Are polyps tumors what are the dangers

Intestinal polyps

Brief overview: intestinal polyps

  • What are intestinal polyps? Mucosal growths that bulge into the intestines
  • Are Colon Polyps Dangerous? In principle no, but there is a risk of degeneration into colon cancer
  • frequency: A third of all over 60 year olds have intestinal polyps
  • Symptoms: Very rare, mostly incidental finding during colonoscopy, possibly slimy or bloody stool, possibly stool changes
  • diagnosis: Usually by means of a colonoscopy
  • treatment: Removal of the intestinal polyps (polypectomy), usually as part of a colonoscopy

Colon Polyps: What Are Colon Polyps?

Colon polyps are mucosal structures that protrude into the intestinal cavity. They can sit flat on the intestinal mucosa, be connected to it by a style or take on a "shaggy" shape.

Polyps are very common in the colon and rectum. They can consist of different fabrics. Mostly they arise from the glandular tissue of the intestinal mucosa. In this case, the intestinal polyps are called adenomas. Adenomas are benign structures that can develop into malignant cancerous tissue.

About 70 percent of intestinal polyps are adenomas!

After the age of seventy, almost half of all people in Germany have at least one polyp in their intestines. A distinction is made between individual polyps and diseases with several or numerous colon polyps. In a so-called polyposis, there are countless polyps in the intestine. Symptoms are mostly diarrhea and abdominal cramps.

Types of intestinal polyps

Doctors differentiate intestinal polyps, which often form anew in the intestine for no apparent cause (neoplastic intestinal polyps such as an adenoma), from polyps that are caused by inflammation, for example (non-neoplastic intestinal polyps). The latter also include hamartomatous polyps. They arise from scattered germ cells and are usually congenital intestinal polyps.

If the upper mucous membrane cells multiply, doctors also speak of hyperplastic intestinal polyps. They are mostly small. Adenomas are typically larger. If intestinal polyps arise from adipose tissue cells, they are called lipomas. Under certain circumstances a polyp is already degenerate - then bowel cancer is present.

Colon polyps: symptoms

Many people ask themselves the questions: How do I notice colon polyps? Are there any specific symptoms? Polyps in the intestine usually do not cause any symptoms. Instead, doctors discover them by chance during a colonoscopy.

Take advantage of the cancer checkups! Colon polyps usually remain symptom-free, but in many cases increase the risk of colon cancer!

Blood in the stool

Occasionally, colon polyps can bleed. The affected person sometimes notices this through reddish discoloration of the stool. Often the blood cannot be seen and can only be detected by special tests (e.g. immunological stool test (iFOBT)). However, polyps in the intestine rarely bleed permanently. However, they can cause symptoms of anemia such as dizziness and weakness.

Changed bowel movements

People may also have slimy stools. Diarrhea and abdominal cramps are also occasionally possible symptoms. In a few cases, colon polyps cause constipation.

Colon polyps: causes and risk factors

Colon polyps are much more common in the western world than, for example, in Asian countries. It is therefore believed that the western lifestyle promotes the development of intestinal polyps. These include foods high in fat and sugar, alcohol consumption and nicotine.

A lack of exercise probably also plays a role in the development of intestinal polyps. Furthermore, genetic factors have a major influence.

Development of intestinal polyps

The lining of the colon renews itself regularly. In the process, old mucous membrane cells are broken down and new cells multiply. They then form the new mucous membrane. This is a continuous process.

During reproduction, small errors (mutations) can arise in the genetic material. The body's natural repair mechanisms usually correct these errors. Every now and then certain mutations change the growth properties of the mucous membrane cells.

Then they reproduce excessively, for example. This creates intestinal polyps. If intestinal polyps persist for a very long time, the damaged cells can degenerate - colon cancer develops. Therefore, doctors remove intestinal polyps preventively.

Colon polyps: genetic factors

Sometimes the tendency to form polyps in the intestines can be inherited. Medical professionals distinguish one genetic predisposition with no demonstrable cause of actual hereditary diseases. Intestinal polyps grow much earlier in life. The risk of developing colon cancer is also increased.

Intestinal polyps in familial adenomatous polyposis (FAP)

In the rare one familial adenomatous polyposis (FAP) Polyps grow from the glandular tissue throughout the intestine (adenomatous intestinal polyps). A hereditary genetic change is the cause. In some cases, however, the mutations also reappear.

Those affected usually have some intestinal polyps as early as their teenage years. In FAP, however, there are often polyps elsewhere, such as in the stomach. Complaints are rather rare. Abdominal pain, diarrhea, weight loss, flatulence or bloody, slimy stools are then possible.

