Overview of Colorectal Polyps
Colorectal polyps are elevated lesions that occur on the mucosal surface of the colorectum and protrude into the lumen of the bowel, most of which are asymptomatic, while a few may have abnormal bowel movements, blood in the stools, abdominal pain and other symptoms. Most of them can be removed endoscopically, and can be treated surgically if necessary.
What are colorectal polyps?
Definition
Colorectal polyps are elevated lesions on the mucosal surface of the colorectum that project into the lumen of the bowel, most commonly found in the sigmoid colon and rectum.
The number of colorectal polyps varies and can be single or multiple, and when the number is more than 100, it is called intestinal polyposis.
Types
According to the number of polyps
Colorectal polyps can be categorized as single or multiple, and when the number of polyps is more than 100, it is called polyposis.
According to histology
can be divided into tumor polyps, misshapen polyps, hyperplastic polyps, inflammatory polyps, etc..
Tumor polyps: also known as adenomatous polyps, which are clear precancerous lesions, including tubular adenomas, chorioadenomas, tubular chorioadenomas, etc. The more the chorionic component is, the higher the rate of cancer.
Erroneous polyp: it is caused by abnormal formation of normal tissues with disturbed tissue structure. Generally, they will not become cancerous.
Hyperplastic polyp: small in size, with a diameter of not more than 5 mm, usually considered as non-neoplastic lesions. However, in recent years, it is found to have certain correlation with colorectal cancer.
Inflammatory polyp: also known as pseudopolyp, which can be seen in inflammatory lesions of the colorectum, such as inflammatory bowel disease and schistosomiasis.
According to endoscopic morphology
Polyps can be categorized into four types according to 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 elevation and the mucosa is less than 90°.
Type ⅠV: the polyp has a distinct tip.
According to Paris typing
The elevated colorectal polyps can be categorized into three types: Ip (with tips), Isp (between Ip and Is, with sub-tips), and Is (widely basal, without tips).
Morbidity
The detection rate of colorectal polyps in China is 14.8% to 17.8%. The prevalence increases with age, with 60-80 years old being the peak of the disease, which can reach 40%~60%.
The prevalence is higher in men than in women.
Questions you may be concerned about
Do colorectal polyps always require surgery?
Not necessarily.
Most colorectal polyps can be removed endoscopically. Only when there are too many polyps, when the polyps are too large, when the location of the polyps is not suitable for endoscopic resection, or when the polyps are cancerous and invade the submucosa, they need to be removed by traditional open surgery or laparoscopic surgery. Polyps located in the rectum can also be removed by anal surgery.
If the polyp has a low probability of malignancy and has no clinical symptoms, it can also be left unresected, but it should be observed dynamically and followed up regularly. Inflammatory polyps should be treated as the primary cause.
What are the early symptoms of colorectal polyps?
Colorectal polyps are usually asymptomatic in the early stage, and a few people may have changes in bowel habits, abdominal discomfort, and blood in the stool.
A few patients may have more frequent bowel movements than before or diarrhea or constipation. If the polyp is located in the rectum, there may also be symptoms of urgency but difficulty in passing stool. Patients may experience recurrent bloating, discomfort, or vague abdominal pain.
If the polyp bleeds, or if the polyp is squeezed and dislodged during a bowel movement, the patient may also have blood in the stool, which is dark red in color or has a bright surface of blood.
How are colorectal polyps detected?
Most can be diagnosed by colonoscopy.
In some cases, polyps may be detected during a physical examination through anal examination or rectal fingerprinting. A colonoscopy can visualize the polyp and confirm the diagnosis. Under the microscope, a biopsy or direct excision of the polyp tissue can be performed to determine the type of pathology.
Other tests, such as fecal occult blood test and blood test, can also help to determine whether the colorectal polyp is combined with bleeding, anemia, or infection.
Causes
Causes
The causes of colorectal polyps are unknown and may be related to the following factors.
