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Todd L. Sack, M.D, FACP
Gastroenterologist with the "Borland Groover Clinic"
www.borland-groover.com

 

Question: "I'm a 48 year old man who recently had a colonoscopy. My Father was diagnosed with colon cancer a few years ago and my family doctor thought I should be checked out too. The gastroenterologist found and removed a polyp from my colon. What exactly is a polyp and what can I do to prevent them?"

 

Answer: A polyp is a growth; all polyps are tumors.   Polyps can be found on the lining of any part of the intestinal tracts - esophagus, stomach, small intestine, or large intestine (colon).  Polyps can be quite tiny - just a few millimeters in diameter - or can be as large as several centimeters in size.  There are several types of polyps, some of which are entirely benign (harmless), some of which are precancerous (could develop into cancers over months or years), and some are cancers already.   At times people confuse polyps with hemorrhoids (sometimes called “piles”), the latter being soft tissue swelling in the anal area and not tumors.

Types of Polyps

When seen under the microscope, pathologists describe  4 common types of colon polyps.  Inflammatory polyps are growths which occur with acute or chronic inflammation.  These are seen commonly in chronic ulcerative colitis where patients may have dozens of inflammatory polyps.  These are benign (not precancerous) though a times may require a biopsy to be certain of this.  Some inflammatory polyps require removal because of bleeding (see our article on Colonscopy).

Juvenile polyps and hyperplastic polyps are two other types of benign and non-precancerous polyps.  They do not need to be removed except to confirm the type of polyp by examining it under a microscope.  The finding of such a polyp is good news as it indicates that the patient likely does not need a repeat colonoscopy to look for other polyps or cancers.  Rarely, either type may grow to several centimeters where they can bleed or cause symptoms due to blockage of the bowel.

Adenomatous polyps (“adenomas”)  are the “bad polyps”.  They are usually precancerous, meaning that they have a potential to develop into cancers over months - to - years.   Adenomas of a diameter of 1cm or larger are especially worrisome.  For this  reason, the gastroenterologist during a colonoscopy procedure will try to remove any polyp over 5mm (half a centimeter) in size to examine it under the microscope to determine if it is an adenoma or even an early cancer.  This  practice has been shown in large studies to prevent colon cancers and early death from cancer.  With an adenomas of 1cm or larger, followup  colonscopy is advised every 3 years in order to remove any further polyps.

My doctor told me I have a colon polyp.  What should I do?

Find out what type and size of colon polyp was found.   If it was a significant adenoma (a centimeter or larger), colonoscopy likely should be performed every 3 years to harvest any new polyps which may grow.  If yours was not an adenoma, you should speak with your doctor before agreeing to another colonoscopy.   For individuals of 50 years or older with no history of polyps or family history of colon cancer, routine screening for colon cancer should include annual stool testing for the presence of blood (the Hemoccult test) and an office flexible sigmoidoscopy every 3 - 5  years.

What causes adenomatous colon polyps?

The cause of adenomas is not known.  They are more common in individuals over 50 years of age or in those with a family history in a first degree relative (parent, sibbling, or child) with adenomatous polyps or of colon cancer.   There are also rare families with hundreds of  colon polyps and a high incidence of colon cancer in young hood.  Abnormal genes have been found in some polyps, indicating that mutations have occurred.

What can I do to prevent adenomatous colon polyps and colon cancer?

Epidemiologic studies point to a healthy diet as the first step in colon cancer prevention.  This is a diet which includes cereals, fresh vegetables and fresh fruits daily, and with less that 30% of the dietary calories from fats.   Other studies suggest that a single multivitamin daily (but not higher doses of vitamins) and plenty of calcium may decrease the risk of cancer or of polyps.  Six Tum's - (calcium carbonate) daily reduced the rate of polyp growth in one 1999 study.

Polyps in other organs of the gastrointestinal tract

Rarely, polyps can occur in the esophagus, stomach or small intestine.  These are far less likely that colon polyps to be pre-cancerous but any polyp needs to be examined closely with biopsies as it may be a cancer.   Even benign polyps may need to be removed with endoscopy or with surgery of bleeding or obstruction develops.

Todd L. Sack, M.D, FACP
Gastroenterology & Hepatology
The Borland-Groover Clinic
www.borland-groover.com
Jacksonville, Florida

 

Editor's Note: Colon cancer is the third most common cause of cancer and third-highest cause of cancer death in both men and women. There are over 131,000 new cases of colon cancer each year in the U.S. Early detection can lead to more effective treatment of colon cancer, but a regular program of colon screening, as discussed above by Dr. Sack, is the key to actually preventing this cancer. This is a very important concept since very few cancers can actually be prevented. 

Colon cancer starts out as a non-cancerous (“benign”) polyp and can take up to several years to degenerate into a cancer. By preventing or removing polyps, the incidence of colon cancer can be significantly reduced.

You can also decrease your risk of colon polyp's (and cancer) by...

  • reducing the amount of fat in your diet

  • increasing your intake of fruits and vegetables to five servings per day

  • exercising

  • limiting alcohol (especially beer)

  • eliminating all tobacco intake

  • watching your weight (obesity is a risk factor).

  • Estrogen replacement may also lower colon cancer risk

Some vitamins and minerals may also help reduce our risk for colon polyps and cancer. This includes vitamin A, C, E and the mineral, selenium (200 meg. per day). 

Additionally, numerous studies have suggested that anti-inflammatory drugs (aspirin, Sulindac®. Ibuprofen, etc.) may help prevent polyp formation and, subsequently, colon cancer. Some studies have suggested that it takes almost 20 years for the benefits of taking these anti-inflammatory medications to occur.

Even though they are available over-the-counter, these medications are not appropriate for all individuals. As with any new supplement or medication, discuss it's use with your personal physician before you ever start taking anything.

Charles H. Booras, M.D.
Co-Founder and Editor,
Jacksonville Medical Park Online

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