• Colorectal polyps are masses of tissue that project into the lumen
• Heterogeneous group of sessile or pedunculated; benign or malignant; mucosal, submucosal, or muscular lesions
• Types include:
• Most adenomas are tubular, tubulovillous, or villous
• Hyperplastic polyps are diminutive lesions most often found in the left colon
• Hamartomas are uncommon (rarely malignant)
• Adenomas are a premalignant lesion
• Vast majority of adenocarcinomas of the large bowel in North America and Europe are believed to evolve from adenomas
• Estimates of the incidence of colonic and rectal polyps in the general population range from 9% to 60%
• Polypoid adenomas are found in about 25% of asymptomatic adults who undergo screening colonoscopy
• Prevalence of adenomas is 30% at age 50 years, 40% at age 60, 50% at age 70, and 55% at age 80
• Mean age is 55 years
• 50% of polyps occur in the sigmoid or rectum
• 50% of patients with adenoma have more than 1 lesion, and 15% have more than 2 lesions
• Increased incidence of adenomas in breast cancer patients has been reported
• Inflammatory polyps have no malignant potential
• Cancer developing in association with hamartomas is rare
• 25% of patients who have 5 or more adenomatous polyps have a synchronous colon cancer at the initial colonoscopy
• Most polyps are asymptomatic but the larger the lesion, the more likely it is to cause symptoms
• Rectal bleeding most common symptom
• Blood is bright red or dark red depending on the location of the polyp
• Bleeding is usually intermittent
• Altered bowel habits (constipation, increased frequency)
• Crampy abdominal pain
• Physical exam yields little information about the colonic polyps themselves
• Polyp may be palpable by digital rectal exam
•Barium enema: Rounded filling defect with smooth, sharply defined margins
• Colonoscopy: Most reliable means of diagnosis with biopsy; treatment with polypectomy
• Malignant neoplasm
• Artifacts seen on barium enema (such as fecal matter, air bubbles, appendices epiploicae, lymph nodes) may be confused with polyps
• Polyps of the colon and rectum are treated because they produce symptoms, because they may be malignant when first discovered, or because they may become malignant later
• Small polyps can be removed with an electrocautery snare
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