Healthy Colon Simulation

Unhealthy Colon Simulation

What is a Colon Polyp and Colon Cancer?

Colon polyps are precancerous growths of 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!

What are the symptoms of Colon Polyps and Colon Cancer?

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 unintentional weight loss, change in bowel habits including constipation and diarrhea, occult or even overt bleeding with anemia and abdominal pain.

Who gets Colon Polyps and Colon Cancer?

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 doubles in the presence of a family history of colon polyps or colon cancer and quadruples if multiple family members are afflicted at a young age. 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 their increase their risk of developing colon polyps and subsequent colon cancer along with other extra-colonic diseases and cancers.

  • Familial Adenomatous Polyposis Syndrome
  • Lynch Syndrome
  • Serrate Polyposis Syndrome
  • Juvenile Polyposis Syndrome
  • Cronkhite Canada Syndrome
  • Peutz Jeghers Syndrome
  • Cowden Syndrome
  • BRCA Syndrome

Aside from family history and genetic syndromes there are other factors, listed below, which increase your risk of developing colon polyps and subsequent colon cancer.

How are Colon Polyps and Colon Cancer diagnosed?

A variety of screening options are available but colonoscopy remains the definitive gold-standard screening modality for not only the diagnosis but also the treatment of colon polyps and cancer. Other tests including fecal DNA/Blood tests, double contrast barium enema and virtual CT colonography also known as “virtual colonoscopy” do NOT have the capabilities of reducing your risk by taking out polyps.

The do-it-yourself (DIY) screening test, Cologaurd, examines DNA in your stool. Despite massive marketing efforts it is important that patients understand the sensitivity and specificity of this test is lower than that of colonoscopy. All patients with a positive test require a costly diagnostic colonoscopy that is often not covered by insurance. Unfortunately, 13% of patients with a positive test have a “false positive” creating unnecessary emotional stress as they deal with the prospect of having caner. More importantly though, 10%-58% of patients are told they have a negative test when in fact they have colon cancer – polyps. This test could possibly cost you your life! In the end colonoscopy is the definitive test and Dr. Mantas has expert training in this procedure.

It is recommended that everyone at the age of 45 years old undergo a screening colonoscopy. Patients with a family history of colon polyps or colon cancer should be screened at age 40 years old or 10 years younger than the afflicted relative. Patients with established genetic syndromes listed above need unique more intensive screening protocols beginning at early age. 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 Transverse

(Normal)

Small Sessile Colon

Polyp (Pre)

Large Sessile Colon

Polyp (Pre)

Pedunculated Colon

Polyp (Pre)

Colon

Cancer

Growth of Colon Tumor

How are Colon Polyps and Colon Cancer treated?

During colonoscopy 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. Once a polyp is found and removed surveillance colonoscopies are needed as the risk of forming future colon polyps is greatly increased. 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.

Small Sessile Colon Polyp

Pre | Intra | Post

Large Sessile Colon Polyp

Pre | Intra | Post

Pedunculated Colon Polyp

Pre | Intra | Post

How can you decrease your risk of Colon Polyps and Colon Cancer?

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. In the end removal of colon polyps during colonoscopy remains the most effective way to decrease your risk of colon cancer.

Where can I learn more about Colon Polyps and Colon Cancer?

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.