Polyps are abnormal tissue growths that most often look like small, flat bumps or tiny mushroomlike stalks. Most polyps are small and less than half an inch wide. Polyps in the colon are the most common, but it’s also possible to develop polyps in places that include: ear canal. cervix.

Polyp is an abnormal growth of tissue projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk, it is said to be pedunculated; if it is attached without a stalk, it is said to be sessile. Polyps are commonly found in the colon, stomach, nose, ear, sinus(es), urinary bladder, and uterus. They may also occur elsewhere in the body where there are mucous membranes, including the cervix, vocal folds, and small intestine. Some polyps are tumors (neoplasms) and others are non-neoplastic, for example, hyperplastic or dysplastic. The neoplastic ones are usually benign, although some can be pre-malignant, or concurrent with a malignancy.

Types of Polyps

  • Inflammatory polyps (pseudopolyps) – There is a well-defined association between identifying pseudopolyps and the spectrum of inflammatory bowel disease. However, a variety of other infectious and non-infectious colitis, including amoebic, ischemic, and schistosomal colitis might be attributed. The larger lesions with greater than 1.5 cm diameter, classifying as giant pseudopolyps, might present as an extensive polyposis syndrome.
  • Familial juvenile polyposis – is inherited via an autosomal dominant pattern. Colon and rectum are most commonly involved. Malignant degeneration through the adenoma and carcinoma transformation is possible. Due to the high malignant yield, annual screening should merit consideration from the age of 10 to 12 years. Although it is an uncommon polyposis syndrome in adults, it has a remarkable significant percentage of polyposis syndrome in the pediatric population.
  • Hyperplastic polyps – The colon is most commonly affected by hyperplastic polyps. Although the hyperplastic polyps do not classify as premalignant lesions, due to the similarities with adenomatous polyps in colonoscopy, once diagnosed, they require removal. They may occur as a polyposis syndrome with multiple/ giant polyps harboring a significantly increased risk of malignancy.
  • Familial polyposis coli – Familial adenomatous polyposis (FAP) or familial polyposis coli is considered as one of the rare causes of colorectal adenocarcinomas. Specific mutation of APC and positive family history are evident in the majority of patients. There is already an extremely significant value of timely screening and surveillance in positive family and personal history of FAP, respectively. Among those affected with FAP, the risk of colorectal cancer goes way up to 100% by the age of 50.
  • Turcot syndrome – Familial colorectal adenocarcinomas, including FAP and HNPCC, may accompany a variety of central nervous system tumors known as Turcot syndrome. Moreover, Turcot syndrome categorizes according to the type of CNS tumor and number of colonic polyps in a couple of subgroups; type I, attributes to the glial tumors and a small number of colonic polyps, while a significant number of polyps and greater risk of medulloblastoma have been well-documented in type II.
  • Cowden syndrome and PTEN hamartoma – PTEN acts as a tumor suppressor gene. Cowden syndrome, as an autosomal dominant syndrome and related to PTEN hamartoma tumor syndrome (PHTS), has a broad range of clinical manifestations including trichilemmomas in the face, malignant pathologies in the breast, thyroid, and gastrointestinal polyps. Obtaining timely screening schedules to exclude malignancies in these patients is crucial. Traditionally, there was a remarkable 80% germline PTEN mutation in patients affected by Cowden syndrome; however, recently, the specificity of these criteria has been questioned.
  • Peutz-Jeghers syndrome – Peutz-Jeghers syndrome, or mucocutaneous pigmentation and polyposis syndrome, is classified as an autosomal dominant hamartomatous polyposis. Although evidence of the remarkable malignant potential is lacking, stepwise screening plans are generally the recommended approach to evaluate not only the GI tract but also other possible sites for malignancies, including breast, upper gastrointestinal tract, pancreas, cervix, ovaries, and testicles.
  • Cronkite-Canada syndrome – Cronkite-Canada syndrome is a rare non-inherited disorder in which patients develop gastrointestinal polyposis in correlation with alopecia, cutaneous pigmentation, and fingernail/toenail atrophy. Diarrhea is a prominent symptom, and malabsorption, vomiting, and protein-losing enteropathy may occur. Most patients die of this disease despite maximal medical therapy, and surgery is only for complications of polyposis such as obstruction. Cowden syndrome is an autosomal dominant disorder with hamartomas of all three of the embryonal cell layers. Facial trichilemmomas, breast cancer, thyroid disease, and gastrointestinal polyps are typical of the syndrome. Patients should have screening for cancers.
  • Attenuated familial adenomatous polyposis (AFAP) – is a recognized variant of FAP. Patients present later in life with fewer polyps (usually 10–100) predominantly located in the right colon, when compared to classic FAP. Colorectal carcinoma develops in more than 50% of these patients but occurs later (average age, 55 years). Patients are also at risk for duodenal polyposis. However, in contrast to FAP, APC gene mutations are present in only about 30% of patients with AFAP. When present, these mutations express in an autosomal dominant pattern. Mutations in MYH, a gene involved in the repair of DNA, also result in the AFAP phenotype but are expressed in an autosomal recessive pattern.
  • Serrated polyps – including sessile serrated adenomas and traditional serrated adenomas, are a recently recognized, histologically distinct group of neoplastic polyps. Endoscopically they are flat lesions and frequently difficult to visualize. These lesions were long thought to be similar to hyperplastic polyps with minimal malignant potential. However, it has become clear that some of these polyps will develop into invasive cancers. Additionally, research has described a familial serrated polyposis syndrome.

