The real case 1 year ago, Professor Ji from a research institute, engaged in geological exploration in the field for a long time, had blood in the stool for a while, thought it was hemorrhoids, used some hemorrhoid medication, but the blood in the stool still came and went. The careful daughter, who had received early education on colorectal tumors, dragged her father to the surgical clinic for consultation. After colonoscopy, multiple polyps with a diameter of 1.0-2.5 cm were found scattered 25-60 cm from the anus, which were immediately removed by endoscopic electrocautery. The postoperative pathology suggested: “villous adenoma with moderate atypical hyperplasia and locally severe atypical hyperplasia (“severe atypical hyperplasia” is equivalent to precancerous lesions). Professor Ji’s daughter was grateful afterwards. The two brothers of Prof. Ji also had a similar history. So I told the father and daughter that it did not end there, and asked him to follow up in 6 months, and a new polyp in the colon was found. I then told Professor Ji that he should have developed familial-like colonic polyposis. So what kind of disease is colorectal (what we normally call colorectal) polypoid lesions? Several signs of colorectal polyps Colorectal polyps are elevated lesions on the mucosal surface of the colorectal lumen, mostly found in the rectum and sigmoid colon. Colorectal polyps are very common, the incidence increases gradually with age, and there is a certain tendency of malignant change, the malignancy rate is about 10%. Colorectal polyps can be single or multiple. When the number of polyps is large, more than 100, it is called colorectal polyposis, and clinically there are two main types of polyposis: dark spot polyposis (P-J syndrome) and familial adenomatous polyposis. Among colorectal polyps, there are two pathological types that should be paid special attention to: first, adenomatous polyps, including tubular, villous and tubular villous adenomas, which have a high probability of carcinogenesis, especially villous adenomas, which are 100% carcinogenic if left untreated. The second is familial polyposis, which is an autosomal dominant disease, precancerous, with a 100% malignancy rate. Colorectal polyps often start insidiously. There are 4 common signs: ① Blood in the stool: many young people with irregular diet and constipation often have blood in the stool, and there is still bleeding after 1 week of medication, or the symptoms often recur after the medication improves, so you need to go to the hospital in time. ②Changes in stool habits and traits: If you find that your stool has become thin, grooved, and mucusy, and if your stool was once a day but now becomes once every two or three days or two or three times a day, you need to pay attention to it. ③Constipation and diarrhea: Patients with chronic diarrhea and constipation need further examination to rule out the possibility of colorectal polyps if medications are not effective. ④Abdominal pain: Those with long-term abdominal pain should undergo colonoscopy, and after excluding colorectal polyps, symptomatic treatment should be performed. Treatment: colonoscopic electrodes should be preferred Currently, the main methods used to diagnose colorectal polyps are colonoscopy and barium enema. Barium enema examination is easily disturbed by feces and cannot be biopsied and further treated, so it has been gradually replaced by colonoscopy. Colonoscopy can not only observe the subtle lesions of the colonic mucosa directly, but also determine the nature of the lesions through biopsy, which is an important means to detect and confirm the diagnosis of colorectal polyps. The best method for treating colorectal polyps is colonoscopic removal. Before the development of endoscopic technology, the treatment of colorectal polyps was mainly open surgery or transanal resection, which was more invasive. Today, with the continuous development of colonoscopy technology, endoscopic removal of colorectal polyps has become the gold standard for the treatment of colorectal polyps. Total colorectal resection is preferred for familial polyposis to completely eliminate the “soil” for polyps to occur. Reminder: regular review after polyp removal Colorectal polyps have a genetic tendency, and the immediate family members of colorectal polyp patients, such as siblings and children, have 4 to 6 times the risk of colorectal polyps and 6 to 10 times the risk of colorectal cancer. Therefore, if there are parents or immediate family members with colon cancer or colon polyps, once you find yourself with abnormalities such as bleeding stools, diarrhea and deformed stools, you should go to the hospital promptly. Colorectal polyps are easily recurring and can appear in any part of the large intestine. Therefore, polyp removal is not a one-time thing, regular colonoscopy is very necessary. Proliferative polyps can be followed up once every 1 to 2 years because of their slow growth. Adenomatous polyps, especially those with atypical hyperplasia, should be followed up for a shorter period of time, usually 6 months to 1 year (severe atypical hyperplasia should be followed up once in 3 months after polyp removal, and if there is no abnormality, it can be extended to 6 months to 1 year). New advances in the study of colorectal polyp genes Japanese researchers have found that colorectal polyps are prone to develop into malignant tumors with metastasis if there are mutations in three genes in colorectal polyp cells, but normal colorectal cells with mutations in these genes do not develop into malignant tumors. The results show that removal of colorectal polyps can effectively prevent colorectal cancer and will help develop new treatments. Researchers from Keio University and the University of Tokyo in Japan noted that five genes, APC, KRAS, SMAD4, TP53, and PIK3CA, were expressed at high frequencies in colorectal cancer cells. They collected normal cells and polyp cells from colorectal polyp patients and used a gene editing technique to mutate all five of these genes in normal cells and found that normal cells did not become cancerous as a result. But as soon as the three genes, KRAS, SMAD4 and TP53, were mutated in the polyp cells, the polyp cells became malignant to cancer cells. The researchers believe that this indicates that more genetic changes are needed for normal colorectal epithelial cells to become cancerous, whereas developed colorectal polyps are susceptible to cancer with only a few genetic mutations. This is consistent with the clinical data that colorectal polyps over 1 cm are prone to develop into colorectal cancer. This provides scientific evidence that the use of endoscopic surgery to remove colorectal polyps is effective in preventing colorectal cancer. Frontier developments in colorectal polyp screening Colonoscopy is the more common and intuitive test for screening. However, given its “invasive” and “potentially perforating” nature and risks, many people are reluctant to undergo it, resulting in patients with mild early symptoms missing the best diagnosis (generally the earlier the cancer is detected, the higher the survival rate of the case). In contrast, in Western countries, a lot of research and practical work has been done in recent years on “non-invasive” and “low-risk” screening methods, and the relevant research results have been applied to clinical practice. Virtual colonoscopy is one of the most popular diagnostic techniques for colorectal lesions in Western countries. A New York research institute and hospital have jointly developed a virtual bowel reconstruction technique based on CT images, which provides a new approach to early colorectal screening.