Colorectal Polyps

I have been told I have polyps in my bowel. Should I start worrying?

Not at all. Polyps are growths of the bowel, usually they are benign, but they require a bit of attention.

Usually? Does this mean that sometimes they can be malignant?

Yes, they can, occasionally. There are several different types of bowel polyps, adenomatous, hyperplastic, serrated, inflammatory… Natural history of adenomatous polyps is to evolve into adenocarcinoma, that is a malignant tumour, but per se polyps are not malignant. Hyperplastic and inflammatory polyps don’t transform into cancer. It is still not perfectly clear the malignant potential of serrated polyps. The polyp-cancer theory – which has been widely proved – says that several progressive genetic abnormalities accounts for the sequential transformation of normal bowel mucosa to polyp and then to cancer. There is a particular phase during this process when a benign polyp can have a malignant area.

So, it is advisable to pick up polyps when they are still benign, isn’t it?

Sure it is! The Bowel Cancer Screening  Programme is aimed at identifying and removing polyps when they are still benign, before they transform into cancer. This is the true “prevention”.

I am not yet of the screening age… should I be investigated to rule out polyps?

Not necessarily, unless you have specific symptoms or a genetic predisposition, that is one or more of your first-degree relatives suffering with bowel polyps or cancer.

What are the symptoms of bowel polyps?

The usual red flag is represented by one or more episode of rectal bleeding. Polyps are usually too small to give any other kind of symptom. In case of rectal bleeding, your GP will refer you to the specialist for investigation and treatment. This is why is so important checking your own stools for traces of blood.

What investigation should I have if polyps are suspected?

The only reliable investigation to identify polyps is colonoscopy, that is a camera test aimed to navigate the whole large bowel to visualize and possibly remove all the polyps. CT-colonography is quite a new non-invasive test able to visualize the whole large bowel with a CT scan, but clearly it is not possible to do any therapeutic manoeuvre. If CT-colonography identifies any polyp, a formal colonoscopy is warranted to confirm and remove the polyps.

That’s amazing… How can they be removed so easily?

Small polyps can be removed or destroyed with endoscopic forceps, whereas bigger polyps are usually removed with a hot snare, which strangulates and cuts the polyp with diathermy.

Can polyps return once they have been removed?

Polyp can recur if they are not removed completely. However, new polyps can arise in a colon which has a genetic predisposition to form polyps. For this reason, if you have had polyps and these have been removed, you should be ona surveillance programme.

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