Causes of Polyps

Men and people who smoke have a higher risk for bladder polyps. Women over 40 years of age and women who have had children are more likely to develop polyps in the uterus.

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For cervical polyps, the risk increases in women over 20 years or age and women who are premenopausal.

People who habitually stress their vocal cords or have acid reflux have a higher risk for throat polyps. But there are no known risk factors for aural polyps.

Talk to your doctor about your individual risks for polyps if you are concerned about a specific type.

Risks for colon polyps

For colon polyps, the risk factors include:

  • eating a high-fat, low-fiber diet
  • being over 50 years of age
  • having a family history of colon polyps and cancer
  • using tobacco and alcohol
  • having an intestinal inflammation disorder like Crohn’s disease
  • being obese
  • not getting enough exercise
  • having type 2 diabetes that isn’t well-managed

African-Americans are also at a higher risk of developing colon polyps.

Risks for stomach polyps

The risk for stomach polyps increases with the following:

  • age — more common in middle to old age
  • bacterial stomach infections
  • familial adenomatous polyposis (FAP), a rare genetic syndrome
  • regular use of proton pump inhibitors like Nexium, Prilosec, and Protonix

Risks for nasal polyps

Nasal polyps are more likely to develop in people who experience the following conditions:

  • ongoing sinus infections
  • allergies
  • asthma
  • cystic fibrosis
  • sensitivity to aspirin

Symptoms of Polyps

Each type of polyp can cause unique symptoms based on location. Below are some common polyp types, their locations, and symptoms.

Type of polyps Location Symptoms
aural ear canal loss of hearing and blood drainage from the ear
cervical cervix, where the uterus connects to the vagina typically no symptoms, but can include bleeding during menstruation (heavier) or sex, or an unusual discharge
colorectal (colon) large intestine, colon, and rectum blood in stool, abdominal pain, constipation, diarrhea
nasal nose or near sinuses similar to the common cold such as headache, nose pain, loss of smell
gastric (stomach) stomach and stomach lining nausea, pain, tenderness, vomiting, bleeding
endometrial (uterine) uterus, usually uterine lining infertility, irregular menstrual bleeding, vaginal bleeding
vocal cord (throat) vocal cords hoarse and breathy voice that develops over a few days to several weeks
bladder bladder lining blood in urine, painful urination, frequent urination

Most colon polyps are noncancerous and do not often cause symptoms until they are in their later stages. But like gastric polyps, they can develop into cancer.