Genetic factors
Colorectal polyps run in families, and patients with a family history of colorectal polyps and colorectal cancer are more likely to develop the disease.
Inflammatory stimulation
Long-term inflammatory stimuli such as ulcerative colitis, intestinal tuberculosis, Crohn’s disease, schistosomiasis infection, amoebic infection, etc., may also be related to the occurrence of colorectal polyps.
High risk factors
Unhealthy living habits
High-fat and low-fiber diet, smoking, lack of exercise, obesity, etc. can lead to an increased prevalence of colorectal polyps.
Disease factors
Gastrointestinal irritation such as chronic diarrhea and constipation may increase the likelihood of colorectal polyp prevalence.
Symptoms
Main Symptoms
Colorectal polyps rarely cause discomfort and most patients have no obvious symptoms.
A small number of patients may experience abnormal bowel movements, blood in the stool, abdominal pain, rectal prolapse and other symptoms.
Bowel movement abnormalities
Diarrhea and constipation may be present.
Blood in stool
It is a common clinical symptom, mainly painless blood in stool.
Bleeding during or after defecation is bright red, sometimes with a small amount of blood on the surface of the stool, or staining the toilet paper red.
The amount of bleeding is usually small; if the polyp is dislodged by squeezing during defecation, or if the polyp is large in size and in a low position, a larger amount of bleeding may occur.
Abdominal pain
A small number of patients may have symptoms such as abdominal stuffiness and discomfort, hidden pain.
Rectal prolapse
When the rectal polyps are large or in large number, due to gravity pulling on the intestinal mucosa, it gradually separates from the muscle layer and prolapses downward.
When defecating, you can feel a mass prolapse, and it can be reset by itself after defecation. In severe cases, the mass can be dislodged when coughing, straining or even standing.
Complications
Anemia
If the polyp surface erosion can cause bleeding, long-term can lead to anemia, easy to fatigue, pale, dizziness and other symptoms.
Intussusception, intestinal obstruction
Large colorectal polyps can affect the rhythm of intestinal peristalsis, so that the proximal intestinal peristalsis is enhanced, thus causing intussusception, abdominal cramps, blood in the stool and abdominal mass.
With the progress of intussusception, abdominal pain worsens, abdominal distension, nausea, vomiting, cessation of defecation and other intestinal obstruction manifestations gradually appear.
Colorectal cancer
Tumorous polyps are recognized as precancerous lesions and are highly likely to develop into malignant tumors.
Colorectal cancer may present the following manifestations.
Changes in stool shape, such as sudden thinning of stool, or less smooth bowel movement.
Finding blood in the stool after defecation.
Change of bowel habit, such as constipation and diarrhea alternately.
Consultation
Department of Medicine
Gastroenterology
If colorectal polyps are found during colonoscopy, prompt medical attention is recommended.
If symptoms such as abdominal pain, blood in the stool, or changes in bowel habits occur, prompt medical attention is recommended.
Preparation for medical treatment
Preparing for the consultation: registration, preparation of documents, and frequently asked questions
Tips
If there is blood in the stool, you should pay attention to whether the blood mixes with the stool, the color of the blood in the stool, 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 recently taken certain medications, such as NSAIDs, anticoagulants, etc.?
List of medical history
Any other intestinal diseases?
Have parents and other family members had colorectal polyps?
Checklist
Test results for the last six months, which can be brought to the doctor’s office
Colonoscopy, pathology report card
Electrocardiogram
Blood test, fecal occult blood, pre-transfusion test
Rectal palpation
Medication list
Medications used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
NSAIDs: aspirin, clopidogrel, ibuprofen, indomethacin
Anticoagulants: warfarin, enoxaparin, rivaroxaban
Diagnosis
Diagnosis is based on
Medical history
There may be a family history of colorectal polyps or colon cancer.
Clinical manifestations
Most of them have no obvious symptoms, and a few of them may have abnormal bowel movement, blood in the stool, abdominal pain, rectal prolapse and other symptoms.
