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BOWEL CONDITIONS

Polyps of the Colon and Rectum

What are polyps?

Polyps are abnormal growths in the inner lining (mucosa) of the large intestine (colon or rectum). Although most polyps are benign, some can progress over time to become colon cancer. Almost all colon cancers originate from a polyp.

There are various types of colonic polyps.

Adenomas may be flat or pedunculated (on a stalk). Over a period of 8-10 years an adenoma may change to develop into cancer. Adenomas found on colonoscopy should be removed completely to make sure there are no cancer cells beginning to form and to prevent future growth into a cancer. Patients with adenomas should have more frequent colonoscopies, every 3 – 5 years, due to the increased risk of recurrent polyps or cancer.

Hyperplastic polyps are usually found in the rectum and generally harbor no cancer potential, unless they are large (>1 cm) or multiple (>30 polyps).

Sessile serrated adenomas are polyps found in the right colon that follow a different pathway to cancer compared with adenomas. These polyps should be removed to prevent growth into cancer. More frequent colonoscopies are recommended (every 3 – 5 years) compared with the general population.

Hamartomas are generally not cancerous, but have been linked to rare hereditary disorders that can predispose to colorectal cancer.

Inflammatory polyps are not true polyps but raised areas of tissue that occur due to inflammation in the colon. Treatment is geared toward treating the condition causing inflammation such as Crohn’s disease or ulcerative colitis.

What are the symptoms of a polyp?

Most polyps are asymptomatic and diagnosed incidentally at the time of colonoscopy. Some polyps can cause bleeding, anemia, mucous discharge, alteration in bowel function, or in rare cases, abdominal pain.

How are polyps diagnosed?

Polyps are diagnosed either by colonoscopy, by x-ray (barium enema) or CT colonography (virtual colonoscopy). Although checking the stool for microscopic blood may be used to screen for colon and rectal disorders, a negative test does NOT exclude the presence of polyps or cancer.

Barium enema or CT colongraphy may diagnose most medium to large polyps, however, if a polyp is found, a colonoscopy is then needed to remove the polyp. Colonoscopy is, therefore, Dr. Zaghiyan’s preferred method for screening because it is the only test that allows both diagnosis and removal of polyps. Colonoscopy performed by Dr. Zaghiyan is generally with sedation and minimal to no discomfort.

How are polyps treated?

Dr. Zaghiyan will remove any polyps seen at the time of your colonoscopy. Large polyps may require more than one treatment for complete removal. Some polyps are too large or in a position that does not allow removal with colonoscopy. Dr. Zaghiyan may recommend surgery for those individuals.

When a polyp is removed, it is sent off for pathological exam to assure that there are no cancer cells beginning to form within the polyp. Pedunculated polyps (on a stalk) that harbor cancer cells (malignant polyps) may need no further treatment if the polyp is removed in its entirety with a negative margin. Sessile (flat) malignant polyps may require surgical resection depending on the depth of cancer invasion into the wall of the colon and other factors seen on pathologic evaluation. Malignant polyps that are not removed in one piece may require surgical excision. Large rectal polyps may be excised by Dr. Zaghiyan, either by transanal excision or a new minimally invasive technique called TAMIS (Trans-Anal Minimally Invasive Surgery).

For a thorough evaluation and treatment recommendation, make an appointment for a consultation with Dr. Zaghiyan in her office in Los Angeles.