Diagnosis Of Polyps

Doctors can find colon polyps only by using certain tests or procedures, such as a colonoscopy or imaging study. Your doctor may first take a medical and family history and perform a physical exam to help decide which test or procedure is best for you.

For example, your doctor may ask if you have any symptoms. He or she may also ask if you have a family history of colon polyps or colorectal cancer. After taking a medical and family history, your doctor may perform a physical exam.

Tests and procedures

  • Flexible sigmoidoscopy – For a flexible sigmoidoscopy, a trained medical professional uses a sigmoidoscope—a flexible, narrow tube with a light and tiny camera on one end—to look inside your rectum and lower colon. Flexible sigmoidoscopy can show irritated or swollen tissue, ulcers, polyps, and cancer.
  • Colonoscopy – During a colonoscopy, a trained medical professional uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope, to look inside your rectum and colon. Colonoscopy can show irritated and swollen tissue, ulcers, polyps, and cancer. The most sensitive test for colorectal polyps and cancer. If polyps are found, your doctor may remove them immediately or take tissue samples (biopsies) for analysis.
  • Virtual colonoscopy – Virtual colonoscopy uses x-rays and a computer to create images of your rectum and colon from outside the body. Virtual colonoscopy can show ulcers, polyps, and cancer. Doctors can’t remove polyps during virtual colonoscopy.
  • Lower gastrointestinal series – For a lower gastrointestinal (GI) series, a doctor uses x-rays and a chalky liquid called barium to view your large intestine. The barium will make your large intestine easier to see on an x-ray. A lower GI series is also called a barium enema.
  • Virtual colonoscopy – a minimally invasive test that uses a CT scan to view your colon. Virtual colonoscopy requires the same bowel preparation as a colonoscopy. If a polyp is found, you’ll need a colonoscopy to have it removed.
  • CT colonography – Also known as a virtual colonoscopy, this uses X-rays and a computer to take pictures of your colon from outside your body. Your doctor can’t take polyps out during this test. If they spot any, you’ll need to have a regular colonoscopy. You’re awake for this test, but you’ll still need to do a special diet to clear out your bowel beforehand.
  • Flexible sigmoidoscopy – in which a slender, lighted tube is inserted in your rectum to examine it and the last third of your colon (sigmoid) and rectum. If a polyp is found, you’ll need a colonoscopy to have it removed.
  • Stool-based tests – This type of test works by checking for the presence of blood in the stool or assessing your stool DNA. If your stool test is positive you will need a colonoscopy.
  • Fecal occult blood testing – (FOBT) may indicate bleeding from a colonic polyp. A positive FOBT due to bleeding from a polyp correlates to the polyp size and proximity to the rectum. Most small polyps will fail to result in a positive FOBT, although the test has a higher sensitivity for larger polyps and for carcinomas. For this reason, FOBT is a part of the screening algorithm for the early detection of colon cancer, despite its poor sensitivity for polyps.
  • Fecal immunochemical testing – (FIT or iFOBT) is a newer, more sensitive screening method than the traditional FOBT. It utilizes specific antibodies to the globin component of the hemoglobin. A recent study compared FIT against colonoscopy as a screening tool for both colorectal cancer and adenomas [].
  • Colonoscopic spectroscopy – using near-infrared autofluorescence (NIR AF) was recently proposed as an adjunct for in vivo diagnosis of colonic ‘pre-cancer and cancer during clinical colonoscopic screening. This method was found to have a sensitivity and specificity of approximately 80% and 90%, respectively, for the classification of benign, pre-cancer lesions and cancer in the colon []. This method, although promising, is still experimental and is not routinely used in clinical practice.
  • Narrow-band imaging – (NBI) is another new endoscopic imaging technique that highlights surface structures and superficial mucosal capillaries during colonoscopy. Even though disagreement exists regarding its effectiveness in increasing the colonoscopic view’s sensitivity, it has recently been shown to have a high sensitivity and specificity for differentiating neoplastic and non-neoplastic polyps [, ]. This modality has also not entered routine clinical practice.
  • Computed tomographic colonography – (also called ‘CT colonography’ or ‘virtual colonoscopy’) is another screening modality, which is suggested for patients who refuse colonoscopy. This modality uses computed tomography of an air-distended prepared colon. With an optimal colon preparation and an experienced radiologist reading the images, some reports indicate that the sensitivity of CT colonography for detecting polyps larger than 5 mm (which are believed to be clinically significant) exceeds 90% [, ]
  • Magnetic resonance colonography – (MRC) is another diagnostic modality that is currently being evaluated. The rationale for using MRC is based on the relatively high radiation exposure during CT colonography []. A recent small-scale study has demonstrated a low sensitivity (despite a high specificity) for detecting large (>10 mm) polyps using MRC []. Therefore, the evidence does not support MRC as a standard diagnostic modality for detecting colorectal polyps and this modality is not routinely used in clinical practice.
  • Capsule endoscopy – is a diagnostic modality that was originally developed to diagnose and evaluate small bowel lesions. Since the capsule passes through the prepared colon after traversing the ileocecal valve and continues to transmit images, it can also detect colonic lesions. A large cohort with suspected colonic lesions underwent a capsule endoscopy with a dual camera capsule designed especially to evaluate the colon (PILLcam colon) and, immediately afterward, had a colonoscopy. The sensitivity and specificity of the capsule endoscopy were shown to be inferior to colonoscopy [].
  • Fecal DNA and antigen testing – is another futuristic modality expected to yield results within the next few decades []. Several technical advances have recently been seen to increase its accuracy, including the use of a DNA preservative buffer with stool collection, DNA amplification methods, and automated assays of several DNA markers []. The stool was analyzed with an automated multi-target stool DNA assay to measure β-actin, mutant KRAS, aberrantly methylated BMP3 and NDRG4, and fecal hemoglobin.
  • Stool DNA analysis – identified individuals with colorectal cancer with 98% sensitivity and 90% specificity. Its sensitivity in respect of advanced adenomas was 57% and for high-grade dysplasia, it was 83% []. In the future, should this modality prove to have even a higher positive predictive value for detecting adenoma or carcinoma, it might obviate the need for any invasive screening tests.
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Second Examination