Through anal visualization and rectal fingerprinting, protruding polyps can be seen, or a bulge in the anal canal can be touched.
Laboratory tests
Fecal occult blood test
To detect occult fecal bleeding for early intervention.
Precautions
Avoid iron-rich foods such as animal offal and animal blood products for 3 days before the test.
If you are taking iron supplements, you need to stop taking them 3 days before the test.
Empty the urine before the test to avoid urine contamination of the fecal specimen.
After defecation, take a small amount of the middle part of the feces as a specimen and put the specimen into a special container.
After taking the specimen, send it for examination as soon as possible to avoid contamination.
Blood test
Most of them are normal. If polyps cause bleeding or infection, changes in the number of blood cells (red blood cells, white blood cells, platelets), morphological distribution, and changes in hemoglobin can be observed.
The presence of infection or anemia can be determined. When there is an infection, the white blood cell count can be seen to be elevated; when there is anemia, the hemoglobin can be seen to be lowered.
Anoscopy
One of the routine tests for anal and rectal diseases, it can clearly observe the characteristics of the lesion and identify whether it is a hemorrhoid or a polyp.
The location, size and shape of the polyp can be directly observed, such as adenomas with a slightly reddish appearance, with a tibial or broad base, and a spherical or hemispherical shape.
For polyps suspected of malignancy, biopsy can be taken under the microscope to further clarify the pathological diagnosis.
In addition to examination, it can also be used as a means of treatment.
Precautions
Fasting, water fasting and fecal evacuation 8 hours before anoscopy.
After 2 hours after the examination, you can drink a moderate amount of water first, and eat some easy-to-digest, softer food after the anesthesia disappears.
If severe abdominal pain or vomiting of blood occurs after the examination, you should consult a doctor in time.
Colonoscopy
One of the most commonly used methods to examine colon polyps, the endoscope enters through the anus and passes through the intestines to reach the site of the polyp.
It can understand the location, size, number and shape of the intestinal polyps, and can clamp part of the diseased tissue at the same time, or directly carry out polypectomy to carry out pathological examination to determine the nature of the polyps.
Precautions
1 day before the examination, eat a liquid diet (e.g. thick rice soup, lotus root powder, etc.), and fast in the morning of the same day.
Take intestinal cleanser to clean the intestines 1 day before the examination to ensure the examination goes smoothly.
Pathologic examination
It can determine the nature and type of lesion and whether there is cancer.
It is the gold standard for determining whether colorectal polyps are cancerous.
Others
Such as ultrasound, abdominal CT, etc., help to identify the disease.
Differential Diagnosis
Hemorrhoids
Similarity: both have symptoms such as bleeding and prolapse.
Differences: Hemorrhoids manifest as blood in stool and anal swelling, pain, itching, initially for the toilet paper stained with blood, occasionally see the blood drops and ejaculation of blood, the late stage of the hemorrhoid nucleus prolapse after defecation, the local feeling of a foreign body, and also see constipation, or defecation, such as unpleasant. Colorectal polyps are mostly located inside the anorectum and reddish in color.
Colorectal cancer
Similarity: constipation and diarrhea.
Differences: Early colorectal cancer is often difficult to be identified by clinical symptoms, but endoscopic biopsy and histopathology can be used for differential diagnosis.
Treatment
The vast majority of colorectal polyps can be resected endoscopically, and the purpose of resection is to clarify the diagnosis and prevent colorectal cancer.
For those who are not suitable for endoscopic resection, if the polyp is located in the rectum, it can be resected by anal surgery; if the polyp is located in the colon, it can be resected by laparoscopic or open surgery; for those who have difficulty in locating the polyp, it is feasible to locate the polyp by intraoperative colonoscopy.
Endoscopic resection
Indications
Botched or broad-based polyps.
Surgical methods
Including endoscopic mucosal resection, endoscopic submucosal dissection, cold excision of polyps, polyp biopsy forceps removal method, high-frequency electrocautery, argon ion coagulation method.
