Overview
Colon polyps refers to the high mucosa of the colon protruding into the intestinal lumen of the superfluous organisms generally no obvious symptoms, may appear abdominal pain, diarrhea, blood in the stool and other symptoms have not yet been clarified, may be related to genetic factors and inflammatory diseases mainly through endoscopic resection or surgical treatment
What are colon polyps?
Definition
A colon polyp is a bulge that rises above the surrounding colonic mucosa and projects into the intestinal lumen. It is most often detected during a routine physical examination and can be diagnosed by colonoscopy.
Staging and classification
According to the nature of the pathology
Adenomatous polyps, hyperplastic polyps, misshapen polyps, inflammatory polyps and so on.
Adenomatous polyps: also known as tumor polyps, is the most common type of colon polyps, is a benign tumor occurring in the intestinal mucosal epithelium.
Hyperplastic polyps: are the most common non-neoplastic polyps, usually <5mm in diameter, and are generally considered to have no malignant tendency or a small malignant tendency.
Dysplastic polyps: are disorganized growths of tissue present at the site. They are mostly juvenile polyps and occur most often in children.
Inflammatory polyps: are often secondary to an inflammatory response or infectious disease within the colorectum and generally have no malignant tendency.
Staging according to Paris
Endoscopically, elevated polyps can be categorized according to the Paris classification into three types: Ip (with protrusions), Is (broad-based, without protrusions), and Isp (in-between).
Endoscopic morphology
Polyps can be categorized into four types based on Yamada typing.
Type I: the polyp is mound-shaped, the elevation is relatively smooth, and the angle between the polyp and the mucosa is >90°.
Type II: polyps are hemispherical, with an approximate angle of 90° between the elevation and the mucosa.
Type III: the polyp is globular, and the angle between the bulge and the mucosa is less than 90°.
Type IV: the polyp has a distinct tip.
Incidence
The incidence of adenomatous polyps increases with age, with a detection rate of 25% to 30% in people aged 50 years and about 50% in people aged 70 years.
The incidence of colon polyps is higher in men than in women.
Questions you may be concerned about
What are the symptoms of colon polyps?
Colon polyps are usually asymptomatic. Some people may have symptoms such as a change in bowel habits, blood in the stool, and abdominal pain.
Patients may experience increased bowel movements or diarrhea or constipation. When there is bleeding from the polyp, there may be blood in the stool, and the stool may be dark red in color. Some patients may experience abdominal discomfort and vague pain.
Persistent bleeding from polyps may also cause patients to experience symptoms of anemia such as fatigue and shortness of breath. When the polyp is too large, it may also complicate intussusception and intestinal obstruction, resulting in abdominal cramps, nausea and vomiting.
How large are colon polyps?
The size of a polyp depends on the type of polyp and whether it is symptomatic or not.
Adenomatous polyps or other polyps with heterogeneous hyperplasia that are suspected to be malignant are usually recommended to be removed, regardless of the size of the polyp.
Inflammatory polyps, hyperplastic polyps, misshapen polyps, etc., if there are no clinical symptoms, do not cause intestinal obstruction, bleeding, can not be resected, but it is recommended that regular follow-up observation.
What kind of food is suitable for patients with colon polyps?
Patients with colon polyps are suitable to eat light food.
Patients with colon polyps are advised to eat more fresh vegetables, fruits and other foods rich in dietary fiber, such as beans, brown rice, etc., to ensure energy intake and to pay attention to the balance of nutrition.
Patients should try to eat less fried foods and other foods with high fat content, eat less spicy and stimulating foods such as chili peppers, and quit smoking and drinking.
Causes
Causes
The causes of colon polyps are not clear, and may be related to the following factors.
Genetic factors
Colon polyps run in families, and those with a family history of colon polyps and colon cancer are more likely to develop the disease.
Familial adenomatous polyposis is a clearly inherited disease.
Juvenile polyposis is an autosomal dominant disorder.
Inflammatory irritation
Long-term inflammatory irritation such as ulcerative colitis, intestinal tuberculosis, Crohn’s disease, schistosomal infections, and amoebic infections may also be associated with the development of colon polyps.
High risk factors
Unhealthy living habits
High-fat and low-fiber diet, smoking, lack of exercise, obesity, etc. can lead to increased incidence of colon polyps.
Disease factors
Gastrointestinal irritation such as chronic diarrhea and constipation may increase the probability of developing the disease.
Symptoms
Main Symptoms
Abnormal bowel movement
There may be diarrhea, constipation, and excessive bowel movements.
