Polyps

• Adenomatous polyps: These are the most common type of polyp, accounting for over two-thirds of all colon polyps. Depending on their shape and size, adenomatous polyps can be further classified as tubular, tubulovillous, or villous adenomas. They have the potential to become cancerous if left untreated.
• Serrated polyps: These are less common but can be harder to identify and have a higher risk of developing cancer.
• Hyperplastic polyps: These polyps are usually small and do not have the potential to become cancerous.
• Inflammatory polyps: These are typically associated with inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease.
• Hamartomatous polyps: A type of non-cancerous growth typically composed of a mixture of normal tissue types, such as muscle, connective tissue, and blood vessels, that are arranged abnormally.

WHO DO COLORECTAL POLYPS AFFECT?

Colorectal polyps can affect anyone.

Patients with an elevated risk of developing Colorectal Polyps typically have one or more of the following risk factors:

• Age, usually over 50 years old, although there is an increasing incidence of younger patients with polyps or colon cancer,
• positive family history of colon cancer or polyps, 
• men
• long-standing tobacco and alcohol use, 
• Type 2 Diabetes, 
• those who are obese with a sedentary lifestyle
• People with inflammatory diseases of the intestine (such as Crohn’s disease)

PREVENTING COLORECTAL POLYPS

While some risk factors for colorectal polyps cannot be changed, you can take steps to reduce your risk. These include

• Eating a healthy diet high in fruits, vegetables, and whole grains and low in red and processed meats.
• Exercising regularly to maintain a healthy weight and reduce inflammation.
• Quitting smoking, which is a known risk factor for colon cancer.
• Getting regular colonoscopies as recommended by your doctor.

CAUSES OF COLORECTAL POLYPS 

The exact cause of colorectal polyps is still unknown. Most cases are sporadic; however, there are likely to be multiple causes. Individuals with certain inherited genetic mutations are more likely to develop polyps and potentially cancers. This includes: 

• 
  Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC). Lynch syndrome is the most common form of inherited colon cancer and also can be associated with tumours in other parts of the abdomen. There are often multiple generations of family members involved. 
• Familial adenomatous polyposis (FAP) is a rare autosomal dominant disorder that causes hundreds or even thousands of polyps to develop in the lining of your colon beginning at a young age. A total proctocolectomy is usually recommended as patients have almost a 100% chance of developing cancer. People with FAP may develop abnormal growths in other body parts and will require regular screening. 
• Gardner syndrome is a variant of FAP that causes polyps to develop throughout your colon and small intestine. You also may develop noncancerous tumours in other parts of your body, including your skin, bones and abdomen.
• MUTYH-associated polyposis (MAP) is a condition similar to FAP that is caused by changes in the MYH gene. People with MAP often develop multiple adenomatous polyps and colon cancer at a young age.
• Peutz-Jeghers syndrome is a condition that usually begins with hyperpigmentation (freckles) developing all over the body, including the lips, gums and feet. Polyps can develop throughout the intestines. These polyps have the potential to transform into cancer.
• Serrated polyposis syndrome is a condition that leads to multiple serrated adenomatous polyps in the colon. These polyps may become cancerous and require removal. Close surveillance and regular colonoscopies may prevent colon cancer and avoid surgical removal of the colon.

SYMPTOMS OF COLORECTAL POLYPS

In most cases, colorectal polyps don’t cause any symptoms. They are often discovered for the first time during routine digestive tract examination or while the physician is running tests for some other complaint. In some cases, patients do experience some symptoms which include:

• Rectal bleeding
• Blood streaked stool or changed the colour of stool
• Constipation or diarrhoea, which lasts more than a week
• Abdominal cramps and pain due to obstruction (usually indicates larger-sized polyps)
• Anaemia

HOW ARE COLORECTAL POLYPS DIAGNOSED?

Colorectal polyps are typically diagnosed during a colonoscopy, which is a procedure that allows your gastroenterologist to examine the colon and rectum using a flexible tube with a camera.

During a colonoscopy, your gastroenterologist inserts the tube into the rectum and slowly advances it through the colon. The camera on the end of the tube allows for the examination of the colon and rectum's lining for any abnormalities, including polyps. 

HOW ARE COLORECTAL POLYPS TREATED?

Polyps can be safely removed during endoscopy or colonoscopy; however, the size and number of polyps and each patient’s circumstances must be assessed.

There are several methods for removing colorectal polyps, including

• Polypectomy: This is the most common method of removing polyps during a colonoscopy. A wire loop or snare is passed through the colonoscope, and the polyp is cut off and removed.
• Endoscopic mucosal resection (EMR): This advanced technique involves injecting fluid under the polyp to lift it off the colon wall before removing it with a snare.
• Endoscopic submucosal dissection (ESD): This advanced technique aims to remove large polyps en bloc (single piece) to allow accurate histologic analysis and reduce recurrence rates. 

After the polyp is removed, it will be sent to a laboratory for analysis to determine whether it is cancerous. If it is, further treatment, such as surgery, radiation therapy, or chemotherapy, may be necessary.

In some cases, a combination of treatments might be necessary. Also, remember that after the polyps are removed, regular follow-up appointments will be necessary to monitor for recurrence or other potential complications.

POST OPERATIVE CARE

• Pain and discomfort after the procedure are uncommon. Your doctor may prescribe pain medication or suggest over-the-counter pain relievers to manage pain.
• You may need to avoid solid food briefly and switch to a liquid diet to give your digestive system time to recover. It is essential to stay hydrated and consume enough fluids.
• It is crucial to schedule and attend follow-up appointments with your doctor. During these appointments, your doctor will discuss the procedure's results and any necessary further treatment or monitoring.
• You may need to avoid strenuous physical activity or exercise briefly after the procedure. Your doctor will advise you on the appropriate level of physical activity and when to resume normal activities.
• Although complications are rare after colorectal polyp removal, monitoring for any signs of infection, bleeding, or other complications is essential. You should contact your doctor immediately if you experience fever, severe pain, or bleeding.



WHAT IF COLORECTAL POLYPS ARE UNTREATED?

If colorectal polyps are detected early and removed, the risk of developing colorectal cancer can be significantly reduced. If you have been diagnosed with colorectal polyps or cancer, following your doctor's recommended treatment plan and scheduling regular follow-up appointments is essential. With early detection and appropriate treatment, the risks associated with colorectal polyps can be minimised, and the chances of successful treatment and recovery can be improved.