Colonic Polyps

Gastroenterology (12%) Core Clinical Conditions

1B The Physician Associate is able to identify the condition as a possible diagnosis: may not have the knowledge/resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately.

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Definition Aetiology Pathophysiology Sign and Symptoms Investigations Management

Colonic polyps refer to abnormal growths that develop in the inner lining of the colon or large intestine. These growths, also known as colorectal polyps, are typically noncancerous but have the potential to become cancerous over time. Colonic polyps vary in size, shape, and number, and they are commonly found during routine colonoscopies or screenings for colorectal cancer.

Types of Colonic Polyps

There are several types of colonic polyps, with the two main categories being non-neoplastic (benign) and neoplastic (potentially cancerous). These types include:
1. Hyperplastic Polyps: These small, typically harmless polyps are the most common. They usually occur in the rectum and sigmoid colon and are unlikely to progress into cancer.
2. Adenomatous Polyps: These polyps are precancerous and have the potential to develop into colorectal cancer. Adenomatous polyps can be further categorised based on their size, structure, and microscopic appearance, including tubular adenomas, tubulovillous adenomas, and villous adenomas.
3. Inflammatory Polyps: These are usually associated with inflammation in the colon and can develop due to conditions like ulcerative colitis and Crohn's disease. Although not generally cancerous, they may need monitoring and treatment.
4. Serrated Polyps: Serrated polyps include various types, such as traditional serrated adenomas and sessile serrated adenomas. Some serrated polyps have a higher likelihood of becoming cancerous and require follow-up examinations.

• Age: The risk of developing colonic polyps increases with age, particularly after the age of 50.

• Family history: Individuals with a family history of colorectal polyps or cancer are more susceptible to developing these growths.

• Inflammatory conditions: Chronic inflammatory disorders of the colon, such as ulcerative colitis and Crohn's disease, are associated with an increased risk.

• Lifestyle factors: Poor dietary choices, lack of physical activity, obesity, and smoking may contribute to the development of colonic polyps.

• Genetic predisposition: Certain genetic factors and inherited syndromes, such as familial adenomatous polyposis (FAP) and Lynch syndrome, can predispose individuals to colonic polyps.

The exact cause of colonic polyps is not yet fully understood. However, several risk factors have been identified, including age, family history, inflammatory bowel disease (IBD), obesity, smoking, and a diet high in fat and low in fibre. These factors may influence the development of polyps through various mechanisms.
Colonic polyps typically arise from the abnormal growth of cells in the lining of the colon or rectum. The process begins with a mutation in the DNA of these cells, which disrupts their normal growth and division. This mutation is often related to alterations in certain genes that regulate cell growth, such as the adenomatous polyposis coli (APC) gene.

Types of Colonic Polyps

Colonic polyps can be categorised into different types based on their histological characteristics. The three main types are:
1. Adenomatous Polyps: These are the most common type of polyps, accounting for approximately 70% of cases. Adenomatous polyps have the potential to progress to colorectal cancer if left untreated. They can be further classified into three subtypes: tubular adenomas, villous adenomas, and tubulovillous adenomas.
2. Hyperplastic Polyps: Hyperplastic polyps are typically small and non-neoplastic. They are considered benign and rarely progress to cancer.
3. Inflammatory Polyps: These polyps develop as a result of chronic inflammation in the colon or rectum, often associated with conditions like ulcerative colitis or Crohn's disease. Inflammatory polyps have a low risk of cancer progression.

1. Rectal Bleeding

One of the most noticeable signs of colonic polyps is rectal bleeding. Blood may appear in the stool or on the toilet paper after wiping. While the bleeding may vary, it is essential not to ignore any occurrence of blood in the stool and to consult a healthcare professional for proper evaluation.

2. Changes in Bowel Habits

Colonic polyps can cause changes in bowel habits. This can manifest as persistent diarrhoea or constipation. If you notice a significant shift in your regular bowel patterns without any apparent cause, it is advisable to seek medical advice to determine the underlying cause, including the possibility of colonic polyps.