Blood in stool
Stools may be dark red in color and is one of the most common clinical symptoms.
Abdominal pain
A small number of patients may have symptoms such as stuffy discomfort and vague pain in the abdomen.
Complications
Anemia
Prolonged intestinal bleeding can lead to anemia, with symptoms such as easy fatigue, pallor, dizziness, etc. Large amounts of bleeding in a short period of time can lead to indifference or even coma.
Intussusception, intestinal obstruction
Large colon polyps can affect the rhythm of intestinal peristalsis and increase proximal intestinal peristalsis, thus causing intussusception, abdominal cramps, bloody stools and abdominal masses.
With the progress of intussusception, abdominal pain increases, abdominal distension, nausea and vomiting, stopping of bowel movement and other intestinal obstruction manifestations.
Consultation
Department of Medicine
Gastroenterology
If colon polyps are found during colonoscopy, prompt consultation is recommended.
For symptoms such as abdominal pain, blood in the stool, and change in bowel habit, timely consultation is recommended.
Preparation for medical treatment
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips
If there is blood in the stool, you should observe whether the blood mixes with the stool, the color of the blood, etc., and tell the doctor about the situation.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, etc.
Are there any symptoms such as abdominal pain or bloating?
How many times and what is the shape of the stool, and is there any blood in the stool?
Have you had any tests and what were the results?
Have you had any treatment, how was it done, and what were the results?
Have you taken certain medications recently, such as salicylates, anticoagulants, etc.?
List of medical history
Any other intestinal diseases?
Have parents and other family members suffered from colon polyps?
Checklist
Test results for the last six months, which can be brought to the doctor’s appointment
Colonoscopy, pathology report card
Electrocardiogram
Blood test, fecal occult blood, pre-transfusion examination
Medication list
Medication in the last 3 months, if available, bring along the box or package to the doctor’s office
NSAIDs: aspirin, clopidogrel, ibuprofen, indomethacin
Anticoagulants: warfarin, enoxaparin, rivaroxaban
Diagnosis
Diagnosis is based on
Medical history
Family history of colon polyps or colon cancer.
Clinical manifestations
Symptoms: changes in bowel habits, such as increased or decreased frequency of bowel movements, occasional abdominal pain, abdominal distension.
Physical examination: patients mostly have no positive signs, very few may have abdominal mass and localized pressure pain.
Laboratory tests
Fecal occult blood test
It is one of the common initial screening tools to determine gastrointestinal bleeding.
Endoscopy
One of the most commonly used tests for colon polyps, the endoscope enters through the anus and passes through the intestine to reach the polyp site.
Endoscopy can understand the location, size, number and shape of intestinal polyps, and can be performed at the same time pathological biopsy, clamping part of the diseased tissue for pathological examination, or direct polypectomy to determine the nature of the polyp.
Fasting is required on the day of colonoscopy. Before the examination, take bowel cleanser as required by the doctor.
Imaging
Ultrasonography
Ultrasonography has the advantage of being non-invasive and convenient, and can be performed first if the patient refuses endoscopy or there is no condition for endoscopy.
An enema is used to instill an ultrasound booster into the intestinal tract before the ultrasound examination is performed.
Ultrasonography can more accurately diagnose intussusception and intestinal polyps.
Precautions: low-fat, semi-slag fluid diet for 1~2 days before the examination, intestinal cleanser the night before the examination, fasting on the day of the examination, and adjusting the position as prescribed by the doctor during the examination.
CT examination
Multi-slice CT colon imaging is fast and non-invasive, and it can also complete the whole colon imaging for patients whose intestinal lumen is narrowed so that the endoscope cannot advance.
At the same time, it can show the situation outside the intestinal lumen, which is conducive to the staging and diagnosis of the disease.
Disadvantages: Multi-layer spiral CT colon imaging is less sensitive to the diameter of less than 5 mm and inflammatory colon polyps, easy to miss the diagnosis; if there is fecal residue in the intestine during the examination, it is easy to cause misdiagnosis.
Precautions: low-fat, half-slag liquid diet for 1 to 2 days before the examination, take intestinal cleanser the night before the examination, fasting on the day of the examination; remove the metal objects, such as headdresses, hairpins, keys, etc., before the examination; 10 minutes before the examination, injection of hypotonic agent to reduce gastrointestinal tension and inhibit peristalsis; adjust the position in compliance with the doctor’s instructions during the examination.
Differential Diagnosis
Colon cancer
Similarity: both have symptoms such as abdominal discomfort and bloody stools.
Differences: Clinical symptoms are often difficult to distinguish, but endoscopy and biopsy can be used for differential diagnosis.
