, but those
polyps can quickly become
malignant. Lynch syndrome
is the most common form of
inherited colon cancer and is
also associated with tumors
in the breast, stomach,
small intestine, urinary tract
and ovary.
Familial adenomatous
polyposis (FAP), a rare
disorder that causes
hundreds or even thousands
of polyps to develop in the
lining of your colon
beginning during your
teenage years. If the polyps
aren't treated, your risk of
developing colon cancer is
nearly 100 percent, usually
before age 40. Genetic
testing can help determine
your risk of FAP.
Gardner's syndrome, a
variant of FAP that causes
polyps to develop
throughout your colon and
small intestine. You may

also develop noncancerous

tumors in other parts of
your body, including your
skin, bones and abdomen.
MYH-associated polyposis
(MAP), a condition similar to
FAP that is caused by
mutations in the MYH gene.
People with MAP often
develop multiple
adenomatous polyps and
colon cancer at a young age.
Genetic testing can help
determine your risk of MAP.
Peutz-Jeghers syndrome, a
condition that usually
begins with freckles
developing all over the
body, including the lips,
gums and feet. Then
noncancerous polyps
develop throughout the
intestines. These polyps
may become malignant, so
people with this condition
have an increased risk of
colon cancer.
Serrated polyposis
syndrome, a condition that
leads to multiple serrated
adenomatous polyps in the
upper part of the colon.
These polyps may become
malignant.

What you can do

Be aware of any preappointment restrictions,

such as not eating solid food
on the day before your
appointment.
Write down your symptoms,
including any that may seem
unrelated to the reason why
you scheduled the
appointment.
Make a list of all your
medications, vitamins and
supplements.
Write down your key
medical information,
including other conditions.
Write down key personal
information, including any
recent changes or stressors
in your life.
Ask a relative or friend to
accompany you to help you
remember what the doctor
says.
Write down questions to ask
your doctor.

PREPARING FOR YOUR

APPOINTMENT
You may be referred to a doctor who
specializes in digestive diseases
(gastroenterologist).

Questions to ask your doctor

What's the most likely cause

of my symptoms?
What kinds of tests do I
need? Do these tests require
any special preparation?
What treatments are
available?What are the
chances these polyps are
malignant?
Is it possible that I have a
genetic condition leading to
colon polyps?
What kind of follow-up
testing do I need?
Should I remove or add any
foods to my diet?I have
other health conditions.
How can I best manage
these conditions together?

TESTS AND DIAGNOSIS

Screening methods include:

What to expect from your doctor

You may be asked:

When did you first begin

experiencing symptoms, and
how severe are they?
Have your symptoms been
continuous or occasional?
Have you or has anyone in
your family had colon cancer
or colon polyps?
Has anyone in your family
had other cancers of the
digestive tract, the uterus,
ovaries or the bladder?
How much do you smoke
and drink?

Colonoscopy, the most

sensitive test for colorectal
polyps and cancer. If polyps
are found, your doctor may
remove them immediately or
take tissue samples
(biopsies) for analysis.
Virtual colonoscopy (CT
colonography), a minimally
invasive test that uses a CT
scan to view your colon.
Virtual colonoscopy requires
the same bowel preparation
as colonoscopy. If a polyp is
found, you'll need
colonoscopy to have it
removed.
Flexible sigmoidoscopy, in
which a slender, lighted
tube is inserted in your
rectum to examine it and
the last third of your colon
(sigmoid). If a polyp is
found, you'll need
colonoscopy to have it
removed.

TREATMENTS AND DRUGS

Your doctor is likely to remove all
polyps discovered during a bowel
examination. The options for removal
include:
Follow-up care

Removal during screening.

Most polyps can be removed
with biopsy forceps or a
wire loop that snares the
polyp. This may be aided by
injecting a liquid under a
polyp to lift it off the wall
for removal. If a polyp is
larger than 0.75 inches
(about 2 centimeters), a
liquid may be injected under
it to lift and isolate the
polyps from surrounding
tissue so that it can be
removed (endoscopic
mucosal resection).
Minimally invasive surgery.
Polyps that are too large or
that can't be reached safely
during screening are usually
removed using minimally
invasive surgery.
Colon and rectum removal.
If you have a rare inherited
syndrome, such as FAP, you
may need surgery to remove
your colon and rectum (total
proctocolectomy).

If you have had an adenomatous polyp

or a serrated polyp, you are at
increased risk of colon cancer. The
level of risk depends on the size,
number and characteristics of the
adenomatous polyps that were
removed.
You'll need follow-up screenings for
polyps. Your doctor is likely to
recommend colonoscopy:

In five years if you had only

one or two small
adenomasIn three years if
you had more than two
adenomas, adenomas
measuring 0.4 inches (about
1 centimeter) or larger, or
adenomas with a broad base
(villous)
Within three years if you
had more than 10 adenomas
Within six months if you had
a very large adenoma or an
adenoma that had to be
removed in pieces

It's important to fully prepare your

colon before colonoscopy. If stool
remains in the colon and obstructs
your doctor's view of the colon wall,

you will likely need a follow-up

colonoscopy sooner than the
guidelines specify.

LIFESTYLE AND HOME REMEDIES

You can greatly reduce your risk of
colon polyps and colorectal cancer by
having regular screenings. Certain
lifestyle changes also can help:

Eat fruits, vegetables and

whole grains.
Reduce your fat intake.

Limit alcohol consumption.

Don't use tobacco.
Stay physically active and
maintain a healthy body
weight.
Talk to your doctor about
calcium. Studies have shown
that increasing your
consumption of calcium may
help prevent recurrence of
colon adenomas. But it isn't
clear whether calcium has
any protective benefits
against colon cancer.
Talk to your doctor about
aspirin. Regular aspirin use
may reduce your risk of
polyps. But aspirin use can
increase your risk of
gastrointestinal bleeding, so
check with your doctor
beforehand.
Consider your options if
you're at high risk. If you
have a family history of
colon polyps, consider
having genetic counseling. If
you've been diagnosed with
a hereditary disorder that
causes colon polyps, you'll
need regular colonoscopy
starting in young adulthood.