Intestinal Polyps are abnormal growths from the lining of the bowel, occurring mostly in the large bowel (aka large intestine/colon) , although there are some inherited conditions where polyps can be found anywhere in the bowel.
The majority do not cause symptoms, and are usually discovered incidentally. Most are benign, though they can become malignant and hence are often removed.
The polyp may arise like a mole hill from the inner lining of the gut wall, or protrude like a stalk (resembling a pin from a ten pin bowling alley with the neck of the polyp being closer to the bowel wall than the more bulbous end). Polyps may be solitary or they maybe found in groups in the bowel.
As mentioned above, some polyps can cause symptoms such as:
- Bleeding from the polyp
- Stool colour changes – blood loss from higher up in the bowel may be partly digested hence the final appearance of a dark tarry stool (long term minor blood loss can result in anaemia)
- Excessive mucus production
- Pain and discomfort
Any of these features generally require a colonoscopy (this is a test that allows examination of the inner lining of the large intestine, the rectum and colon, using a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding) with the passage of a semi-flexible camera with adjacent tubes along which other tools can be passed. These tools can be manipulated under direct vision beyond the end of the colonoscope. One ‘tool’ that is used is a wire loop that can be put around the neck of a pedunculated polyp. As there are not usually pain fibres in this type of polyp, it should be a painless procedure.
Sessile polyps (ie those found in the gut wall) can be cut away, though it is more likely that there will be a complication, such as increased bleeding, owing to its anatomical features.
Other surgical techniques include ‘key hole surgery,’ or very uncommonly, an open abdominal operation.
The polyp(s) is always sent away for histological confirmation that it was completely removed, that there are no cancerous changes and whether or not it is a type that may re-form.
Repeated colonoscopies on a regular basis may be needed, eg patients who have inflammatory bowel disorders such as Crohn’s disease, adenoma or ulcerative colitis.
There are a number of inheritable disorders that can be associated with multiple polyps (and in some cases with an increased likelihood of cancerous change).
This is characterised by freckles developing on the gums and lips and is associated with polyps developing anywhere in the bowel (these polyps have the potential to become cancerous)
Familial Adenomatous Polyposis (FAP)
A rare disorder wherein thousands of polyps can develop in the colon, and an indefinite number can become cancerous. By 40 years of age, colon cancer is a virtual certainty without treatment for FAP. Gardner’s syndrome is a variant of this in that malignant growth occur in the colon +/- small intestine and other tissues as well, e.g. breast and bones.
This is the most common form of inheritable malignancy, in which a few polyps are found in the colon, but they rapidly become cancerous and may rapidly disseminate. It is associated with breast, ovarian and renal tract tumours.
For patients with the symptoms/signs investigations should be conducted to determine their origin, such as colonoscopy or CT colonoscopy. Patients with inheritable disorders such as mentioned above should be screened to ensure that colonic polyps are treated appropriately (as well as other potential sites).
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