Colonic Polyps

What are Colonic Polyps?

Colonic polyps, also known as colon polyps are cell growths that occur on the colon surface. These clumps of cells have a base on the colon epithelial surface and protrude into the large intestine cavity.

Some of these polyps can evolve into colon cancer, which can be a fatal diagnosis if discovered at a late stage.

Who does Colonic Polyps Affect?

While colonic polyps can affect anyone, they commonly occur in adults of ages 50 and above.

Patients with an elevated risk of developing Colonic Polyps typically have one or more of the following pre-existing conditions:

• People with inflammatory diseases of the intestine (such as Crohn’s disease), 
• positive family history of colon cancer or polyps, 
• long standing tobacco and alcohol use, 
• uncontrolled Type 2 Diabetes, or 
• those who are obese with a sedentary lifestyle 

How do Colonic Polyps Occur?

Colonic polyps occur when there is abnormal proliferation and growth of tissue. When this growth occurs, it results in the formation of polyps which are in fact small clumps of these cells. This growth can either benign or malignant and varies in each case.

Causes of Colonic Polyps

The exact cause of colonic polyps is still unknown. Mutations resulting in uncontrolled proliferation of cells is one explanation that is being considered.

Symptoms of Colonic Polyps

In most cases, colonic polyps don’t cause any symptoms. They are often discovered for the first time during routine digestive tract examination or while the physician is running tests for some other complaint. In some cases, patients do experience some symptoms which include:

• Rectal bleeding
• Blood streaked stool or changed color of stool
• Constipation or diarrhea, which lasts more than a week
• Abdominal cramps and pain due to obstruction (usually indicates larger sized polyps)
• Anemia

Types of Colonic Polyps

Colonic polyps can be classified broadly into benign and malignant polyps. Further classification of these types can be done as following:

Benign Polyps

• Hyperplastic polyps
• Inflammatory polyps
• Hamartomatous polyps

Malignant Polyps

• Adenomas (have the potential to become cancerous)
  
• Serrated polyps

Adenomatous polyps are the most common type of polyps diagnosed. Peptic ulcers can be classified based on location into gastric ulcers, affecting the stomach lining and duodenal ulcers, which occur in the duodenal region of the small intestine.

Stages of Colonic Polyps

Colonic polyps can be specified into stages based on their size and proliferation depth. Malignant polyps can further be staged and graded based on their histological profile.

How are Colonic Polyps Diagnosed?

Most of the polyps are first discovered during routine screening examinations. The doctor begins by taking complete history and a thorough physical examination. Some screening methods to identify polyps include: 

• Stool tests to identify blood in stool, as a precursor to colonoscopy.
• Colonoscopy, which allows the doctor to visually examine the large colon. If polyps are discovered, the doctor may take some biopsy samples for lab analysis. The pathologist is able to determine whether the polyps are benign or malignant by examining the sample under a microscope.
• Virtual colonography using a CT scan.
• Flexible sigmoidoscopy

How are Colonic Polyps Treated?

The treatment for polyps involves their removal. Often times they are removed in the colonoscopic procedure at the same when they are discovered using a forceps or a wire loop attachment.

In certain cases with larger sized polyps, laparoscopic surgery may be required. And in very advanced cases or cases of inherited syndrome causing polyps (FAP- Familial adenomatous polyposis), the doctor may recommend complete colon and rectum removal with surgery. 

Removing Polyps and Doing Biopsies

During the course of your colonoscopy, your Gastroenterologists will use air or medical Carbon Dioxide gas to inflate the colon to help see the lumen. If your Gastroenterologist sees a polyp (benign growth) or other abnormalities, he or she may remove it in its entirety or a piece of it if it’s too big to safely be removed with a colonoscope.

The equipment used includes biopsy forceps or a snare. You can see that there is a channel at the tip of the colonoscope. Most colonoscopes have multiple channels — it is through the channels that your Gastroenterologist can utilise the equipment to remove the polyps.

Why are Polyps or Tissue Sent to the Laboratory?

After removing a polyp, your Gastroenterologist will retrieve and send the tissue to a laboratory to determine the nature of the lesion. Most colon cancer starts as noncancerous polyps. Because the underlying nature of colon polyps can’t be determined without being examined under a microscope by an experienced Histopathologist, most polyps are removed during colonoscopy. The colon doesn’t feel pinching or burning sensations, and as patients are sedated, people don’t feel a polyp being removed. The colon pain receptors do feel the stretching sensation from air distension, but your Gastroenterologist will try to remove most of the air inside the colon (by suctioning) before completing the procedure.

After Removal of Polyps

When a polyp is removed from the lining of the bowel, a small ulcer or sore remains at the removal site, which can be prone to bleed, either immediately or within two weeks (called “delayed bleeding”). If you had polyps removed during your colonoscopy, your Gastroenterologist may specifically request withholding blood-thinning medications or advising against alcohol consumption for a certain number of days. Ask your doctor if he or she wants you to withhold any medications, and when it is safe to resume taking your normal medicines. Some over-the-counter medicines may increase the risks of bleeding post-procedure, and you should ask your Gastroenterologist if you can continue to take them.

Within 30-40 minutes after the procedure or when you are fully awake, your doctor will be able to reassure you; or advise you whether there was something serious or concerning detected on the examination. You will be provided with a written report which contains photos of the large bowel taken during the examination. A copy of the report will be sent to your Family Doctor, either via email or by post on the same day. The majority of individuals undergoing colonoscopy get reassuring news that the examination was normal or that only small polyps were found which had been safely and successfully removed. If your Gastroenterologist is concerned about something found during the examination, the doctor will request you to return – usually within a week or two to discuss the laboratory results.

Waiting for results of biopsies can be unnerving. Be sure you or your family member driving you home gets a chance to review the report of the colonoscopy with your doctor before you leave the endoscopy centre. Knowing whether you have something to be concerned about, or your doctor doesn’t want to see you for 5-10 years will be reassuring. Don’t spend too much time worrying about biopsy results, but be comforted by the fact that you took the proper steps for your health by getting a colonoscopy, and that you will take the proper steps for what happens next. The results may simply show an advanced polyp that may have been caught in time, and if colon cancer does occur, it’s curable when caught early. Doctors continue to discover more about colon cancer and the factors that influence its development, and as you’re finding out, they also have effective screening tools that aid in its prevention.

What if Colorectal Polyps are Untreated?

If left untreated, colorectal polyps can cause issues such as obstruction, chronic constipation and diarrhea. In cases of malignant polyps, they can develop into colon cancer which can be fatal, unless timely removed.