Polyps and Colon Cancer
by Alan Kronhaus, M.D.

A polyp is defined as a growth or overproduction of cells that project, often on a stalk, from the lining of the digestive tract. Polyps are found most commonly in the large intestine or “colon.” Polyps of the colon are almost always benign and usually produce no symptoms.

About 30% of the general population will develop intestinal polyps at some point in life, the likelihood increasing with age. Polyps don’t usually cause problems so people who have them usually don’t know it. They are important primarily because 1% of them eventually turn into cancer. Because the polyps that eventually turn malignant cannot be identified in advance, they are all suspect. The larger the polyp, the greater the chance that it contains cancerous cells.

A polyp is a type of growth called a “neoplasm,” which means simply "new growth." When neoplastic growth is limited, as it usually is, the result is a benign swelling or mass of cells called a “tumor.” When neoplastic growth is unlimited, the result is a malignant mass of cells called a “cancer.” Cancers do not stop growing. The problems they cause depend on how aggressively they grow, and how quickly they transfer or “metastasize” to other locations.
All colon cancers begin life as polyps. It takes a long time for a polyp to grow larger and transform into a malignancy – at least 5 years, and perhaps up to 15 years. By the time a cancer causes symptoms, it’s a serious problem. That’s why it’s so important to be vigilant about screening for polyps: it’s the best way to guard against colon cancer!

Location of Intestinal Polyps
The chances of a polyp becoming cancerous depend to some extent on its location within the digestive tract. Ninety-five percent of all intestinal polyps develop inside the large bowel. The stomach's lining is host to polyps of similar appearance, but there is no agreement as to their potential for becoming stomach cancer. Polyps in the small bowel do not seem to have malignant potential. They can, however, cause trouble by producing obstruction.

Symptoms
The most common symptom of colon polyps or cancer is no symptom at all. That’s why routine screening is so important.

Even benign polyps can cause painless rectal bleeding, or bleeding not apparent to the naked eye, which in turn can cause anemia. As colon polyps evolve into cancers, they can produce symptoms like altered bowel habits, lower abdominal pain, or the symptoms associated with blood loss, called “anemia,” which include fatigue, palpitations, lightheadedness, or cardiac chest pain, called “angina.” Large growths eventually cause intestinal obstruction, which produces cramping abdo-minal pain with nausea and vomiting.

Risk Factors
Studies suggest that diet plays an important role in the formation of polyps and in the development of colon cancer. Animal fats--though not vegetable fats--are the single most important dietary factor. Lack of fiber in the diet may also contribute to polyp formation. Smoking is another significant risk factor. Women who have been diagnosed with breast, ovarian, or uterine cancer are also at increased risk for colon cancer.

Polyps tend to cluster in families so that having a first degree relative (sibling, parent or child) with colon polyps raises one’s chances of having polyps. There are several hereditary disorders that produce large numbers of intestinal polyps. Those diseases, including Familial Polyposis and Gardner’s Syndrome, are rare genetic disorders that can be inherited from either parent.

Prevention, Diagnosis & Treatment
Routine screening for bowel cancer is strongly recommended for everyone over the age of 50. Screening may be as simple as testing the stool for blood, which should be done at least every couple of years, or as elaborate as colonoscopy. Colonoscopy is a procedure in which the doctor threads an instrument called a colonoscope up through the entire large bowel. Most polyps are in the lower segment of the colon, called the sigmoid colon, and can be seen with a shorter scope called a sigmoidoscope.

For most people, increased dietary fiber and decreased animal fat are the best preventives known. For the occasional intestinal polyp that arises, routine screening is the best way to identify it and prevent it from becoming cancerous.

All polyps should be removed as preventive care. Most of them can be taken out through a colonoscope. It has been shown that the removal of polyps significantly reduces the risk of getting colon cancer. Complications like obstruction or perforation are surgical emergencies.

Dr. Alan Kronhaus is owner of Doctors Making Housecalls. The number is 919.932.5700 or visit www.doctorsmakinghousecalls.com

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