Diseases Of Large Bowel :
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What Is A Colonic Polyp?
A polyp is a benign (non-cancerous) growth of the lining of the colon (large bowel).
It can be anything from 2mm up to 5cm or more in diameter.
Commonly, the abnormal cells form a small ball (about the size of a pea) on the end of a stalk of normal cells.
The type of cell that forms the polyp varies and is important in determining its potential for developing into a cancer.
If it is necessary to spare the colon from its normal digestive work while it heals, a temporary opening of colon onto the skin of the abdominal wall (colostomy) may be done. The proximal end of the colon is passed through the abdominal wall and the edges sewn to the skin. A removable bag is then attached to the skin around the colostomy and the stool then passes into the bag. In most cases, depending on the disease process being treated, colostomies are temporary and can be closed with another operation at a later date.
If a large portion of the bowel is removed or the distal end of the colon is too diseased to reconnect to the proximal intestine, the colostomy may be permanent.
Large Bowel Disease
The Division of Gastroenterology provides diagnosis and treatment for many large bowel diseases, including:
- Colon cancer
- Colon polyps
- Ulcerative colitis
- Crohn's disease
- Irritable Bowel Syndrome
Types Of Polyp
Metaplastic polyps versus adenomatous polyps
The most common sort of polyp is a metaplastic polyp (in which cells change from one normal type to another). These usually do not grow much more than 5mm in diameter and have almost no risk of becoming malignant (cancerous). These polyps can be very similar in appearance to adenomatous polyps, the next most common type, which do have the potential to become malignant.
About 50 per cent of people aged 60 will have at least one adenomatous polyp of 1cm diameter or greater. Familial polyposis coli (familial adenomatous polyposis or FAP ) involves multiple adenomatous polyps, often in their hundreds. This condition carries a very high risk of colon cancer.
Other Rarer Types Of Polyps
Other rarer types of polyps include:
- Juvenile polyps: these are usually solitary polyps called hamartomas that affect 1 to 2 per cent of older children or adolescents. A single polyp carries no significant cancer risk but when these polyps are inherited and usually multiple (about one third of patients), the colon cancer risk is about 10 per cent. In this case, regular surveillance after excision (cutting out) of all polyps is required.
- Peutz-Jeghers polyps: found in Peutz-Jeghers syndrome, in association with freckling of the lips, are also of the hamartomatous type. These usually present in early adult life and carry a low but definite risk of malignancy, probably around five per cent per polyp, so they need excision. The number of polyps per individual is very variable and ranges, from as few as one or two to as many as 20 or more. Peutz-Jeghers polyps can also occur in the small intestine and can then be difficult to diagnose because they are beyond the reach of conventional fibre-optic endoscopes (internal telescope instruments). Such polyps tend to present with symptoms of obstruction (bowel blockage) or abdominal pain. Diagnosis is usually made with barium X-rays (taken after the patient swallows barium liquid to show up the inside of the intestine). Treatment will usually be an operation that opens up the abdomen.
- Inflammatory pseudopolyps: can occur as a complication of ulcerative colitis or Crohn's disease of the colon. They are completely harmless and carry no risk of cancer but they can be confused with adenomatous polyps on examination.
- Cronkhite-Canada syndrome: an exceptionally rare condition, involves multiple colon polyps, hyperpigmentation (darkening of the skin) and nail atrophy (wasting away). The syndrome is not inherited and affects middle-aged or older individuals. It is linked with malabsorption and has been reported to respond to vitamin E therapy
Most polyps can be removed during colonoscopy while the patient is sedated. This is done by passing a wire snare down the colonoscope, looping and tightening the snare around the stalk of the polyp, then passing an electric current through the wire. This coagulates the blood vessels and then cuts through the stalk. The polyp is then usually sent to the pathology laboratory for microscopic examination.
The polypectomy is painless because the colon nerves are only sensitive to stretching. Polypectomy is very safe but carries a risk of perforation (going through the bowel wall) in about one case in 300 and bleeding in one case per 100. Bleeding usually stops by itself and only rarely needs treatment with blood transfusion.
Occasionally, a polyp is too large to be removed endoscopically, usually when the diameter is more than about 4cm and, particularly, if the base of the polyp is broad with no well-defined stalk. In these cases, endoscopic removal can carry an unacceptably high risk of bleeding or perforation. Such polyps are also more likely to already contain cancer and removal by surgery that opens up the abdomen can be the safest option to ensure cure.
Large, rectal polyps can sometimes be removed through the anus under general anaesthetic without the need to cut open the abdomen.
As with any surgery, risks include infection and bleeding. Anesthesia-related risks include reactions to medications and problems with breathing.
Additional risks include:
- Bulging through the incision
- Narrowing (stricture) of the opening
- Blockage of the intestine from scar tissue
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