Colon Polyps: When Surgery is Necessary and What to Consider

Q: Colon Polyps: When Surgery is Necessary and What to Consider

Polyps： Polyps are protrusions on the intestinal wall formed by abnormal proliferation of the epithelium. <br>Polyps can generally be classified into hyperplastic polyps and adenomatous polyps, with only adenomatous polyps having the potential to undergo malignant transformation.

Intestinal polyps

Two years ago, I was diagnosed with polyps in my intestines in Taiwan.
I have been experiencing constipation and diarrhea.
Recently, I mentioned this issue to my doctor, and the doctor here in the U.S.
recommended that I undergo surgery to remove the polyps immediately.
Is this necessary, and what should I be aware of?

James, 50~59 year old female. Ask Date: 2000/11/15

Dr. Yang Guojun reply Internal Medicine

Polyps: Polyps are protrusions on the intestinal wall formed by abnormal proliferation of the epithelium.
Polyps can generally be classified into hyperplastic polyps and adenomatous polyps, with only adenomatous polyps having the potential to undergo malignant transformation.
The likelihood of cancer development is also related to the size of the adenomatous polyps.
Colorectal polyposis is often a familial condition, known as familial adenomatous polyposis (FAP).
This condition is inherited in an autosomal dominant manner and carries a risk of malignant transformation, necessitating regular surveillance.
If there is a family history of this condition, first-degree relatives should also be screened.
However, due to the excessive number of polyps in colorectal polyposis, it may not be possible to remove all polyps, making regular monitoring the only viable option.
In some cases, a colectomy may be required to prevent cancer development.
The risk of malignant transformation in adenomatous polyps is correlated with their size; generally, polyps smaller than 1 cm have a 1% chance of becoming cancerous, while those larger than 1 cm have a 5-15% chance.
Fortunately, the increasing use of colonoscopy in recent years allows for the removal of visible colorectal polyps, which is expected to significantly reduce the incidence of colorectal cancer.
Genetics: The carcinogenic mechanisms of colorectal cancer involve a series of mutations in oncogenes and tumor suppressor genes.
One hereditary condition, familial adenomatous polyposis, is an example of autosomal dominant inheritance.
Studies have indicated that the risk factors for developing colorectal cancer include the size of adenomatous polyps, with smaller polyps having a 1% risk of cancer and larger polyps having a 5-15% risk.
Additionally, there are non-familial colorectal cancer patients, whose families also have an 8-12% chance of developing colorectal cancer, thus all first-degree relatives of colorectal cancer patients should undergo screening.
Diet: Almost all studies suggest that a diet high in fat is a major contributing factor to colorectal cancer.
Similarly, high consumption of red meat and alcohol is also likely to increase the risk of colorectal cancer.
Research has confirmed that adequate exercise and increased dietary fiber can reduce the risk of colorectal cancer.
The specific and non-specific symptoms that present clinically can vary depending on the location of the colorectal cancer.
Typically, the colon is divided into left and right sides at the midpoint of the transverse colon.
The right side of the colon has a larger diameter and liquid stool contents, and being farther from the anus, it is less likely to present with bright red bleeding even if a tumor is bleeding, often leading to patients presenting with chronic anemia.
As the tumor grows, it may not cause obstruction, but there may be opportunities to palpate an abdominal mass.
Conversely, the left side of the colon, being closer to the anus and having a smaller diameter, is more likely to present with blood in the stool.
As the tumor enlarges, it can narrow the intestinal lumen, leading to changes in bowel habits, constipation, diarrhea, and a sensation of incomplete evacuation.
Therefore, we do not know the current size of your polyps.
If you are returning to Taiwan soon, I recommend you visit our clinic for treatment.
Dr.
Yang Guojun, who previously served as a research physician in the Gastroenterology and Hepatology Department at National Taiwan University Hospital, can arrange for another colonoscopy to determine whether surgery is necessary (TEL: 037-261920).

Reply Date: 2000/11/15

More Info

Colon polyps are abnormal growths on the lining of the colon, and they can vary in size and type. The two main categories of polyps are hyperplastic polyps, which are generally benign, and adenomatous polyps, which have the potential to become cancerous over time. Understanding the nature of the polyps and the associated risks is crucial in determining whether surgery is necessary.

In your case, you mentioned that you were diagnosed with polyps two years ago and have been experiencing symptoms such as constipation and diarrhea. These symptoms can sometimes be associated with polyps, as they may obstruct the passage of stool or cause changes in bowel habits. The recommendation from your doctor in the United States to have the polyps surgically removed is likely based on the type of polyps you have, their size, and your overall health history.

When is Surgery Necessary?
1. Type of Polyp: If the polyps are adenomatous, especially if they are larger than 1 cm, there is a higher risk of them becoming cancerous. In such cases, removal is often recommended to prevent the development of colorectal cancer.

2. Size of Polyp: Larger polyps, particularly those over 1 cm, have a greater likelihood of harboring cancerous cells. The risk of cancer increases with the size of the polyp, making surgical intervention more critical.

3. Symptoms: If you are experiencing significant symptoms such as bleeding, persistent abdominal pain, or changes in bowel habits, this may warrant more immediate action.

4. Family History: A family history of colorectal cancer or polyps can also increase your risk and may necessitate more aggressive treatment.

Considerations Before Surgery
1. Diagnosis Confirmation: Ensure that the type of polyps you have is accurately diagnosed. This may involve a colonoscopy where the polyps can be visualized and possibly biopsied.

2. Second Opinion: If you have any doubts about the necessity of surgery, seeking a second opinion from another gastroenterologist or colorectal surgeon can provide additional insights.

3. Surgical Risks: Like any surgery, there are risks involved, including bleeding, infection, and complications from anesthesia. Discuss these risks with your surgeon to make an informed decision.

4. Post-Surgery Monitoring: After the removal of polyps, regular follow-up colonoscopies are essential to monitor for new polyps or any signs of recurrence. The frequency of these follow-ups will depend on the number and type of polyps removed.

5. Diet and Lifestyle: Post-surgery, adopting a diet rich in fiber, fruits, and vegetables can help maintain bowel health and reduce the risk of new polyp formation. Avoiding high-fat diets and processed foods is also advisable.

Conclusion
In summary, if your doctor in the U.S. has recommended immediate surgery for your colon polyps, it is likely based on a thorough assessment of their characteristics and your health history. It is essential to weigh the risks and benefits of surgery, consider a second opinion if needed, and plan for ongoing monitoring post-surgery. Remember, early intervention can significantly reduce the risk of colorectal cancer, making it crucial to address any polyps that pose a potential threat.

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