Colonic Polyps

Background/Epidemiology

  • Slow growing overgrowth of the colonic mucosa.
    • Most common type is hyperplastic (90%) and <0.5cm
    • Adenomas account for ~10% (precancerous- 10% >1cm – have a 10% chance of becoming malignant)
      • i.e. Carry a small risk of becoming malignant (<1%)
  • Extremely common (50% of patients >60 will have them- over half of these will be multiple)
  • Polyps can be
    • Pedunculated
    • Sessile (flat)-
      • often more concerning as the distance to invade is shorter and more difficult to remove
  • Histologically, they can be classified as
    • tubular
    • villous (higher risk of neoplastic transformation)
    • tubulovillous

Presentation

  • Most patients are asymptomatic
    • May be identified by faecal occult blood test as part of the colon cancer screening programme or by digital rectal examination for another cause
  • If symptomatic, most common presentations are
    • PR bleeding (chronic bleeding may cause anaemia)
    • Change in bowel habit- can be either constipation or diarrhoea

Identification/Diagnosis and Management

  • Proctoscopy/sigmoidoscopy will be able to visualise polyps and endoscopic removal  (polypectomy) should be performed then
  • Endoscopic investigations should be repeated after 3-5 years, ideally until age 75 to check for new growths

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