Postoperative care
Bed rest for 6 hours, avoid heavy physical activity for 2 weeks.
Dietary adjustments: fasting for one day, followed by a gradual transition of food from a slag-free semi-liquid diet to a normal diet, avoiding raw, hard and rough food for 2 weeks.
If you have any abdominal pain, black stool or blood in stool after surgery, please contact your doctor promptly.
Transanal resection
Suitable for those who are not suitable for endoscopic resection and the polyp is located in the rectum.
For polyps 5 to 10 centimeters from the anal verge, resection via the anal sphincter route is feasible.
Laparoscopic or open surgery
Indications
Polyps located in special areas where endoscopic resection is difficult.
The polyps are large in number or suspected to be cancerous, invading the deep layer of submucosa. If the endoscopic pathology confirms that the polyps are cancerous and invade the deep layer of submucosa (the depth of infiltration is more than 1 mm), the treatment should be carried out 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 polypectomy.
Postoperative care
Eat according to the order of gradual transition 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.
Keep the surgical incision area dry and clean on a daily basis. If there is fever, swelling and pain at the surgical incision area, please contact your doctor promptly.
Prognosis
Cure
The prognosis is good if diagnosed early and treated with excision.
Removal of polyps before they become malignant usually does not affect life expectancy.
Early screening and timely removal of tumorigenic polyps can prevent the development of cancer; if treatment is delayed, cancer may develop and the prognosis is poor.
Harmfulness
Patients may suffer from constipation, diarrhea and other symptoms, affecting daily life and work.
Prolonged blood in stool will cause anemia, and those with large amount of bleeding will experience dizziness and shock, which can be life-threatening.
Some colorectal polyps have cancer risk.
Daily
Daily Management
Dietary management
Avoid spicy and stimulating foods, such as chili peppers and ginger.
Increase fibrous foods, such as an appropriate amount of fresh vegetables like leeks, celery and groundnuts, as well as fresh fruits, whole grains or foods with mixed sugars.
Reduce the intake of fatty foods and replace fried foods with boiled and steamed foods.
Eat less pickled and smoked food and no moldy food.
Drink 2,000 ml of water daily to keep your body hydrated.
Exercise Management
Being sedentary is not good for health, moderate activity every 45 minutes to 1 hour.
Those who are overweight need to reduce weight through exercise. They can formulate an exercise program under the guidance of a professional doctor and stick to it.
Life Management
Rest more, combine work and rest, and avoid excessive fatigue.
Maintain emotional stability, avoid emotional excitement and tension.
Stay optimistic and have a good mindset to cope with stress.
Make a habit of regular defecation, do not read newspaper, listen to the radio, play with cell phone during defecation, and the defecation time should not be too long.
Follow-up review
If colorectal polyps are found by colonoscopy, regular follow-up colonoscopy should be conducted as prescribed by the doctor after standardized treatment.
Tumor polyps are usually reviewed 6 months after surgery, or as prescribed by the doctor for regular follow-up.
Non-neoplastic polyps are usually reviewed within 1 year after surgery, or as prescribed by the doctor.
If symptoms do not decrease, or even worsen, you need to see a doctor.
Tests such as colonoscopy, rectal examination, and fecal occult blood test may be done during follow-up.
Prevention
The cause of colorectal polyps is still unclear and there are no effective preventive measures. However, paying attention to the following aspects of life can help reduce the risk of the disease and facilitate early detection and timely treatment.
People with a family history of colorectal polyps or colorectal cancer should have regular screening colonoscopies before the age of 50.
People with familial adenomatous polyposis are advised to begin screening colonoscopies in adolescence.
Aggressively treat primary diseases such as ulcerative colitis and hemorrhoids.
Eat more vegetables, fruits and foods rich in dietary fiber such as oats, and drink more water to prevent constipation.
Exercise appropriately to improve physical fitness and resistance, such as jogging and playing ball games.
Quit smoking.