Internal Medicine

Colon polyps

definition

Colon polyps are thickened growths on the lining of the colon that protrude into the lumen of the intestine. It is a benign tumor that can degenerate and lead to colon cancer. They are either broad-based or stalked. The polyps are also divided into a non-hereditary and a hereditary form. Colon polyps are primarily a disease of old age. 20% of men over the age of 60 are affected. They are the most common benign tumor of the colon.

Symptoms

Colon polyps are usually asymptomatic. This means that they do not cause any discomfort. That is why colon cancer screening from the age of 55 is very important. Often polyps are found here that have not caused any symptoms and would therefore otherwise not have been noticed.

With every adenoma there is a risk of degeneration. Therefore, all adenomas should be removed. Has the polyp degenerates into a malignant (malicious) Tumor has occurred this may be caused by abdominal pain or blood in the stool or the stool turning black (Tarry stool) demonstrate. However, bowel tumors often only cause symptoms at a significantly advanced stage. Therefore, in many cases they are only discovered at a stage in which the therapy is more difficult compared to the early stage.

Read more on this topic at: These are the symptoms that help you recognize colon polyps

Pain

Colon polyps usually do not cause symptoms. In most cases, pain only occurs when the polyp has transformed into a malignant tumor that is growing rapidly.

Due to the fact that polyps do not cause any symptoms, colon cancer screening is of great importance from the age of 55. For patients in whom colon cancer occurs or has occurred in the family, the health insurance company may also undertake preventive examinations before the age of 55. The treating family doctor can be asked about this.

diarrhea

In most cases, intestinal polyps do not cause any symptoms and therefore often go undetected for a long time. However, larger polyps in particular sometimes cause non-specific symptoms such as blood in the stool or abdominal pain. Recurring diarrhea can also be an indication of intestinal polyps. Colon polyps often lead to a change from diarrhea and constipation.

Bleeding

The top layer of cells in intestinal polyps can rupture, causing occasional bleeding. The affected people then notice small amounts of blood in the stool. Most of the time the blood is bright red due to the fresh bleeding, but a black color is also possible. This is the case when the blood is in the intestine for a long time, where it is broken down and turns dark.

Often, however, the blood is not visible to the naked eye and is then viewed as a hidden (occult) Called blood. Special tests can tell whether there is blood in the stool.

Also read our topic: Blood in the stool

Causes of Colon Polyps

Colon polyps result from increased growth of the intestinal mucosa.

Environmental influences and malnutrition are possible causes. In particular, increased consumption of animal fat and protein increases the risk of colon polyps.
Colon polyps can also be genetically determined.

Familial adenomatous polyposis (FAP) is a risk factor for the development of papillary tumors. This is a congenital disease in which those affected develop numerous polyps (mucosal protuberances) in the large intestine due to a genetic mutation.

Read more about this under: Optic disc carcinoma

Can these arise from stress?

There are a number of risk factors that promote the development of intestinal polyps.In addition to genetic factors, an unhealthy lifestyle promotes the formation of polyps from the intestinal mucosa. In addition to an unhealthy diet, obesity and excessive alcohol and tobacco consumption, this also includes stress.

Diseases related to intestinal polyps

Colon polyps can occur either singly or in groups. If more than 100 polyps have formed in the intestine, one speaks of a polyposis. In most cases polyposis is inherited; spontaneous occurrence of so many intestinal polyps is rather rare.

Polyposis occurs in a number of intestinal diseases, the most common of which is familial adenomatous polyposis (FAP) is. This is an inherited disease that is caused by the mutation of a tumor suppressor gene (APC gene) is conditional. Those affected usually show numerous adenomatous intestinal polyps at an early age, especially in the area of the colon (large intestine). Since the entire colon is littered with polyps, there is a very high risk (almost 100%) that patients will develop colon cancer over time. The only treatment option currently is to use the entire colon as part of a Colectomy to remove.

Cronkhite Canada Syndrome is another condition associated with colon polyps. The patients develop numerous polyps in the stomach and intestines. In addition to severe diarrhea and weight loss, the symptoms also include hyperpigmentation of the skin, especially on the arms. Therapy is currently not possible and many patients die within a very short time after the diagnosis.

Familial juvenile polyposis is a very rare disease. With this inherited disease, numerous polyps form in the entire digestive tract in childhood or adolescence, which can lead to chronic bleeding. If left untreated, patients have a very high risk of developing colorectal cancer. Cowden syndrome and Peutz-Jeghers syndrome are also hereditary diseases that are associated with an increased incidence of intestinal polyps.

Colon polyps in children

Individual intestinal polyps can occur spontaneously even in children without an identifiable cause, although this is rarely the case overall. If children have many intestinal polyps, it is usually an inherited bowel disease, such as familial adenomatous polyposis (FAP) or familial juvenile polyposis. Symptoms of colon polyps in children include pain during bowel movements, frequent abdominal pain, and blood in the stool or diaper. A pediatrician should be consulted to clarify the symptoms. If intestinal polyps are suspected, a colonoscopy is performed under general anesthesia, even in young children.

Types of colon polyps

There are different types of colon polyps. A rough distinction can be made between neoplastic and non-neoplastic polyps.

The non-neoplastic polyps include the inflammatory polyps. These occur, for example, as so-called pseudopolyps in chronic inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. The group of hyperplastic polyps is also one of the non-neoplastic polyps. They are usually small (3-5 mm) and often multiple. This means that there are several of these polyps. Hyperplastic polyps of the size mentioned are usually benign.

