Colon Polyps
All information about the causes, symptoms, treatment, and prognosis of abnormal cell accumulations in the inner mucosa of the colon.
Symptoms and causes
Colon polyps are abnormal tissue growths in the lining of the distal large intestine. In most cases, these cell accumulations are benign, although over time the risk of malignant transformation increases.
The size of colonic polyps varies, ranging from a few millimeters to several centimeters. Depending on their characteristics, they can be classified into two main types:
- Sessile polyps: have a broad base attached to the colon wall. They may be flat or appear as a mucosal protuberance. They are more common in the ascending colon.
- Sessile serrated adenomas: due to their nature, they have a high likelihood of becoming cancerous. Their serrated structure makes them difficult to detect. Complete removal is essential to reduce the risk of colorectal cancer.
- Tubulovillous sessile adenomas: have a glandular structure that can be tubular, villous, or mixed. Their size is directly proportional to the risk of malignant transformation.
- Hyperplastic polyps: the most common, especially in the sigmoid colon. They are small (<5 mm in diameter), dense, serrated, and pale in color, which can make them resemble normal intestinal mucosa.
- Pedunculated polyps: consist of a thin stalk anchored to the mucosal tissue and a larger head. The stalk facilitates mobility, making them easier to identify and remove.
- Tubular adenomas: have a tube-shaped structure. They carry a low cancer risk.
- Villous adenomas: have a villous, hair-like protruding configuration and a high malignancy risk.
- Tubulovillous adenomas: combine tubular and villous characteristics.
Early diagnosis of polyps is essential to prevent colorectal cancer. As they are usually asymptomatic, routine screenings are performed in at-risk populations to detect them as early as possible.
Symptoms
Colon polyps are usually asymptomatic and are often discovered incidentally during examinations for other reasons or, as mentioned, through routine screenings.
When symptoms occur, they may include:
- Changes in bowel habits: frequently diarrhea or constipation lasting more than one week.
- Changes in stool color: presence of blood may cause stools to appear red or black.
- Abdominal pain.
- Rectal bleeding.
- Anemia: recurrent blood loss can lead to iron deficiency.
Causes
Polyps develop due to uncontrolled cell growth in the mucosal tissue lining the colon. The exact causes are not fully understood.
Risk Factors
The risk of developing colon polyps increases in the following situations:
- Age: more common after 45 years.
- Crohn’s disease.
- Ulcerative colitis.
- Obesity.
- Sedentary lifestyle.
- Smoking.
- Excessive alcohol consumption.
- Diabetes.
- Family history of colon polyps: frequently associated with hereditary syndromes such as:
- Familial adenomatous polyposis.
- Hereditary colorectal cancer (Lynch syndrome).
- Juvenile polyposis syndrome.
Complications
The main complication of these polyps is malignant transformation, leading to colorectal cancer.
Prevention
There is no completely effective method to prevent colon polyps, but the following strategies can reduce risk:
- Regular screenings: fecal occult blood tests are performed in individuals aged 50–69. Positive results are followed by colonoscopy to detect and remove polyps.
- Healthy diet: rich in fruits, vegetables, and cereals, low in fats.
- Avoid smoking and alcohol consumption.
- Regular moderate physical activity.
Which specialist treats colon polyps?
Colon polyps are diagnosed and treated in the specialty of General and digestive system surgery.
Diagnosis
Screening and diagnostic procedures for colon polyps include:
- Fecal occult blood test: two or three samples from different bowel movements are collected. In the laboratory, a reagent (guaiac) is added to detect hemoglobin, producing a blue or green color.
- Colonoscopy: a flexible tube with a camera at the tip is inserted through the anus and advanced into the colon to visualize polyps.
For patients with a family history of polyps or colorectal cancer, genetic testing is recommended to identify altered genes that increase disease risk. These tests are performed using blood, saliva, or polyp tissue samples.
Treatment
When polyps are detected, the recommended treatment is complete removal to reduce the risk of colorectal cancer. The approach depends on the polyp characteristics, patient needs, and surgeon preference:
- Polypectomy via colonoscopy: small, visible polyps are removed during diagnostic examination.
- Minimally invasive surgery: large or complex polyps are removed via laparoscopic surgery, using two or three abdominal ports to insert instruments and a camera for resection.
- Proctocolectomy: for patients with high-risk genetic syndromes, partial or total colon removal is performed.
Follow-up is essential to detect any malignant transformation early. Periodic colonoscopies are the most reliable method to monitor colon health. In Spain, recommended intervals are:
- Every five years for small polyps without abnormalities.
- Every three years for more than three polyps or villous/mixed histology with abnormal growth.
- Every six months to one year for more than ten adenomas or a very large polyp that required fragmentation for removal.
