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Anthony Villano

, MD, Fox Chase Cancer Center

Переглянуто/перевірено: Жов 2023
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An intestinal polyp is any mass of tissue that arises from the bowel wall and protrudes into the lumen. Most are asymptomatic except for minor bleeding, which is usually occult. The main concern is malignant transformation; most colon cancers Колоректальний рак Colorectal cancer is extremely common. Symptoms include blood in the stool and change in bowel habits. Screening using one of several methods is recommended for appropriate populations. Diagnosis... прочитати більше Колоректальний рак arise in a previously benign adenomatous polyp. Diagnosis is by endoscopy. Treatment is endoscopic removal.

Polyps may be sessile or pedunculated and vary considerably in size. Incidence of polyps ranges from 7 to 50%; the higher figure includes very small polyps (usually hyperplastic polyps or adenomas) found at autopsy. Polyps, often multiple, occur most commonly in the rectum and sigmoid and decrease in frequency toward the cecum. Multiple polyps may represent familial adenomatous polyposis Сімейний аденоматозний поліпоз Familial adenomatous polyposis is a hereditary disorder causing numerous colonic polyps and frequently resulting in colon carcinoma, often by age 40. Patients are usually asymptomatic but may... прочитати більше Сімейний аденоматозний поліпоз . About 25% of patients with cancer of the large bowel also have satellite adenomatous polyps.

Adenomatous (neoplastic) polyps are of greatest concern. Such lesions are classified histologically as tubular adenomas, tubulovillous adenomas (villoglandular polyps), or villous adenomas. The likelihood of cancer in an adenomatous polyp at the time of discovery is related to size, histologic type, and degree of dysplasia; a 1.5-cm tubular adenoma has a 2% risk of containing a cancer vs a 35% risk in 3-cm villous adenomas. Serrated adenomas, a somewhat more aggressive type of adenoma, may develop from hyperplastic polyps.

Nonadenomatous (nonneoplastic) polyps include hyperplastic polyps, hamartomas (see Peutz-Jeghers Syndrome Синдром Пейтца-Єгерса Peutz-Jeghers syndrome is an autosomal dominant disease with multiple hamartomatous polyps in the stomach, small bowel, and colon along with distinctive pigmented skin lesions. Most (66 to 94%)... прочитати більше Синдром Пейтца-Єгерса ), juvenile polyps, pseudopolyps, lipomas, leiomyomas, and other rarer tumors. Juvenile polyps occur in children, typically outgrow their blood supply, and autoamputate some time during or after puberty. Treatment is required only for uncontrollable bleeding or intussusception. Inflammatory polyps and pseudopolyps occur in chronic ulcerative colitis Виразковий коліт Ulcerative colitis is a chronic inflammatory and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea. Extraintestinal symptoms, particularly arthritis... прочитати більше Виразковий коліт and in Crohn disease Хвороба Крона Crohn disease is a chronic transmural inflammatory bowel disease that usually affects the distal ileum and colon but may occur in any part of the gastrointestinal tract. Symptoms include diarrhea... прочитати більше Хвороба Крона of the colon. Multiple juvenile polyps (but not sporadic ones) convey an increased cancer risk. The specific number of polyps resulting in increased risk is not known.

Приклади колоректальних поліпів

Symptoms and Signs of Colorectal Polyps

Most polyps are asymptomatic. Rectal bleeding, usually occult and rarely massive, is the most frequent complaint.

Cramps, abdominal pain, or obstruction may occur with a large lesion.

Rectal polyps may be palpable by digital examination. Occasionally, a polyp on a long pedicle may prolapse through the anus.

Diagnosis of Colorectal Polyps

  • Colonoscopy

Diagnosis of colonic polyps is usually made by colonoscopy. Barium enema, particularly double-contrast examination, is effective, but colonoscopy is preferred because polyps also may be removed during that procedure. Because rectal polyps are often multiple and may coexist with cancer, complete colonoscopy to the cecum is mandatory even if a distal lesion is found by flexible sigmoidoscopy.

During colonoscopy, any polyps seen are removed and evaluated for possible cancer.

Treatment of Colorectal Polyps

  • Complete removal during colonoscopy

  • Sometimes follow with surgical resection

  • Follow-up surveillance colonoscopy

Polyps should be removed completely with a snare or biopsy forceps during total colonoscopy. 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 (as in colon cancer Колоректальний рак Colorectal cancer is extremely common. Symptoms include blood in the stool and change in bowel habits. Screening using one of several methods is recommended for appropriate populations. Diagnosis... прочитати більше Колоректальний рак ).

The scheduling of follow-up examinations after polypectomy is controversial and varies by the number, size, and type of polyps removed (1 Довідковий матеріал щодо лікування An intestinal polyp is any mass of tissue that arises from the bowel wall and protrudes into the lumen. Most are asymptomatic except for minor bleeding, which is usually occult. The main concern... прочитати більше Довідковий матеріал щодо лікування ). For example, guidelines recommend a repeat total colonoscopy (or barium enema if total colonoscopy is impossible) 3 years after removal of a tubular adenoma ≥ 10 mm or a villous adenoma of any size.

Довідковий матеріал щодо лікування

  • 1. Gupta S, Lieberman D, Anderson JC, et al: Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 115(3):415-434, 2020. doi: 10.14309/ajg.0000000000000544

Prevention of Colorectal Polyps

Aspirin and COX-2 inhibitors may help prevent formation of new polyps in patients with polyps or colon cancer (1 Довідковий матеріал щодо профілактики An intestinal polyp is any mass of tissue that arises from the bowel wall and protrudes into the lumen. Most are asymptomatic except for minor bleeding, which is usually occult. The main concern... прочитати більше Довідковий матеріал щодо профілактики ). The potential benefits of long-term therapy with these agents must be weighed against the potential adverse effects (eg, bleeding, renal dysfunction).

Довідковий матеріал щодо профілактики

  • 1. Cook NR, Lee IM, Zhang SM, et al: Alternate-day, low-dose aspirin and cancer risk: Long-term observational follow-up of a randomized trial. Ann Int Med 159:77–85, 2013. doi: 10.7326/0003-4819-159-2-201307160-00002

Ключові моменти

  • Colonic polyps are common; the incidence ranges from 7 to 50% (depending on the diagnostic method used).

  • The main concern is malignant transformation, which occurs at different rates depending on the size and type of polyp.

  • The main symptom is bleeding, usually occult and rarely massive.

  • Colonoscopy is the recommended diagnostic and therapeutic procedure.

Додаткова інформація

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