If left untreated, they almost always develop into colon cancer. People who have loved ones with this condition should have their bowels checked regularly. In addition, relatives should be tested for FAP as part of genetic counseling.

Experts recommend an annual recto-sigmoidoscopy ("small" colonoscopy) from the age of ten to people suspected of having FAP!

If you find intestinal polyps in the small colonoscopy of the rectum and the S-shaped section of the intestine immediately in front of it, doctors mirror the entire intestine as a result. An annual complete colonoscopy is then advisable.

FAP also has irregular tooth structures or changes in retinal pigmentation in the eye. If those affected have tumors in bones (e.g. osteomas) and other tissue (e.g. epidermoid cysts), doctors speak of what is known as Gardner syndrome, a special form of FAP.

The risk of developing thyroid cancer is also slightly increased. In addition to colon polyps, around 80 percent of FAP patients also have thyroid nodules. Growths in the liver are also possible.

MUTYH-associated polyposis (MAP)

Also with the MUTYH-associated polyposis (MAP) an inherited genetic defect is the cause of early and frequent colon polyps. However, the disease is milder than FAP, fewer polyps develop, and they develop later in life.

The genetic defect is inherited as an autosomal recessive trait. This means that parents can carry the mutated gene without being sick. If the father and mother each pass on a mutated gene, there is a risk that the offspring will become ill. Affected people have an 80 to 100 percent risk of developing colon cancer once in their life.

Cronkhite Canada Syndrome

With the rare one Cronkhite Canada Syndrome Colon polyps occur throughout the gastrointestinal tract. There are also brownish spots on the skin. The structure of the fingernails and toenails can change, and the hair on the head can fall out.

The syndrome usually occurs after the age of fifty. Severe diarrhea, which flushes electrolytes and proteins from the body, and threatening intestinal bleeding are problematic. In contrast to other genetic colon polyps, there is no higher risk of colon cancer here.

There is no specific treatment for Cronkhite Canada Syndrome. But sometimes it responds to immune-suppressing therapy (immunosuppression).

Birt-Hogg-Dube Syndrome

At the Birt-Hogg-Dube Syndrome There are numerous colon polyps in the large intestine, which can very often develop into colon cancer. In addition, tumors of the skin, kidneys and lungs appear.

Hamartomatous Polyposis Syndromes

A hamartomatous syndrome can be associated with tumors in almost all parts of the body. They arise from dispersed germinal tissue. These are cells from embryonic development. These cells are not structured like the normal intestinal mucosa.

If colon polyps occur as part of such a syndrome, the risk of colon cancer is increased. Most of the time, the disease occurs at a young age. Examples of hamartomatous intestinal polyps are:

  • Peutz-Jeghers Syndrome: Diagnosis around 35 years of age; often polyps in the small intestine; Risk of colon cancer about 40 percent, increased risk of pancreatic cancer, breast cancer or ovarian cancer; often pigmentation disorders in the mouth area
  • Familial juvenile polyposis: With about a third familial accumulation, risk of colon cancer about 20-70 percent
  • Cowden Syndrome: Many intestinal polyps, but also in the rest of the gastrointestinal tract, also growths on the skin, often thyroid diseases including cancer, high risk of breast cancer; increased risk of colon cancer

Examinations and diagnosis

Your family doctor is the first point of contact, for example with bowel movements. He usually also plans colon cancer screening. For this he will refer you to a gastrointestinal specialist (gastroenterologist).

Collection of the medical history (anamnesis)

The doctor first asks a few questions to get clues about the patient's bowel health:

  • Have you suffered or suffered from constipation, diarrhea, or irregular bowel movements?
  • Have you noticed that your stool is bloody or slimy?
  • Do you have intestinal diseases in your family?
  • Have you accidentally lost weight in the last few weeks and months?

Physical examination

This is followed by the physical examination. The doctor can use the stethoscope to hear intestinal noises. Then he feels the stomach for possible hardening. An ultrasound machine can sometimes show colon polyps in the rectum.

The doctor can also feel polyps in the rectum. To do this, he puts a finger into the anus. This so-called digital rectal examination (DRU) is also used for prostate cancer screening in men. The doctor may also find signs of bleeding from bloody stool remains on the glove.

Colonoscopy (colonoscopy)

A colonoscopy is the most reliable way to detect colon polyps. A flexible tube with a camera (endoscope, colonoscope) and light source is inserted into the intestine and pushed forward. If the doctor discovers a polyp in the intestine, he can remove it directly.