Treatment
Treatment principle: Most of the colon polyps can be removed by endoscopy, and those who are not suitable for endoscopic resection can be removed by laparoscopic or open surgery.
Surgical treatment
Endoscopic surgery
Indications
Endoscopic removal of broad-based adenomatous polyps that are clipped or less than 2 centimeters in diameter.
Endoscopic treatments
Including endoscopic mucosal resection, endoscopic mucosal dissection, and loop removal of polyps.
Postoperative care
Patients should take bed rest for 6 hours and avoid heavy physical activities for 2 weeks.
Dietary adjustment: fasting for one day, followed by food gradually transitioning from a slag-free semi-liquid diet to a normal diet, and avoiding raw, hard and rough food for 2 weeks.
Please contact your doctor if you have any abdominal pain, black stool or blood in stool after surgery.
Surgical Removal of Colon Polyps
Suitable Crowd
Patients with wide base polyps larger than 2 centimeters in diameter, polyps located in special areas that are difficult to remove endoscopically.
Patients with a large number of polyps or suspected cancerous lesions that invade the deep submucosal layer. Endoscopic pathology confirms that the polyps have cancer invading into the deep layer of submucosa (infiltration depth greater than 1 mm), and should be treated according to the principle of radical treatment of colorectal cancer.
Surgical methods
Resection can be performed laparoscopically or openly.
Laparoscopy is often combined with endoscopy for polyp removal.
Postoperative care
Diet: refer to the order of eating from light liquid food to low-fat liquid food and then to low-fat semi-liquid food, and then eat general food after the gastrointestinal function gradually recovers, avoiding spicy and stimulating food.
Incision protection: Keep the surgical incision dry and clean. If there is fever, swelling and pain at the surgical incision, please contact your doctor promptly.
Surgical Complications
Intestinal perforation
It mainly manifests as severe abdominal pain and distension. Once it happens, laparoscopy or caesarean section should be performed immediately to repair the intestinal perforation.
Bleeding
Including intraoperative bleeding and postoperative bleeding, manifested as bloody or black stool. A small amount of bleeding can be stopped by high-frequency electrocoagulation through colonoscopy or conservative treatment by internal medicine; if the bleeding is large, the bleeding point should be explored and stopped by laparoscopy or open surgery.
Prognosis
Cure
For single benign colon polyps, surgical removal of the polyp is basically curative.
There is a certain probability of recurrence and reoccurrence of colon polyps, so regular review is recommended.
Hazards
Intestinal irritation symptoms: constipation or increased frequency of bowel movements, affecting daily life.
Anemia: long-term blood in stool will cause anemia, and those with large amount of bleeding will experience dizziness and shock, which is life-threatening in serious cases.
Intussusception, intestinal obstruction: Larger polyps may cause intussusception, intestinal obstruction, etc., resulting in abdominal distension, abdominal pain, blood in the stool, and cessation of defecation.
Some colon polyps are at risk of becoming cancerous.
Daily
Daily management
Dietary management
After eating a normal diet, you should also eat a light diet, with less stimulating and high-fat foods, and more fiber-rich vegetables and brown rice.
Exercise Management
Being sedentary is not good for health. Reduce sedentary time and moderate activity every 45 minutes to one hour.
Those who are overweight need to reduce their weight through exercise. They can formulate an exercise program under the guidance of a professional doctor and stick to it.
Strengthen the resistance by exercising appropriately.
Follow-up and review
Colon polyps are prone to recurrence, so regular follow-ups and colonoscopy are needed after surgery.
Depending on the risk level of the polyp, the time of follow-up should be decided according to the doctor’s treatment plan.
In the case of a single benign colon polyp, it is best to repeat the colonoscopy once a year after removal.
For multiple benign colon polyps, a colonoscopy should be done every year.
In the case of bowel polyps that are prone to recurrence and cancer, they should be rechecked 3 months after surgery; if there is no abnormality, this can be extended to every 6 months to 1 year.
If the symptoms do not decrease, or even worsen, timely consultation is needed.
Prevention
A good lifestyle is helpful in preventing intestinal polyps. Regular medical checkups can detect intestinal polyps as early as possible.
Eat a light diet, less greasy, spicy and irritating food, etc. Quit smoking and drinking.
Exercise appropriately. If you are overweight, you can formulate recipes and exercise programs under the guidance of a professional doctor to reduce your weight.
Have regular colonoscopies, especially for those with a family history of intestinal polyps.
Inflammation in the intestines needs to be treated promptly.