Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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: -Neoplastic (adenomas/carcinomas)-Hamartomas-Inflammatory-Hyperplastic• 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 +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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 +++ Laboratory Findings + • Anemia may be present with rectal bleeding +++ Imaging Findings + •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• Diverticula +++ Rule Out + • Malignant neoplasm + • History and physical exam• Digital rectal exam• Proctoscopy• Colonoscopy with biopsy/polypectomy• Barium enema +++ When to Admit + • Bleeding or other complications such as perforation, severe abdominal pain, obstruction + • 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 +++ Surgery ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.