Intestinal Polyps

Intestinal polyps are usually benign mucosal tumors located in the cavity of the colon. They can be of different shape (mushroom-like, cushion-like) and size, and can occur individually or in groups.

In about 50 percent of those affected, the polyps are located in the rectum, also known as the rectum. Depending on the type of tissue, there are different types of intestinal polyps. In an estimated 90 percent of cases, one can assume a so-called adenoma, which can increase in size and possibly form precursors of colon cancer. If it exceeds a diameter of about one centimeter, the risk is increased. In rare cases, hereditary colon polyps may also occur. If such a case exists, the risk of colon cancer is particularly high.

In the population, about ten percent are affected by intestinal polyps. The number of people affected increases with age. In the group of people over 60 years of age, about one in three suffers from tumors of the intestinal mucosa.

How intestinal polyps develop is still largely unclear. However, it is suspected that genetic, environmental and especially nutritional factors play a role.

In general, it can be said that the population of Western industrialized countries has a higher risk of intestinal polyps than, for example, Africans or Asians. From this fact, researchers conclude that diet plays a not insignificant role in the development of polyps. In particular, the consumption of meat and animal fats, as well as a low consumption of plant fibers can promote the development of intestinal polyps.

Among hereditary diseases, there are also some, albeit rare, diseases that are associated with intestinal polyps. These include Familial Adenomatous Polyposis (FAP) and Hamartous Polyposis Syndrome, which in turn are subdivided into Familial Juvenile Polyposis and Peutz-Jeghers Syndrome.

Normally, intestinal polyps do not cause any symptoms. In most cases, they are discovered by chance during a colonoscopy or rectoscopy. As the size of the colon polyps increases, so do the symptoms. These include:

• Diarrhea or constipation (called "changing bowel habits").
• Blood (in the case of large bleeding polyps) and mucus in the stool
• anaemia due to blood loss
• Difficulty in emptying the bowel or obstruction of the bowel cavity

To diagnose intestinal polyps, the doctor asks about the nature of the symptoms, as well as any family history. He then carefully palpates the rectum with his finger, as this is where the majority of polyps are located. In order to make a reliable diagnosis, the following options are available:

• A stool sample is taken and examined for traces of blood (fecal occult blood test).
• By means of a colonoscopy, the doctor can examine the colon in detail. In the event that the doctor is able to remove the polyps immediately in the course of this examination, he examines them. This examination is also used to diagnose colon cancer.
• If endoscopy is not possible, an X-ray examination with contrast medium can be performed. This examination allows the entire intestine to be viewed.
• With the help of a CT colonoscopy (virtual colonoscopy) polyps in the intestine can be made visible.

If an adenoma is found during the examination, the entire colon should be examined for further adenomas. The probability of this is about one third.

Since intestinal polyps cannot be treated with medication, the only option is to remove the polyps during an endoscopic examination. This is the safest method, as the polyps can form precursors of tumors. This is followed by an examination under the microscope (histological examination).

If this examination shows that there are no cell changes, there will be no further colonoscopy. If, however, some cells in the polyps have already undergone a transformation, a control colonoscopy will be performed after some time. The size of a polyp is decisive for the risk of developing colon cancer.

An increased risk of colon cancer exists in the rarely hereditary colon polyps. In this case, the entire colon is removed as a precautionary measure (colectomy), even if no changes are found yet. In the course of this operation, the small intestine is connected to the sphincter of the anus so that normal defecation is still possible. If the affected person is very young, this operation is not performed until after puberty.

Intestinal polyps are usually benign, but in the worst case they can develop into intestinal cancer, which is why they are removed by the doctor as a precaution.

If the removal of the adenoma is only partial, lumps can form again in the same place. By examining the size, number and shape of the adenomas, it is possible to assess whether there is a high risk of bowel cancer.

Even a healthy diet does not necessarily guarantee that you will not develop bowel cancer.

Within the framework of the statutory early detection of cancer, you are entitled to the following examinations:

• From the age of 50: test for hidden blood in the stool, as well as palpation examination of the rectum.
• From the age of 55: Colonoscopy every ten years. If you do not wish to have a colonoscopy, you can have a test for hidden blood in the stool and a palpation of the rectum every two years from the age of 56.
• If there is a family history of adenomatous polyps or if there are relatives in the family who suffer from a form of polyp, this examination should be carried out earlier and more frequently.
• If adenomatous polyps have been removed, a colonoscopy should be performed every three years in order to detect the formation of new tumours in good time.