Colon polyps are growths in the lining of the colon. They vary in morphology, location, size, type and, most importantly, in their propensity to turn into colon cancer. This emphasizes a paramount principle – almost all colon cancers derive from prior colon polyps. Thus, if one removes colon polyps during screening colonoscopies the risk of colon cancer decreases dramatically. This paradigm was established after two large clinical trials in the 1990s, the United States National Polyp Study and the Veteran’s Affairs Cooperative Study, found a 75% decreased risk in colon cancer incidence following removal of polyps during colonoscopy!
It is important to understand that polyps generally do NOT cause symptoms alerting you of their presence – hence the use of screening colonoscopies. Very large colon polyps and cancer can manifest with symptoms of weight loss, change in bowel habits including constipation and diarrhea, occult or even overt bleeding with anemia and abdominal pain.
Presently, colon cancer is the 3rd most cancer and 2nd most common cause of cancer death in the United States. In the general population there is a 6% lifetime risk of developing cancer and about a quarter of patients at the age of 50yo have high-risk colon polyps. This risk increases in the presence of a family history of colon polyps or colon cancer. If a patient has a first-degree relative with colon polyps or colon cancer then their lifetime risk of developing colon polyps or colon cancer increases to nearly 20%. This risk is even higher if there is more than one first-degree relative with colon polyps or colon cancer and if their diagnosis was made at a young age.
Some patients have genetic syndromes, listed below, which greatly increase their risk of developing colon polyps and subsequent colon cancer along with other extra-colonic diseases and cancers.
Aside from family history and genetic syndromes there are other factors which increase your risk of developing colon polyps and subsequent colon cancer.
A variety of tests are available to diagnose colon polyps and colon cancer. Diagnostic tests that do not have capabilities of reducing your risk by taking out polyps include fecal occult blood and DNA tests, double contrast barium enema and CT colonography also known as “virtual colonoscopy”. The definitive test for not only diagnosing but also removing polyps is colonoscopy. Dr. Mantas has expert training in this procedure including all techniques in removing polyps. For screening Dr. Mantas recommends that every patient at the age of 50 years old or African Americans at the age of 45 years old undergo a screening colonoscopy. Patients with a family history of colon polyps or colon cancer or patients with established or suspected genetic syndromes listed above need unique more intensive screening protocols at an earlier age than 45-50 years old. Please Dr. Mantas to discuss these specific screening regimens. Once a polyp is found and removed surveillance colonoscopies are needed as the risk of forming future colon polyps or cancer is greatly increased.
Colon polyps are removed using a variety endoscopic techniques including biopsy forceps and cautery snares. Dr. Mantas even has expertise in removing larger polyps using advanced techniques including endoscopic mucosal resection obviating the need for surgery. Depending on the number, type and size of polyps and adequacy of colon prep Dr. Mantas recommends surveillance colonoscopies ranging in frequency from 10 years to 6 months. If colon cancer is diagnosed various treatment options are available including surgery, chemotherapy and radiation depending on stage.
In addition to losing weight by diet and exercise and eliminating modifiable risk factors listed above, supplementing your diet with calcium, fibers, fruits, vegetables and foods with high anti-oxidant content (selenium, folate, carotene, vitamin C, vitamin E, vitamin D) has been shown to decrease one’s risk of developing colon polyps and colon cancer. In addition certain medications appear to decrease one’s risk including the use of aspirin and hormone replacement therapy. These measures may be important to consider especially in someone who is at higher risk because of a family history.
A variety of other disorders can affect the colon, rectum and anus. Suggestive symptoms include diarrhea, constipation, bleeding, lower abdominal pain, anorectal pain and bowel urgency. Please visit Dr. Mantas if you feel that you have a colo-rectal-anal disorder. Other common colo-rectal-anal disorders include microscopic colitis and fecal incontinence.