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Polyps

Polyps - arising as masses of tissue above the mucosal membrane - may develop in the rectum or colon, where they protrude into the Gl tract. Polyps are classified according to tissue type: They include common polypoid adenomas, villous adenomas, familial polyposis, focal polypoid hyperplasia, and juvenile polyps (hamartomas). Polyps also may be described by their appearance: They may be pedunculated (attached by a stalk to the intestinal wall) or sessile (attached to the intestinal wall with a broad base and no stalk).

Most polyps are benign. However, villous and familial polyps show a marked inclination to become malignant. A striking feature of familial polyposis is its frequent association with rectosigmoid adenocarcinoma.

Villous adenomas are most prevalent in men over age 55; common polypoid adenomas, in white women between ages 45 and 60. The incidence in both sexes increases after age 70. Juvenile polyps occur most commonly in children under age 10 and are characterized by rectal bleeding.

Causes

Polyps are very common in adults, who have an increased chance of acquiring them as they age. While quite rare in 20-year-olds, it’s estimated that the average 60-year-old without special risk factors for polyps has a 25 percent chance of having a polyp. We don’t know what causes polyps. Some experts believe a high-fat, low-fiber diet can be a predisposition to polyp formation. There may be a genetic risk to develop polyps as well.

Signs and Symptoms

In many patients, assessment findings are minimal because these patients have no obvious symptoms. Usually, polyps are discovered incidentally during a digital examination or rectosigmoidoscopy. Rarely, the patient history reveals obvious rectal bleeding and diarrhea.

Diagnostic tests

Proctosigmoidoscopy or colonoscopy with biopsy confirms the diagnosis.

Stool analyses detect occult blood in the stools of about 5% of patients with polyps.

Hemoglobin (Hb) level and hematocrit (HCT) may decrease with rectal bleeding.

Treatment

The therapeutic regimen depends on the type and size of the polyps and their location in the rectum or colon. Polypectomy may be performed if the polyp is pedunculated. This procedure uses an electrocautery snare inserted through a sigmoidoscope or a colonoscope. Even large, pedunculated polyps can be removed by this method. Sessile polyps usually require abdominal surgery for removal. Some benign polyps aren't removed but are monitored periodically for changes by routine sigmoidoscopy or colonoscopy.

Depending on the extent of GI involvement, familial polyposis requires total abdominoperineal resection with a permanent ileostomy or subtotal colectomy with an ileoproctostomy. Juvenile polyps are prone to autoamputation; if this doesn't occur, snare removal during colonoscopy is the treatment of choice.

Prevention

Diet--It only makes sense that a disease that originates in the gut should somehow be related to diet. While genetic factors are probably the most important, let's look at the effects of diet.

Other Factors--The large nurse's study, mentioned before, has shown other factors that appear to be related to colon cancer.

  1. Cigarette Smoking - long-term smokers had more colon cancer than non-smokers
  2. Leisure Time Activities - those nurses who were more active in their daily lives had fewer cancers
  3. Estrogen - those nurses who continued to use estrogen hormones had fewer cancers. However, it is not recommended that you take estrogen just for this possible reason


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