Polyps of the colon and rectum
Diagnosis of polyps and colon cancer
PROCTOLOGY – 2009
SURGICAL DIVISION CB 6 RZD – MOSCOW
Polyps and adenomas are inherently intestinal tumors. The tumor – a newly formed tissue. The cause of cancer is a genetic abnormality which resulted in impaired cell growth in a correct and adequate, and it begins to grow uncontrollably, and in violation of their differentiation. All tumors of the nature of their growth can be divided into malignant and benign.
What is a polyp
Polyp – a growth of glandular epithelium. The shape of the polyps can be in the form of a mushroom cap on a thin or thick stalk.
The reasons for the formation of polyps
Establish the exact cause of the polyp in a particular case is difficult because they often do not manifest themselves. Most of these benign polyps are discovered by accident. Such patients usually go to the doctor complaining of bowel dysfunction, discomfort, pain in the anus, sometimes abnormal discharge in the form of blood or pus from mucus. These symptoms are typical of other diseases rectum and colon, such as proctitis, hemorrhoids, anal fissures, colitis, colorectal cancer or colon, etc.
Specify the exact numbers of occurrence of polyps and adenomas is not possible, since most of them simply never shows up. According to the works of Russian and foreign researchers found that the average incidence of adenomas of the colon is in the range 2.5 – 7.5% of the total number of patients studied.
But, of course, the true incidence of colonic polyps Kishi above, as this survey researchers have not examined the other divisions of the colon, which is about 50% of all polyps and adenomas of the colon.
Among the reasons, or more precisely the factors that influence the occurrence of colon polyps, one can note the state of the environment, and lack of exercise. An equally important factor in the formation of polyps of the colon is the nature of power.
As you know, in today's developed countries in people's diet is dominated by foods rich in fat and carbohydrates, and the amount of fiber is low. This causes poor motility of the colon, it stagnated in the feces, bile acids, which have an effect on the intestinal mucosa.
This in turn affects the composition of the natural microflora of the colon, which is also reflected in the composition of enzymes which it secretes.
The researchers also found a relationship between the formation of polyps and other factors such as male gender, atherosclerosis, tumors, diverticula in the digestive tract, and inflammatory bowel disease.
The classification of benign tumors of the colon
All benign tumors of the colon can be divided into:
- Adenomatosis (adenomatous polyposis of the intestine)
Tumor-like lesions. These are:
- Peutz Jeghers apolip, and polyposis
- Juvenile polyps and polyposis
- Inflammatory polyp
- Hyperplastic (metaplastic) polyp
- Benign lymphoid polyps and polyposis
- Deep cystic colitis
For a hyperplastic polyp is characterized by small size (up to polviny centimeters). It is slightly above the level of the mucosa and represent growth of soft consistency and normal color.
For glandular and glandular-villous polyps is characterized by larger sizes (up to 2-3 cm in diameter). Typically, such polyps have a leg, sometimes even a wide base. The color of normal polyps, as well as the color of the colon mucosa, but its consistency can be thicker. Often these polyps may ulcerate or bleed.
Villous adenomas of To harakterno lobed structure. This surface looks like a raspberry. The size of such polyps greater than that of tubular adenomas.
Classification of polyps
The most common type of benign tumors of the colon are epithelial tumors. They occur in 92% of all benign tumors. Moreover, it is glandular tumors are most susceptible to malignant degeneration – malignancy.
According to their histological structure of the polyps of the colon are divided into:
- hyperplasia (2%)
- iron (51.6%)
- glandular-villous (21.5%)
- villous (14.7%)
It is noted that the magnitude of effect on polyp risk of malignancy – the larger it is, the higher the risk of malignant transformation of the polyp.
In addition, colon polyps can be:
There are also diffuse (familial) polyposis. When the disease has been a significant number of polyps, not only in the colon. It should be noted that the number of polyps also affect the risk of malignancy. It is higher when multiple polyps (up to 20%). Solitary polyps maligniziruyutsya at least – in 1-4% of cases.
When a family risk of malignant transformation of polyps is quite significant and reaches 80-100%.
Villous adenoma in the usual visual inspection (by sigmoidoscopy or colonoscopy) is a reddish color due to the abundance of blood vessels in it. These blood vessels are usually easily injured and bleeding, which is important to consider because it is not a sign of malignancy, but only their characteristic feature.
The manifestations of polyps of colon and rectum
The most common benign neoplasm of rectum and colon in patients asymptomatic or detected incidentally during endoscopy (colonoscopy, sigmoidoscopy) for other diseases.