  • If no polyps are found on the first examination it is recommended that a second examination should be done 10 years later.
  • If the only polyps that are found are hyperplastic polyps, and they are limited to the rectum and sigmoid colon and they are all less than one centimeter in size, a second examination is recommended in 10 years.
  • If one or two tubular adenomas are found and they are less than one centimeter in size, a second examination is recommended in five years through a longer interval may be reasonable as well.
  • If three to ten adenomas are found, it is recommended that a second examination be done in three years.
  • If more than ten adenomas are found, it is recommended that a second examination be done in three years or less.
  • If one or more tubular adenomas are found that are greater than one centimeter in size, a second examination is recommended in three years.
  • If one or more adenomas are found of any size and their histology is villous, a second examination is recommended in three years.
  • If one or more adenomas are found and any show high-grade dysplasia, a second examination is recommended in three years.
  • If serrated polyps are found, recommendations are less secure because much less information is available about the future risk of polyps and cancers. Concerns are greater (and the interval to the next examination should be shorter) if the polyps are proximal (in the ascending colon), are larger (more than one centimeter in size), and particularly if they show dysplasia.
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Treatment For Colonic Polyps

Doctors treat colon polyps by removing them.

In most cases, doctors use special tools during a colonoscopy or flexible sigmoidoscopy to remove colon polyps. After doctors remove the polyp, they send it for testing to check for cancer. A pathologist will review the test results and send a report to your doctor. Doctors can remove almost all polyps without surgery.

