Colonic Polyps and Cancer

Colonic polyp
Polyp is discrete mass of the tissue, that protrude into the lumen of the bowel
Polyps are categorized as non neoplastic polyps and neoplastic polyps
Neoplastic polyps
  • Adenoma
Non neoplastic polyps
  • Hyperplastic polyps
  • Juvenile polyps
  • Peutz Jeghers polyps
  • Inflammatory polyps  
Adenoma 
Adenoma are benign neoplastic polyps, and are of two types, tubular and villous adenomas. Polyps which are larger than 2 cms and with villous morphology are more likely to have transformation to malignancy
Polyps less than 5 mm are called diminutive polyp, these polyps are highly unlikely to have malignant potential
           
Risk factors
  • Inherited susceptibility
  • Excessive dietary intake of fat and low fiber
 
Clinical features
  • Most of the polyps are clinically silent
  • Pain abdomen
  • Rectal bleeding
  • Diarrhea and constipation
  • Colonic obstruction
Detection of colonic polyps
  • Most of the polyps are diagnosed during colonoscopy.
Treatment
  • Adenomas without deeper invasion can be taken out endoscopically, resected polyp should be submitted for histopathology to confirm the complete resection
  • Polyp with invasion of deeper layers should be taken out surgically
Colon cancer
Colon cancer is a major cause of morbidity and mortality
Risk factors
  • High fat low fiber diet
  • Smoking
  • Colorectal adenomas   polyposis syndromes
  • Family history of colorectal cancer
  • Ulcerative colitis and Crohn’s disease
Symptoms
  • Tumor on the right side of the colon, are larger in size and present with chronic bleed and there may be palpable mass also
  • Tumor on the left side of the colon present with change in bowel habits, pain abdomen, anemia and chronic bleed
Diagnosis           
  • Colonoscopy is done for confirmation of diagnosis, biopsy is taken from abnormal areas for histopathological confirmation
Staging
  • CECT abdomen and chest are done to r/o distant metastasis
 
Treatment
  • Surgery is the treatment of choice for colon cancer
  • Patients with advanced disease (disease beyond serosa/lymph node positive cases patients with liver metastasis) should be offered chemotherapy

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