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July 17, 2012

Added By :
Dr Shairi Abdullah

What are colorectal polyps and why are they important ?
Colon and rectum (colorectal) polyps are abnormal fleshy growths on the inner lining of the colon or rectum. The colon and rectum form the large intestine. The length of the colon and rectum are approximately 5 feet and 5 inches respectively.  Colorectal polyps are common – they occur in around 20% of adults. Some polyps appear flat while others have a stalk. The significance of polyps is that most colorectal cancers arise from them. However, not all polyps develop into cancer. Colorectal cancer is one of the most common cancers worldwide.  In Malaysia, statistics show that colorectal cancer is the most common cancer in men and the second most common cancer in women (National Cancer Registry,2006).
There are 2 main types of colorectal polyps:
1)    Hyperplastic and inflammatory polyps – usually do not develop into cancer.
2)    Adenomatous polyps –  may develop  into cancer over the course of several years. 2/3 of colon polyps are adenomatous.   
Your risk of colorectal cancer is higher if you are older, have a first degree relative ( brother, sister, parent or child ) with colorectal cancer, if your adenomatous polyp is larger than 1 cm or it is a type of adenomatous polyp called villous adenoma.  
What are the symptoms of colorectal polyps ?
Most people with colorectal polyps have no symptoms. Sometimes, polyps can cause bleeding, discharge of mucus, diarrhoea and rarely, abdominal pain.
How are colorectal polyps diagnosed ?
Polyps are diagnosed either by colorectal endoscopy or x ray examination.  There are 2 types of colorectal endoscopy – sigmoidoscopy and colonoscopy. Sigmoidoscopy allows the doctor to examine the lower one third of the colon and colonoscopy permits examination of the entire colon. During colonoscopy, the doctor inserts a colonoscope, which is a long thin flexible tube with a camera, into the anus and advances the tube carefully through the large intestinal canal. Polyps can be removed and biopsies can be done during endoscopy.
X rays using CT technology (CT colonography) or barium are alternatives to colonoscopy in specific circumstances, however they cannot treat polyps and a colonoscopy may still be required if a polyp is detected .
Do colorectal polyps need to be treated ?
 The risk of the polyp becoming cancer is eliminated if it is completely removed during colonoscopy. An experienced doctor can often differentiate adenomatous polyps from hyperplastic polyps by looking at its appearance during colonoscopy. However, that is not a completely certain way of predicting whether a polyp will become cancer and most doctors would prefer to remove all polyps.
Colorectal polyp removal
Removal of polyps is called polypectomy. The majority of polyps can be removed during colonoscopy by using special instruments which are passed through the colonoscope . Prior to colonoscopy, you will be provided advice on taking laxatives to cleanse your intestines. Let your doctor know if you are on any blood thinners such as aspirin, Ticlid® , Plavix® and warfarin.
Polypectomy is performed by burning the polyp with an electric current or cutting it out using a wire snare . Polypectomy is painless because the colon nerves are only sensitive to stretching. Large polyps may require more than one treatment for complete removal. Occasionally, some polyps cannot be removed during colonoscopy because of their position or size and surgery may be required.
Polypectomy is safe and complications are rare.  The risks of polypectomy are bleeding and perforation (creating a hole in the wall of the intestine). Bleeding usually stops by itself. Sometimes the doctor may need to use electric current or clips to stop the bleeding; blood transfusion is only rarely required. Perforation may need to be treated with surgery.
Is follow up treatment required?
A polyp that is completely removed will not recur but new polyps can grow. A repeat colonoscopy is recommended. The time interval for the next colonoscopy may range from a few months to a few years and depends on factors such as number and size of polyps in the initial colonoscopy, whether the polyps could be completely removed, microscopic appearance of the polyp and whether your intestine was adequately cleansed with laxatives ( presence of stools in the intestine may make it difficult for the doctor to see smaller polyps). Discuss with your gastroenterologist regarding when your next colonoscopy is due.
Removal of polyps is one of the best ways of preventing colorectal cancer. Some other measures which may help to prevent colorectal polyps and cancer are to eat a diet low in fats but high in vegetables, fibre and fruits, maintain a healthy weight, avoid excessive alcohol use and stop smoking.
Risk of colorectal polyps and cancer in your family
If you have colorectal polyps or cancer, your first degree relatives may be at higher risk of developing polyps or cancer. Therefore they may need to undergo screening tests such as colonoscopy – the gastroenterologist can provide advice regarding screening of family members.

Dr Anil K Radhakrishnan-  Consultant Gastroenterologist, Hepatologist & Physician
KPJ Klang Specialist Hospital, Klang, Malaysia