Intestinal polyps are a common clinical intestinal disease, the detection rate of intestinal polyps in the general population is reported to be more than one-third, and the detection rate of intestinal polyps increases significantly with age, especially among men >50 years old, the detection rate of intestinal polyps is close to 50%. Intestinal polyps are often asymptomatic, most of them are found during physical examinations, so what should be done when colonoscopy reveals intestinal polyps?
First, look at what is intestinal polyps
Intestinal polyp is actually a general term for all the elevated lesions on the surface of the intestinal mucosa, commonly known as the lumps of flesh that grow in the intestinal canal. These polyps can grow in the whole gastrointestinal tract, but are most common in the large intestine, especially in the rectum and sigmoid colon, and can range in size and diameter from 2 mm to more than 20 mm.
Endoscopically, the polyps can be divided into cauliflower-like polyps, papillary polyps, bridging polyps, broad-based polyps, and polyps with tissues according to their appearance. Pathological biopsies are further divided into: adenomatous polyps, inflammatory polyps, misshapen polyps and hyperplastic polyps. Adenomatous polyps are the most common type, including tubular adenomas, villous adenomas and mixed adenomas.
Second, why will grow intestinal polyps
1, genetic factors
Polyp is like a person’s physical characteristics, is also hereditary, in the clinical found that the family members have adenomatous polyps, other members of the possibility of intestinal polyps significantly higher, especially familial polyposis with obvious family heredity. The formation of some polyps is closely related to genetic mutations and genetic factors, genetic mutations can be inherited by parents to their offspring, children in the genetic male and female is equal, there is no gender differences.
2.Living and eating habits
Intestinal polyps and dietary structure changes or unhealthy eating habits are related, especially often eat spicy and stimulating, pickled food, eat high protein, high fat, low dietary fiber food, especially some people love to eat red meat, red meat early contains polyps can lead to the growth of ferrous hemoglobin and other ingredients, it is easy to form polyps. In addition, long-term sedentary, lack of exercise, physical obesity, the incidence of polyps is significantly higher than other people.
3.Inflammatory stimulation
Intestinal inflammatory stimulation is the main reason for the formation of polyps, because the stimulation of long-term chronic inflammation, so that the mucosa on the surface of the intestinal part is stimulated to form chronic hyperplasia, long-term hyperplasia will lead to the formation of intestinal polyps. Chronic inflammation of the intestine is common in ulcerative colitis, amoebic dysentery, intestinal tuberculosis, etc.
Why intestinal polyps and intestinal cancer are closely related
Intestinal polyps can be divided into non-neoplastic and neoplastic polyps, of which neoplastic polyps account for 70% to 80%. Non-neoplastic polyps are mainly polyps caused by proliferative polyps and inflammation, which usually do not turn into malignant tumors. In contrast, tumor polyps are commonly adenomatous polyps, which have about 10% chance of developing into intestinal cancer after a few years if left untreated. Statistics show that 90% of colorectal cancers evolve from colorectal adenomas. The cancer rate of intestinal polyps is related to the tissue type, size, location and age of the polyps.
In terms of site: adenomas in the rectum and sigmoid colon have the highest incidence and carcinoma rate, while the transverse colon has the lowest.
In terms of size: the cancer rate of adenomas below 1 cm is 1%-2%, the cancer rate of adenomas between 1 and 2 cm is 10%-20%, and the cancer rate of adenomas above 2 cm is 30%-60%.
In terms of single or multiple adenomas: the cancer rate of single adenoma is 20%-30%, and the cancer rate of multiple adenomas is 30%-80%.
From age: the cancer rate of polyps from 40 to 60 years old is 10%-20%, from 60 to 69 years old is 15%-25%, from 70 years old and above is >30%, and from 80 years old and above is >50%.
From the pathological type: the cancer rate is 2% to 6% for tubular adenoma, 10% to 30% for villous tubular adenoma, and 20% to 50% for villous adenoma, respectively.
