COLON POLYP REMOVAL IN INDIA

Colon Polyps (Benign Colon Tumors) in India

Colon polyps are small benign tumors that grow on the inside walls of the large intestine, usually in or near the rectum. They range in size from a tiny grape to a small plum. Some, known as familial polyposis, are inherited, but the cause of most colon polyps is unknown. They become more common after age 40; most adults eventually develop them.

The majority of colon polyps remain small and cause no symptoms. Sometimes, however, they grow large enough to interfere with normal bowel function, causing a change in the size and shape of the stools, possible constipation or diarrhea, bleeding (which may or not be visible in the stool), and abdominal pain.

A more serious concern is that some colon polyps contain cells that are or may become cancerous. This almost always happens in familial polyposis and is common if there are many or recurrent polyps. Thus, early detection and removal of colon polyps can help prevent colon cancer.

What is a Tumor?

All tissues of the body are made up of millions of tiny individual cells. In health, there is a delicate balance. Old cells are constantly dying and are replaced by new healthy cells. If too many new cells form, they create a lump or mass which is called a tumor. Tumors can be benign or malignant. Benign tumors are not cancer. They can usually be removed and, in most cases, they do not grow back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life. Malignant tumors are cancer. Cells in these tumors are abnormal and they continue to divide uncontrollably. Without treatment, they can invade and spread to nearby tissues and organs.

Treatment in India

• Complete removal during colonoscopy

• Sometimes follow with surgical resection

• Follow-up surveillance colonoscopy

Polyps should be removed completely with a snare or electrosurgical biopsy forceps during total colonoscopy; complete excision is particularly important for large villous adenomas, which have a high potential for cancer. If colonoscopic removal is unsuccessful, laparotomy should be done.

Subsequent treatment depends on the histology of the polyp. If dysplastic epithelium does not invade the muscularis mucosa, the line of resection in the polyp’s stalk is clear, and the lesion is well differentiated, endoscopic excision and close endoscopic follow-up should suffice. Patients with deeper invasion, an unclear resection line, or a poorly differentiated lesion should have segmental resection of the colon. Because invasion through the muscularis mucosa provides access to lymphatics and increases the potential for lymph node metastasis, such patients should have further evaluation .

The scheduling of follow-up examinations after polypectomy is controversial. Most authorities recommend total colonoscopy annually for 2 yr (or barium enema if total colonoscopy is impossible), with removal of newly discovered lesions. If two annual examinations are negative for new lesions, colonoscopy is recommended every 2 to 3 yr .

How does the doctor test for colon polyps ?

The doctor can use one or more tests to check for colon polyp :

• Barium Enema. The doctor puts a liquid called barium into your rectum before taking x rays of your large intestine. Barium makes your intestine look white in the pictures. Polyps are dark, so they’re easy to see.

• Sigmoidoscopy. With this test, the doctor puts a thin, flexible tube into your rectum. The tube is called a sigmoidoscope, and it has a light in it. The doctor uses the sigmoidoscope to look at the last third of your large intestine.

• Colonoscopy.The doctor will give you medicine to sedate you during the colonoscopy. This test is like the sigmoidoscopy, but the doctor looks at the entire large intestine with a long, flexible tube with a camera that shows images on a TV screen. The tube has a tool that can remove polyps. The doctor usually removes polyps during colonoscopy.

• Computerized Tomography (CT) Scan. With this test, also called virtualcolonoscopy, the doctor puts a thin, flexible tube into your rectum. A machine using x rays and computers creates pictures of the large intestine that can be seen on a screen.

The CT scan takes less time than a colonoscopy because polyps are not removed during the test. If the CT scan shows polyps, you will need a colonoscopy so they can be removed.

• Stool Test. The doctor will ask you to bring a stool sample in a special cup. The stool is tested in the laboratory for signs of cancer, such as DNA changes or blood.

What are the types of colon polyps?

There are basically 4 types of polyps that commonly occur within the colon: 

• Inflammatory- Most often found in patients with ulcerative colitis or Crohn’s disease. Often called “pseudopolyps” (false polyps), they are not true polyps, but just a reaction to chronic inflammation of the colon wall. They are not the type that turns to cancer. They are usually biopsied to verify type.

• Hyperplastic – A common type of polyp which is usually very small and found in the rectum. They are considered to be low risk for cancer.

• Tubular adenoma or adenomatous polyp – This is the most common type of polyp and the one referred to most often when a doctor speaks of colon polyps. About 70% of polyps removed are of this type. Adenomas carry a definite cancer risk which rises as the polyp grows larger. Adenomatous polyps usually cause no symptoms, but if detected early they can be removed during colonoscopy before any cancer cells form. The good news is that polyps grow slowly and may take years to turn into cancer. Patients with a history of adenomatous polyps must be periodically reexamined.

• Villous adenoma or tubulovillous adenoma- About 15% of polyps removed are of this type. This is a much more serious type of polyp that has a very high cancer risk as it grows larger. Often they are larger and sessile and not on a stem making removal more difficult. Smaller ones can be removed in piecemeal fashion – sometimes over several colonoscopies. Larger sessile villous adenomas may require surgery for complete removal. Follow up depends on size and completeness of removal.

Causes

Polyps are very common in men and women of all races who live in industrialized countries, which suggests that dietary and environmental factors play a role in their development.

Lifestyle — Although the exact causes are not completely understood, lifestyle risk factors include the following:

• A high fat diet
• A diet high in red meat
• A low fiber diet
• Cigarette smoking
• Obesity

On the other hand, use of aspirin and other NSAIDs and a high calcium diet may protect against the development of colon cancer.

How is a polyp of the colon and rectum diagnosed?

Polyps are diagnosed either by an X-ray called a barium enema or by examining the entire colon carefully using a colonoscope. A colonoscope is a thin flexible telescope that is passed up from the anus. During a colonoscopy the doctor will usually take a small piece of the polyp for examination.