A neoplasm is the formation of new tissue. The group of neoplastic polyps mainly includes adenomas. In principle, all adenomas carry the risk of malignant degeneration, so they can develop into a malignant tumor. The risk depends on the type of adenoma.

There are three types. The most common are the tubular adenomas, they make up about 70% of the adenomas in the large intestine. If they are less than 1 cm in size, they have a risk of degeneration of around 1%. From a size of over 1 cm, the risk of degeneration can increase up to 50%.

The second form are the villous adenomas. They make up about 10% of the adenomas in the colon. The risk of degeneration is 20-40%.

The third form of adenoma is a hybrid of the tubular and villous adenoma, the so-called tubulovillous adenoma. It makes up about 20% of all colon polyps.

How can you recognize malignant intestinal polyps?

Initially benign growths from the intestinal mucosa can develop into malignant intestinal polyps over time. Depending on the size and type of polyp, the growths have a different risk of degeneration. Most polyps are adenomas. These are new formations of the intestinal mucosa. These polyps are at the greatest risk of developing into cancer. Large polyps in particular often become malignant and should therefore be removed in good time.

Large polyps that are malignant can cause a variety of symptoms. These include abdominal pain, blood or mucus build-up in the stool, changes in stool behavior (diarrhea or constipation) and gas. These symptoms can also be caused by harmless benign intestinal polyps and are not a clear indication of degeneration. Unexplained weight loss in the past few weeks and severe exhaustion can indicate malignant intestinal polyps. A degenerate intestinal polyp can only be clearly identified by a doctor through a colonoscopy.

You may also be interested in this topic:

Colon cancer
Colon cancer screening

How fast do intestinal polyps grow?

Usually, benign colon polyps grow very slowly and it takes several years for a polyp to develop into a malignant tumor. Regular preventive examinations in the form of colonoscopies are therefore very useful from the age of 50, as any malignant growths can be discovered and removed very early on. In general, the faster an intestinal polyp grows, the higher its risk of degeneration.

Colon polyp therapy

Very small colon polyps can be removed with forceps during the endoscopic examination. Slightly larger colon polyps are removed with the help of an electric snare. Both procedures are called endoscopic polypectomy.

If there is an accumulation of polyps, it may be necessary to carry out this treatment in several sessions. The removed tissue is always examined histologically to rule out that it is a malignant growth. Polyps that are particularly large (3-5 cm) must be operated on. The associated intestinal section is completely removed. If there is a familial polyposis, the entire intestine must be removed. In addition, genetic counseling is provided to provide information about the inheritance risk. In addition, further diagnostics must be carried out in this case to rule out that other organs are also affected.

Read more on this topic at: Remove colon

How can you remove colon polyps?

Colon polyps are removed as part of a colonoscopy. Polyps should generally be removed for histological examination. In most cases, the colonoscopy cannot distinguish between the different types. Thus it cannot be decided with certainty whether there is a risk of degeneration or not.

A snare is usually used to remove a polyp. For this purpose, the polyp is grasped with the loop and then separated by adding electricity. It is painless for the patient. The polyp is then retrieved with special instruments and sent to the pathologist, who examines the polyp in its tissue. The pathologist can then make the above-mentioned classification.

A polyp removal is without complications in most cases. However, bleeding from the ablation site can rarely occur. This bleeding must then be treated endoscopically, i.e. as part of a renewed reflection of the intestine.

Read more about the topic here: This is how colon polyps are removed

diagnosis

Colon polyps are diagnosed through a colonoscopy. In a colonoscopy, the examiner inserts a long, flexible tube with a camera into the patient's anus and pushes it forward to the beginning of the colon.

When the tube is withdrawn, the mucous membrane of the large intestine can be assessed via the camera. The patient is given a sleeping pill for the duration of the examination so that he does not notice anything from the examination. The examination has a very low risk and can be carried out on an outpatient basis (in an internal medicine practice) in stable patients.

In order to have a clear view of the mucous membrane during the examination, the intestine must first be cleaned. For this, the patient is given a laxative. The advantage of the endoscopic examination is that colon polyps that have been discovered can be removed immediately or tissue samples can be taken.

Read more about the topic here: Colonoscopy (colonoscopy)

forecast

Thanks to the possibility of early detection as part of a colonoscopy, it is now easy to identify and remove colon polyps at an early stage. This significantly reduces the risk of cancer development.

In general, polyps are safe and removal is sufficient therapy. Once polyps have developed, additional polyps are often discovered during subsequent colonoscopies. It is therefore always advisable to carry out check-ups at regular intervals.

prophylaxis

Statutory health insurance pays for a prophylactic colonoscopy for people over 50 years of age. It is worth taking advantage of this, as polyps recognized early can be easily removed, while polyps that are not recognized represent a high risk of cancer.

Furthermore, it makes sense to eat less fat and protein and to eat more fiber. A conscious diet with salad, vegetables and fruit is supposed to prevent intestinal diseases.

Read more on this topic at: These are the symptoms that help you recognize colon polyps

Summary

Colon polyps are a common condition. They are mostly not discovered or by chance during a preventive colonoscopy or a colonoscopy with other questions. Most colon polyps are harmless, but polyps that are discovered must always be removed and then examined histologically, because in rare cases they can be very dangerous and represent a preliminary stage of colon cancer.

Due to the increased incidence of colon polyps in the older population (> 60 years), it makes sense to have an annual colonoscopy as a preventive measure. Statutory health insurance pays prophylactic colonoscopy for people over 50 years of age.

Hereditary polyposis syndromes are a rare cause of colon polyps. Familial adenomatous polyposis with a cancer risk of over 90% is particularly dangerous.