If you have colon polyps, your doctor will ask you to get tested regularly in the future because you have a higher chance of developing more polyps.

Your doctor is likely to remove all polyps discovered during a bowel examination.

  • Eat less meat – Eat a healthy diet, with minimal red meat—especially processed or cured meats. Studies suggest that people with meat-rich diets tend to have higher rates of colon cancer.
  • antioxidants –  Several associations have been explored for antioxidants including selenium, beta carotene, and vitamins A, C, and E. Most of the studies that have been done do not support a role for these agents in preventing polyps or in preventing colon cancer. A limited amount of support is available for the use of selenium to prevent polyps, but selenium is not recommended for use outside of experimental trials.
  • Supplemental dietary calcium – has been demonstrated in one study to prevent the formation of polyps. The benefit was seen with supplementation of 1200 mg of calcium per day. There is some concern about using calcium since higher dietary and supplemental levels are associated with an increase in vascular disease. The intake of calcium that was studied was higher than the recommended intake of calcium, 800 mg per day.
  • NSAIDs – The best support for a treatment to prevent polyps is with nonsteroidal anti-inflammatory drugs (NSAIDs), a class of drugs that includes aspirin, ibuprofen (Motrin, Advil), celecoxib (Celebrex), and many others. Aspirin has been shown in several studies to reduce the formation of polyps by 30% to 50%. The effect is likely to occur with higher doses of aspirin (more than the 81-325 mg that is recommended for cardiovascular disease prevention), and there is concern about aspirin’s side effect of gastrointestinal bleeding at these doses.
  • Celecoxib (Celebrex), a “COX-2 selective NSAID” – or Cox-2 inhibitor has been shown to reduce colon polyps 30% to 50% as well, but there is a lingering concern about the possible cardiovascular side effects that may be seen with most NSAIDs (though the data supporting this side effect is conflicting). It may be used in patients with genetic polyposis syndromes who choose not to have their colons removed. Celecoxib might be considered in patients with a low risk for cardiovascular disease who develop adenomatous polyps frequently.
  • Sulindac (Clinoril) – a “non-selective NSAID” has been shown to prevent polyps in patients with sporadic adenoma as well as genetic syndromes. As with celecoxib, there is concern about cardiovascular side effects and gastrointestinal ulceration and bleeding.
  • Aspirin – Taking a low dose of aspirin every day for a long period of time may help prevent polyps from developing into colorectal cancer in some people. However, taking aspirin daily may cause side effects such as bleeding in your stomach or intestines. Talk with your doctor before you start taking aspirin daily.

Some types of colon polyp are far likelier to become malignant than are others. But a doctor who specializes in analyzing tissue samples (pathologist) usually must examine polyp tissue under a microscope to determine whether it’s potentially cancerous.

Surgery

  • Removal with forceps or a wire loop (polypectomy) – If a polyp is larger than 0.4 inches (about 1 centimeter), a liquid may be injected under it to lift and isolate the polyp from surrounding tissue so that it can be removed.
  • Minimally invasive surgery – Polyps that are too large or that can’t be removed safely during screening are usually removed laparoscopically, which is performed by inserting an instrument called a laparoscope into the bowel.
  • Colon and rectum removal – If you have a rare inherited syndrome, such as FAP, you may need surgery to remove your colon and rectum (total proctocolectomy).
  • Laparoscopy – During a laparoscopy, the doctor will make a small incision into the abdomen or pelvis and insert an instrument called a laparoscope into the bowel. They use this technique to remove polyps that are too large or cannot be removed safely by colonoscopy.
  • Removing the colon and rectum – This procedure, known as a total proctocolectomy, is only necessary when a person has a severe condition or cancer. Doctors recommend this option for those with rare inherited conditions, such as familial adenomatous polyposis (FAP). FAP is an inherited condition that causes cancer of the colon and rectum, and polyp removal may prevent cancer from developing.

REferences

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