D. What should I do if I found intestinal polyps?
Generally speaking, the principle of treatment for intestinal polyps is to remove them immediately under colonoscopy once they are found, and to perform pathological biopsy, and to review them regularly.
Because adenomatous polyps are recognized as precancerous lesions, equivalent to a “time bomb” in the intestine, with the increase in the number of polyps, the chance of cancer increases rapidly, even if they are inflammatory polyps (not considered cancerous in the past), but with the increase in polyps, they may bring a series of clinical symptoms, such as long-term blood in the stool, diarrhea, intussusception and even intestinal obstruction. Moreover, there is a possibility of adenoma change when it grows. Therefore, any polyps have the possibility of cancer, found intestinal polyps, no matter what the nature, should be removed as soon as possible to eliminate future problems.
5.Will the intestinal polyp recur after removal?
Intestinal polyps may still recur after the cut, that is, after the polyps are removed, polyps may grow back. Generally polyps larger than 1cm cm, after its removal, there will be a certain chance of recurrence, if the removal is not clean, the possibility of recurrence will be higher. For some people who are obese and have high blood lipids, they also have a higher chance of recurrence, and people who have a family history of intestinal polyps have a higher risk of recurrence of polyps. In addition, during the colonoscopy, it may appear that some areas are easily obscured, and thus the removal is incomplete, allowing intestinal polyps to remain. Therefore, do not take it lightly after the removal of intestinal polyps, you must follow up regularly, regular re-examination of colonoscopy, once found polyps still need to be removed endoscopically.
Six, how to regularly review after removal of polyps
If it is a single benign polyp, you need to review colonoscopy once a year at the beginning, and no recurrence for 2 to 3 years, then you can review colonoscopy once every 3 years.
In case of multiple benign polyps, colonoscopy should be repeated once a year.
In the case of non-tip type polyps removed in pieces, colonoscopy should be repeated 3 to 6 months after surgery.
If it is a single adenomatous polyp less than 1 cm in diameter, the colonoscopy can be repeated once a year.
In case of multiple or adenomatous polyps larger than 10 cm in diameter, especially those with villi structure and high-grade intraepithelial neoplasia, review 3 to 6 months after polypectomy.
If cancerous polyps are found, they should be reviewed more closely after resection.
Seven, how to reduce the recurrence of intestinal polyps
1.Adjust the diet and living habits
Eat less high-fat, high-protein food, especially red meat such as pork, beef, lamb, etc. Eat more dietary fiber, dietary fiber-rich foods have coarse grains, such as millet, corn, barley, oats, wheat buckwheat. There are also some vegetables and fruits, such as celery, leeks, spinach, cabbage, apples, bananas, oranges, peaches and so on. Develop a good routine, insist on early to bed and early to rise, and three meals a day should be regular, do not overeat, quit drinking, smoking habits.
2.Treat intestinal diseases
Intestinal infections and intestinal flora dysbiosis are closely related to the occurrence of intestinal polyps. Therefore, the chronic inflammation of the intestinal tract should be actively treated, while avoiding the long-term use of broad-spectrum antibiotics to reduce the occurrence of dysbiosis, you can properly apply probiotics such as bifidobacteria and lactobacilli to provide nutrition for the intestine, the production of acetic acid and lactic acid, acidification of the intestine, inhibit the growth of harmful microorganisms, and provide a healthy environment for the growth of intestinal cells, can reduce the possibility of intestinal cells into polyps and cancer, to prevent the occurrence of intestinal polyps.
3.Drug prevention
There is no special treatment and prevention of intestinal polyps, it is believed that non-steroidal anti-inflammatory drugs have a significant role in reducing the incidence of colorectal polyps and rectal cancer, long-term use of aspirin can reduce the occurrence of adenomas after colorectal adenoma surgery, sulindac can be used to treat familial adenomatous polyposis, which can delay the growth of polyps and reduce the chance of cancer, thereby reducing the rate of colon resection. The use of calcium, folic acid, and metformin for the treatment of intestinal polyps has also been studied, but the long-term efficacy is uncertain.