Intestinal polyps – causes, symptoms & therapy

Intestinal polyps are mucosal protrusions in the lumen (inside of a hollow organ) of the intestine, which usually do not cause any symptoms and are tumors in more than half of the cases that have their origin in the glandular tissue of the intestinal mucosa (adenomas).

An intestinal polyp is also referred to as a benign (non-cancerous) tumour , but can degenerate into a malignant tumor (carcinoma) as it progresses, depending on its histological condition (fine tissue properties) and size.

causes

Intestinal polyps can be traced back to a variety of causes. It is believed that diet and lifestyle promote the development of colon polyps.A high consumption of animal fats combined with a low-fiber diet can promote the development of intestinal polyps, especially in correlation with excessive nicotine and alcohol consumption and obesity .

In rare cases, colon polyps can be hereditary. Genetic diseases that are associated with an increased occurrence include familial adenomatous polyposis (FAP), in which intestinal polyps can already be present early in adolescence.

There is also Gardner syndrome (polyposis intestinalis), which is characterized by other benign tumors in addition to intestinal polyps. Furthermore, the Peutz-Jeghers syndrome (hyperpigmentation), the Cowden syndrome and the Turcot syndrome. These special forms, which are inherited in an autosomal dominant manner, are associated with an increased risk of degeneration, with the risk of degeneration being 70 to 100 percent in the case of adenomatous polyposis.

When to the doctor?

Since intestinal polyps can only be diagnosed with certainty during a colonoscopy, the patient is already receiving medical treatment when the term is mentioned for the first time. Many patients are relieved because intestinal polyps trigger symptoms very similar to those of colon cancer – which the patient does not have with this diagnosis. However, being diagnosed with colon polyps doesn’t mean it’s all over now.

The doctor must give the affected patient a recommendation for further treatment, and the patient should follow this recommendation. Intestinal polyps themselves are harmless in this condition, but they can develop into colon cancer. In order to prevent this, the discovered intestinal polyps should therefore be completely removed and examined histologically. This is done as part of a minor operation.

In order to prepare for this and to receive information about the procedure, another doctor’s appointment should be made as soon as possible in the case of intestinal polyps. Only when all intestinal polyps have been removed is the patient completely healthy again. Even after that, it can make sense to have regular check-ups with your doctor, because colon polyps can come back and, undetected, could become colon cancer over time. The patient should regard the early detection as an opportunity for their own health and use it through preventive examinations in order to stay healthy for as long as possible.

symptoms and course

Colon polyps are usually asymptomatic, which is why they are often diagnosed during a colon examination performed for other reasons.

In the further course and with increase in size, intestinal polyps can sometimes lead to blood in the stool , ileus ( intestinal obstruction ), colic or abdominal pain. Some forms of polyps can cause mucus discharge and blackening of the stool (melena). Intestinal polyps are usually benign growths at the beginning, which have a different risk of degeneration depending on their tissue properties and size.

Because of the general risk of malignant degeneration, polyps should be diagnosed and removed early (endoscopic removal, polypectomy), although the probability of recurrence after removal of an intestinal polyp is relatively high at 30 to 50%.

Diagnose

If intestinal polyps are located in the lower part of the rectum, they can be diagnosed by rectal palpation (examination of the rectum with a finger). If a haemooccult test (detection of occult, invisible blood in the stool) is positive, this also indicates possible intestinal polyps. The diagnosis is confirmed by a colonoscopy ( colonoscopy ), during which a biopsy (tissue removal) with subsequent histological analysis of the tissue sample and, if necessary, an endoscopic removal can be carried out. As part of the histological examination, it is also clarified whether the removed intestinal polyp already contains degenerated cells.

complications

When intestinal polyps are diagnosed, many patients are initially relieved. Before the gastroscopy and biopsy, it was not conclusively clarified whether it was actually intestinal polyps or possibly a tumor in the intestine. However, after this diagnosis and removal of the colon polyps, the patient should continue to be cautious. Because once polyps have appeared in the colon, they can recur and they can also progress to colon cancer. Intestinal polyps often go unnoticed for a long time, so that without medical examinations after the first appearance, it can easily happen that an intestinal polyp turns malignant unnoticed.

With colorectal cancer, it takes a very long time before the first symptoms appear – and these in turn are characteristic of an advanced stage in which a cure is no longer possible. In order to avoid the malignant change in an intestinal polyp, patients must therefore attend regular doctor’s appointments, even after a successful and complete removal, in order to notice in good time when they come back.

Some patients, and in very rare cases undergoing surgery to remove colon polyps, experience unusually heavy bleeding or are unable to tolerate anesthesia. However, these are general risks of any surgical intervention, which fortunately only happen in exceptional cases and can also be treated by emergency measures if they occur.

treatment and therapy

Because of their risk of degeneration, intestinal polyps are always removed endoscopically ( colonoscopy ) and then analyzed for their histological properties in order to determine their degree of degeneration. For this purpose, the intestinal polyps are surrounded by the endoscope (viewing device) with a small loop and removed. Above a certain size (3-5 cm), intestinal polyps can no longer be removed endoscopically and must be surgically removed.

Surgical intervention is also required for colon polyps that have already grown into the underlying layers of the mucous membrane and for large numbers of colon polyps caused by hereditary diseases.

The postoperative check-ups depend on the size, number and histological properties of the colon polyps. If, for example, one or two small intestinal polyps (less than 1 cm in size) are removed with a low risk of degeneration, a control colonoscopy after five years is usually sufficient.For those affected with 3 to 10 intestinal polyps or at least one intestinal polyp that is at least one centimeter in size or has villous fine tissue (shaggy structure), a control colonoscopy is recommended after three years.

In the case of colon polyps that show an early stage of colon cancer limited to the mucous membrane (intraepithelial neoplasia) and have been completely removed, a follow-up endoscopy after three years is also sufficient.

If complete removal is not confirmed histologically, a timely check (2-6 months) is recommended. If large intestinal polyps are removed in several smaller steps (piecemeal technique), the removal site of the intestinal polyps should also be checked within 2-6 months.

prevention

Colon polyps cannot be prevented 100%. However, a healthy, high-fiber diet with a minimal amount of animal fat, avoidance of nicotine and alcohol, and regular exercise are recommended to reduce the risk of colon polyps and thus the risk of colon cancer. For the early diagnosis and treatment of intestinal polyps, annual check-ups with a hemoccult test (from the age of 50) and regular colonoscopies (every 3-5 years) as well as thorough monitoring of risk patients (if there is a family predisposition) are recommended.