3. Abdominal Pain

Persistent or recurrent abdominal pain or discomfort can indicate the presence of colonic polyps. The discomfort may range from mild to severe and can sometimes be accompanied by cramping. Any unexplained or long-lasting abdominal pain should be discussed with a healthcare professional.

4. Iron Deficiency Anaemia

The presence of colonic polyps can lead to chronic blood loss, resulting in iron deficiency anaemia. Iron deficiency anaemia can cause symptoms such as fatigue, weakness, dizziness, pale skin, and shortness of breath. If you experience these symptoms, especially if combined with other signs mentioned, it is important to seek medical attention promptly.

5. Unexplained Weight Loss

Unintended weight loss can sometimes be associated with colonic polyps, particularly if they have become cancerous. If you have experienced a significant weight loss without any changes in diet or physical activity, it is essential to consult a healthcare professional for further evaluation.

1. History and Physical Examination:
The PA will inquire about symptoms like rectal bleeding, changes in bowel habits, abdominal pain, or family history of colon polyps or colorectal cancer. A thorough physical examination will also be conducted to assess any abnormal findings.
2. Colonoscopy:
Colonoscopy is considered the gold standard for diagnosing colonic polyps. During this procedure, a flexible tube with a camera called a colonoscope is inserted through the rectum to visualize the entire colon and rectum. The colonoscope allows the doctor to identify and inspect polyps directly. If any suspicious polyps are identified, they can be removed or biopsied for further analysis.
3. Virtual Colonoscopy (CT Colonography):
Virtual colonoscopy, also known as CT colonography, is a non-invasive alternative to traditional colonoscopy. It uses a CT scanner to obtain detailed images of the colon. These images are then examined by a radiologist to detect any abnormalities, including polyps. If polyps are found, a follow-up colonoscopy may be required for their removal or biopsy.
4. Flexible Sigmoidoscopy:
Flexible sigmoidoscopy is a procedure that examines the rectum and the lower part of the colon. Although it does not visualize the entire colon like a colonoscopy, it can identify polyps in the lower region. If polyps are detected during sigmoidoscopy, a colonoscopy is usually recommended to assess the rest of the colon.
5. Faecal immunochemical test (FIT) :
A FIT test is a stool test that detects the presence of hidden blood in the feces, which may indicate the presence of polyps or other colorectal abnormalities. If the FIT is positive, further investigations such as colonoscopy will be required to identify the source of the bleeding.
6. Genetic Testing:
In cases where there is a family history of colon polyps or colorectal cancer, genetic testing may be recommended. Genetic tests can identify specific gene mutations that increase the risk of developing polyps or cancer. This information can help determine the appropriate surveillance and management plan for individuals with a genetic predisposition.

Treatment Options

The management options for colonic polyps depend on their classification and other factors such as patient age, overall health, and individual risk assessments. The main treatment approaches include:
1. Surgery: surgery may also be recommended if the polyp is causing symptoms or if multiple polyps are present.
2. Surveillance: After polyp removal, ongoing surveillance is essential to monitor for recurrence or the development of new polyps. The timing and frequency of surveillance colonoscopies depend on several factors, including polyp characteristics, family history, and patient risk factors. Regular surveillance ensures early detection of any new growths or abnormalities.

Lifestyle Modifications and Prevention

In addition to the above treatment options, individuals can take steps to reduce their risk of developing colonic polyps:

• Healthy Lifestyle: Maintaining a healthy weight, regular exercise, and consumption of a balanced diet rich in fruits, vegetables, and whole grains can decrease the risk of developing polyps.

• Smoking and Alcohol Cessation: Avoiding or quitting smoking and limiting alcohol consumption can significantly reduce the risk of polyp formation.

• Regular Screening: Undergoing recommended screening tests, such as colonoscopy, is crucial for early detection and timely intervention.

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