Intestinal polyps are small bumps that form in the innermost lining of the intestine, especially in the large intestine, then in the colon and rectum. The shape of these polyps can resemble that of a small mushroom or cauliflower, which protrudes towards the internal lumen of the organ, with or without stem as appropriate. Intestinal polyps can be single or multiple and vary in size; sometimes they measure a few millimeters, other times they reach a few centimeters in diameter. Usually, intestinal polyps do not cause symptoms and have a benign nature, that is, they do not evolve into other serious pathologies. However, there is a certain risk of transformation into a malignant sense; this degeneration, however very slow, is more probable for some types of polyps, such as large ones. For this reason, the early identification and removal of suspicious colon polyps prevents their possible evolution into colorectal cancer.
Intestinal polyps can appear at any age, although in most cases they develop after age 50. The causes of this phenomenon are not yet completely clear, however it is known that some factors can favor its appearance. The risk of intestinal polyps increases especially if there is a certain "familiarity", ie if intestinal polyps have already been found in other close family members. Smoking, obesity, low physical activity and alcohol abuse also increase the chances of suffering from it.Among the predisposing dietary factors, we remember the excessive consumption of red meat and saturated fats in general; vice versa, diets rich in fiber and sufficient physical activity seem to have a protective role. Another important factor that increases the chances of developing polyps is the presence of chronic inflammatory diseases of the colorectal, including ulcerative colitis and Crohn's disease.
There are several types of intestinal polyps, mainly classified according to their shape. In particular, pedunculated polyps and sessile polyps can be distinguished. The first, the pedunculated ones, as the name implies, have a peduncle, that is a sort of stem, to which a head is attached. To make a comparison, they resemble small mushrooms that protrude above the inner lining of the intestine. Conversely, sessile polyps are peduncleless and very flat; not having the stem, they resemble a lump on the intestine wall. Due to this shape, unlike pedunculated polyps (which can be cut at the base of the stem), the surgical removal of sessile polyps is more difficult. In addition to their shape, intestinal polyps can also be classified according to their number. Some people develop a single intestinal polyp, others have multiple polyps. Specifically, we speak of polyposis when there are more than one hundred polyps. As regards the relationship between polyps and colorectal cancer, it should be emphasized once again that not all polyps are at risk of malignant evolution. In this sense too, in fact, it is possible to distinguish different types of polyps. Hyperplastic polyps, for example, are small growths characterized by a rapidly proliferating mucosa and considered essentially harmless, because their transformation into a malignant tumor is rare. Hamartomatous polyps, also called juvenile polyps, are also non-neoplastic lesions, generally of family origin. Finally, neoplastic or adenomatous polyps are found, which are more prone to turn into a malignant neoplasm over time. It is therefore correct to consider colorectal adenomas as precancerous lesions. Without going into too much detail, even adenomatous polyps, in turn, are divided into tubular, villous and tubular-villous polyps. Among these subtypes, those with the greatest cancer risk are villous polyps.
As mentioned, most intestinal polyps do not cause particular symptoms or ailments. Their discovery, therefore, is often occasional, for example during screening tests or endoscopic examinations performed for other reasons. If an intestinal polyp reaches a considerable size, localized or diffuse pain in the abdomen may appear; in the case in which the dimensions are such as to occlude the intestinal lumen, real abdominal colic appears accompanied by nausea and vomiting. In some cases, the presence of polyps is accompanied by the presence of mucus in the stool, diarrhea or blood loss from the rectum. These leaks are often imperceptible, therefore not visible to the naked eye. There are two alarm bells to pay attention to, because they could signal the presence of a colon polyp or colorectal cancer. The first is a significant and inexplicable change in the usual evacuation rhythm, which lasts for a few weeks. The second is the visual finding of blood or mucus in the stool, or a change in their shape such as an abnormal thinness.
Given the frequent presence of intestinal polyps, a screening by colonoscopy, to be repeated every decade from the age of 50, can dispel any doubts. In individuals with a familial predisposition, this screening can begin earlier, for example by the age of 40 or 45. Colonoscopy is also used when the presence of intestinal polyps is suspected based on the symptoms present. The examination is carried out by introducing a flexible optical fiber instrument through the anal orifice, and then it gently ascends along the rectum and colon. In this way the colonoscopy is able to directly transmit the images of the intestinal mucosa, highlighting the " possible presence of polyps. Also, during a colonoscopy it is possible to remove small polyps or perform biopsies. Histological examination is then performed on these biopsy samples, which allows us to ascertain the nature of the polyps and the risk of malignant evolution. Another diagnostic test is a double-contrast barium enema; it is a special X-ray which, thanks to the barium and the air introduced into the colon, allows to visualize the polyps in the radiographic images. It is however a second choice examination, performed in cases in which the colonoscopy cannot be performed on the patient. Only in cases where the polyps give rise to small blood loss, a stool test for the search for the so-called "occult blood" can identify this anomaly and direct you to a colonoscopy for verification.
In general, the removal of any polyps identified during the colonoscopy is always recommended. This approach must be understood as a form of prevention against colorectal cancer, also in consideration of the fact that it is not possible to establish with absolute certainty whether a polyp will become malignant or not. As anticipated, most intestinal polyps can be surgically removed during colonoscopy. The colonoscope, in fact, houses a channel through which a loop or a metal forceps can pass. These devices allow you to remove a polyp, using a procedure called endoscopic polypectomy. However, if the polyps are large or are present in difficult-to-access locations, other surgical, endoscopic or laparoscopic approaches may be required for their complete removal. Once removed, the polyp is sent to the laboratory to determine if it is benign or if there are signs of a possible neoplastic transformation. Based on the results of the analyzes and various other factors, such as size, for example, the doctor will be able to advise how often to undergo future check-ups.
