Intestinal polyps are all elevated lesions on the mucosa of our intestine, including tumorigenic and non-tumorigenic lesions. Polyps are generally small, elongated, curved, irregularly shaped, free at one end or attached to the intestinal wall at both ends and suspended in the middle, in the form of a bridge. Before the pathological nature is determined, they are collectively called polyps.
First, the formation of intestinal polyps are mainly due to the following reasons: 1, infection: inflammatory polyps and chronic inflammation of the intestine; 2, age: the incidence of colorectal polyps increases with age; 3, embryonic abnormalities: juvenile polyposis is mostly misshapen tumors, may be related to abnormal embryonic development; 4, habits and genetics: low-fiber diet and colorectal polyps; smoking and adenomatous polyps are closely related; The occurrence of certain polyposis is related to heredity, such as familial non-polyposis colorectal cancer and familial adenomatous polyposis, etc.
Common high-risk groups include: family members with colon cancer or colon polyps; long-term eaters of high-fat, high-animal protein, low-fiber and fried foods; age greater than 50 years. In addition, the longer you sit, the higher the risk of developing intestinal polyps. It is recommended that these types of people have an annual examination such as electronic colonoscopy, anal finger examination and fecal occult blood to detect colon adenomas with cancer tendency in time. In Europe and the United States, where colorectal cancer is highly prevalent, from the age of 50, it is recommended for all people to have an annual occult blood test on naturally excreted stool and a complete colonoscopy every 5 to 10 years for early detection.
First of all, non-neoplastic polyps are generally not cancerous, mainly including: 1. Juvenile polyps: common in young children, mostly under 10 years old. They often occur in the rectum, are round and spherical, mostly single, and are pathologically characterized by retention cystic cavity of different sizes, which is a kind of misshapen tumor. 2. Inflammatory polyps: also called pseudopolyps. Is the ulcer of the colonic mucosa in the healing process of fibrous tissue hyperplasia and ulcer submucosal edema, so that the normal mucosal surface gradually elevated and formed. It is commonly found in chronic ulcerative colitis, amebic dysentery, schistosomiasis, intestinal tuberculosis and other intestinal diseases.
Adenomatous polyps are recognized as precancerous lesions. Adenomatous polyps can be divided into three types, namely tubular adenoma, villous adenoma and tubular choroidal adenoma, with tubular adenoma being the most common.
In terms of age of onset, adenomatous polyps develop cancer 5 to 10 years earlier than colorectal cancer. According to the adenoma to cancer development theory published by Morson in 1976, this time is about 10 years. However, according to some recent literature, it takes at least 5 years to develop from adenomatous polyps to cancer, and the average is between 5 and 10 years. In addition adenomatous polyp carcinogenesis is related to its size, morphology and pathological type. Broad-based adenomas have a higher rate of carcinogenesis than ciliated adenomas; the larger the adenoma, the greater the likelihood of carcinogenesis; and the more villous components in the adenoma structure, the greater the likelihood of carcinogenesis.
There are also special types of adenomatous polyps: flat polyps and lateral developmental polyps. Flat polyps are adenomas that are flat or slightly elevated on the surface of the colonic mucosa and have an adenomatous component that is no more than twice the thickness of the surrounding normal mucosa. It has been reported that the proportion of flat adenomas with severe heterogeneous hyperplasia exceeds that of the usual raised polyps. Therefore, flat adenomas are generally considered to be a cancer-prone type of adenoma. The larger the size of polypoid adenoma, the more malignant it tends to be. However, flat adenomas may become malignant at an early stage and become flat early colorectal cancer. Lateral developmental polyp refers to a type of flat elevated lesion originating from the colonic mucosa, which rarely invades the deeper layers of the intestinal wall and spreads laterally and superficially mainly along the mucosal surface,
They are also called proliferative tumors and precancerous lesions. At the early stage of growth, because there is no obvious difference between them and the surrounding mucosa, the mucosal surface is only slightly congested, rough or small granular elevation, so the diagnosis is often easily missed under endoscopy. However, mucosal staining with indigo carmine or methylene blue can help improve the diagnosis rate. Some dynamic studies have shown that its benign lesions can develop into progressive colorectal cancer within 3 years, so early diagnosis and treatment of LST can reduce the risk of colorectal cancer.
In clinical work, the treatment plan is generally decided according to the size, number, presence of complications and pathological nature of intestinal polyps: 1. Small polyps are usually removed during colonoscopy and sent for pathological examination.
2.Adenomas >3cm in diameter, especially villous adenomas, should be surgically removed: those below the peritoneal fold should be removed through the anus, while those above the peritoneal fold should be removed openly or under laparoscopy.
If adenoma penetrates the mucosal muscle layer or infiltrates the submucosa, it is invasive cancer and should be treated according to the principles of colorectal cancer treatment. If the adenoma malignant lesion does not penetrate the mucosal muscle layer, does not invade the small blood vessels and lymph, has a good differentiation degree, and has no residue on the cutting edge, it is not necessary to do surgery after removal, but should be closely observed.
4, inflammatory polyps to treat the primary intestinal disease, inflammatory stimuli disappear, polyps can disappear on their own; proliferative polyps symptoms are not obvious, no special treatment.
Intestinal polyps are not a major disease, but they should not be ignored. For polyps in the colonoscopy report, we should first clarify the nature through pathology, and then take the corresponding treatment plan. For recurrent polyp growth, we must pay attention to the possibility of genetic disease and also to whether it is accompanied by other diseases. For patients who are found to have intestinal polyps but do not need special treatment for the time being, they must pay attention to their daily diet and have regular colonoscopies.