Then pathologists examine the tissue. In doing so, they recognize which intestinal polyp is present. Adenomas are divided into three sub-forms. Depending on the type, the risk of developing cancer from the intestinal polyp varies:

  • Tubular adenoma: most common form (60-65 percent), tubular growth, in the reflection you can see the intestinal polyps hanging on the intestinal wall like on a stalk, risk of degeneration about four percent
  • Villous adenoma: relatively rare (5-10 percent), large areas, looking like a lawn in the reflection, about half of these intestinal polyps degenerate into colon cancer
  • Tubulovillous adenoma: about 20-25 percent of adenomas, a hybrid of tubular and villous intestinal polyps

Abdominal CT / MRI

If a colonoscopy is not possible, doctors can switch to a virtual colonoscopy. They make sectional images using computed tomography (CT) or magnetic resonance tomography (MRT). As a rule, however, only intestinal polyps that are larger than one centimeter can be seen.

Video capsule endoscopy

In video capsule endoscopy, patients swallow a small capsule with a camera. As it travels through the digestive tract, it takes pictures of the intestinal lining. This examination is very time consuming and expensive. Usually it only makes sense if other examination methods fail. On the other hand, it is important in the case of hereditary intestinal polyps, because it also takes pictures in the small intestine, which an endoscope cannot reach.

Read more about the examinations

Find out here which examinations can be useful for this disease:

prevention

Colon polyps and colon cancer are not uncommon diseases. For every person in Germany, the health insurance companies pay preventive examinations from a certain age:

  • From 50 years: annual stool test for hidden (occult) blood (immunological stool test (iFOBT)
  • Men over 50, women over 55 years: Colonoscopy every ten years; if there are any abnormalities, the interval between the next colonoscopy is shortened
  • If the colonoscopy is refused: every five years small mirroring only up to the S-shaped section of the intestine and annual stool tests for occult blood

If colon polyps accumulate in the family, doctors recommend colonoscopy more often and earlier. Exactly how often depends on the type of hereditary colon polyp or colon cancer disease.

If first-degree relatives (children, parents or siblings) have an adenoma before the age of 50, those affected should have a mirror image ten years before the age at which the relative developed the intestinal polyp.

Talk to your loved ones! This is the only way to better assess the risk of colon polyps and ultimately colon cancer!

If you then suspect a family history or even a hereditary disease, talk to a doctor you trust about it. He can refer you to specialists. Sometimes a genetic counseling is also advisable.

You can find out more about this in our articles about colon cancer and colon cancer screening.

treatment

Since an intestinal polyp can develop into cancer, the doctor removes it - usually as part of a colonoscopy (polypectomy). How exactly he removes the intestinal polyp ultimately also depends on its size:

Doctors usually remove intestinal polyps less than five millimeters with biopsy forceps. He uses an electric loop for larger intestinal polyps.

If the intestinal polyps sit broadly on the mucous membrane, it is hardly possible to remove the loop. Then the doctor does a colonoscopy with a small operation (transanal endoscopic microsurgery, TEM).

Large polyps sometimes need to be removed through the abdominal wall with surgery. In rare cases, surgeons remove a whole. In people who have genetic polyposis and are at a very high risk of colon cancer, the colon is sometimes operated on as a precautionary measure.

Course of the disease and prognosis

A polyp is actually a benign colon tumor. However, if it persists for a long time, it can develop into colon cancer. On average, it takes five to ten years for an adenoma to develop into colon cancer (adenoma-carcinoma sequence).

The larger the colon polyps, the greater the risk of colon cancer.

Tips for colon polyps

  • nutrition: Diets high in fat, sugar and meat with little fiber, alcohol and nicotine promote the development of colon polyps and colon cancer. Therefore, make sure you have a balanced diet.
  • Move: Regular exercise helps keep your body fit. This also prevents colon polyps or colon cancer.
  • prevention: You can also take advantage of the preventive examinations offered. The health insurance companies cover the costs at certain intervals. Ideally, contact your family doctor for this.
  • control: If the doctor has removed colon polyps, ideally follow the advice of your treating doctor. If necessary, he recommends that you have an earlier check-up than after the usual ten years.
  • Pre-existing illness: Be especially careful if your family is burdened. Many intestinal polyps, but also chronic inflammatory bowel diseases such as ulcerative colitis or other malignant tumor diseases in the family ultimately also increase your risk of colon cancer.

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