If a polyp reaches Bole large size (2-3 cm), then there are abnormal discharge (bloody, mucous membranes). Patients may complain about the appearance of discomfort in the abdomen and anus pain. There are disorders of intestinal motility, such as constipation or diarrhea.
Thus, the main manifestations of polyps of the colon are:
- Bleeding from the rectum. Rectal bleeding can be a symptom of various proctologic zaboelvaniya, such as hemorrhoids, anal fissure, ulcerative colitis, colorectal cancer or colon cancer. It is very important with the appearance of rectal bleeding, do not hesitate and immediately go to the proctologist to find out the cause.
- Constipation. They are associated with partial intestinal obstruction with polyps. With significant amounts polyps interfere with normal bowel motility, resulting in a marked slowing the passage of the intestine.
- Pain in the abdomen. This feature is found in the polyps rarely, and mostly associated with inflammatory changes in the polyp.
Diagnosis of polyps and colon cancer
Almost all types of colorectal cancer or colon initially appear on the background of polyps. But the polyps grow slowly, usually over several years. It is therefore very important role in the prevention of colon cancer belongs to the methods of research. Detection of malignant polyps at an early stage, it ensures the success of his cure in 90%.
The very first method of investigation in proctology is a digital rectal examination. This method allows the physician to assess the condition of the site of the rectum to 10 cm from the edge of the anus. This study should always be used. Digital rectal examination reveals other diseases of the rectum such as hemorrhoids, rectal fistulas, anal fissures. In addition, such a study to determine the state of the prostate in men, detect diseases of the surrounding tissue (cysts and tumors).
This is followed by another, equally important method for diagnosis of diseases of colon and rectal cancer – sigmoidoscopy.
Before the patient is held to carry out sigmoidoscopy enema, laxatives are appointed. The method of sigmoidoscopy can not replace any other methods such as X-rays, ultrasound, etc., as it allows the doctor to uvit "firsthand" the presence of polyps and assess the condition of the rectal wall. It is known that more than half of all colon polyps localized in the rectum and sigmoid, ie, they can identify rectoscope.
If polyps are found in the sigmoid colon, it is recommended to study the higher parts of the colon, as these are often combined with polyps polyps in other parts of the gastrointestinal tract. For this purpose, used X-ray contrast methods, and endoscopic techniques for the study of the stomach and intestines (gastroscopy, colonoscopy).
Irrigoscopy. This method of X-ray studies of the colon. It lies in the fact that in the large intestine barium suspension is introduced, followed by an X-ray done. Irrigoscopy can detect polyps larger than 1 cm in size small polyps detected by barium enema can be less. In this case, we recommend a colonoscopy.
Colonoscopy – a method for endoscopic investigation of the colon. It differs from sigmoidoscopy fact that in this case, a longer flexible tube that is inserted into the rectum and moves above the sigmoid colon. For the colonoscopy requires careful preparation of the patient enemas.
A biopsy. This method consists in the fact that finding a suspicious piece of tissue, the doctor takes a piece of it for histological examination. Biopsy can be performed during a sigmoidoscopy or colonoscopy. This is the only method to reliably say whether in this case, cancer or not.
Fecal occult blood test. This is an important method for studying the pathology of the gastrointestinal tract. It is the study of feces for the presence of blood components. For his conduct to follow doctor's instructions. They lie in the fact that on the eve before the analysis can not brush your teeth, take some drugs (particularly iron supplements). Fecal occult blood test is not specific for polyps. Polyps may be no bleeding, and the presence of blood in the stool may also be at many other diseases of rectum and colon, which we have already mentioned.
Among the new methods of investigation for the presence of gastrointestinal polyps and other growths can be noted computed tomography.
Hyperplastic polyps are usually small growths about the size of 5 cm, which dominate the mucosa of the colon. They have a soft texture and days are characterized by normal color.
For adenomatous polyps is characterized by the fact that they can reach sizes of up to 2-3 cm, to be on the leg or on a broad basis. In color they resemble the intestinal mucosa, but their texture is more dense.
Adenopapillomatoznye polyps (glandular-villous) are usually more than 1 cm in size. They have a velvety surface, which can sometimes be melkodolchatoy. These polyps can erode and bleed.
CENTER PROCTOLOGY Professor PROMA – GERMANY
SURGICAL DIVISION CB 6 RZD – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
AID IN THE TREATMENT –
Removal of colon polyps
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