colorectal polyp
Jump to navigation
Jump to search
Introduction
Grossly visible protrusion from the colonic mucosal surface.
Classification
- serrated polyp
- adenomatous polyp
- other
- non neoplastic hamartoma (juvenile polyp)
- inflammatory polyp[2]
Etiology
- modifiable risk factors[2]
- high dietary fat
- red meat
- low dietary fiber
- smoking
- excessive alcohol ingestion
- obesity
- type 2 diabetes
- physical inactivity
Pathology
- only adenomatous polyps are clearly premalignant*
- only a minority of adenomatous polyps develop into cancer (< 1%)
- most colorectal carcinomas begin as adenomatous polyps
* hyperplastic polyps may be associated with colorectal cancers that show microsatellite instability[3]
Clinical manifestations
- most polyps produce no symptoms
Laboratory
- polyps are found on sigmoidoscopy or colonoscopy
- occult blood in stool occurs in only 5% of patients with colonic polyps
Complications
- colorectal cancer risk for non-advanced adenomas or small serrated polyps no different than no polyps[9]
- patients with any polyps with higher colorectal cancer incidence
- those with sessile serrated polyps, tubulovillous adenomas, or villous adenomas with higher colorectal cancer mortality[11]
Management
- see colorectal adenomatous polyp
- repeat colonoscopy in 10 years for rectosigmoid hyperplastic polyp < 10 m
- 1-2 tubular adenomas < 10 mm, surveillance in 5-10 years
- 3-4 tubular adenomas < 10 mm, surveillance in 3-5 years
- any tubular adenoma > 10 mm, 5-10 tubular adenomas < 10 mm, villous adenoma, or high-grade dysplasia, surveillance in 3 years
- > 10 tubular adenomas, surveillance in 3 years + investigate genetic cause
- sessile serrated polyps all < 10 mm without dysplasia
- sessile serrated polyp > 10 mm or with dysplasia, or serrated adenoma, surveillance in 3 years[2]
- serrated polyposis syndrome, surveillance in 1 year[2]
- endoscopic resection of solitary juvenile polyps*
- endoscopic surveillance unnecessary[2]
- surgical resection (rather than endoscopic polypectomy) of non-malignant colorectal polyps is associated with increased morbidity & mortality[10]
- prevention:
* criteria for juvenile polyposis coli:
- >= 3 juvenile colorectal polyps, juvenile polyps throughout the GI tract, juvenile polyp with family history of juvenile polyposis coli
More general terms
More specific terms
- colorectal adenomatous polyp; tubular adenoma; villous adenoma
- hyperplastic polyp
- serrated colorectal polyp; serrated adenoma
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1426
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2018, 2021.
- ↑ 3.0 3.1 Journal Watch 21(19):151, 2001 Hawkins NJ, Ward RL. Sporadic colorectal cancers with microsatellite instability and their possible origin in hyperplastic polyps and serrated adenomas. J Natl Cancer Inst 93:1307, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11535705
- ↑ Martinez ME et al One-Year Risk for Advanced Colorectal Neoplasia: U.S. Versus U.K. Risk-Stratification Guidelines Ann Intern Med. 18 December 2012;157(12):856-864 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23247939 <Internet> http://annals.org/article.aspx?articleid=1485310
- ↑ East JE, Saunders BP, Jass JR. Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am. 2008 Mar;37(1):25-46, v PMID: https://www.ncbi.nlm.nih.gov/pubmed/18313538
- ↑ Miller HL, Mukherjee R, Tian J, Nagar AB. Colonoscopy surveillance after polypectomy may be extended beyond five years. J Clin Gastroenterol. 2010 Sep;44(8):e162-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20628313
- ↑ Rapuri S, Spencer J, Eckels D. Importance of postpolypectomy surveillance and postpolypectomy compliance to follow-up screening--review of literature. Int J Colorectal Dis. 2008 May;23(5):453-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18193238
- ↑ Lieberman DA, Rex DK, Winawer SJ et al Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep;143(3):844-57 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22763141 (corresponding NGC guideline withdrawn Feb 2018)
- ↑ 9.0 9.1 He X, Hang D, Wu K et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2019 Jul 11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31302144 https://www.gastrojournal.org/article/S0016-5085(19)41086-X/pdf
- ↑ 10.0 10.1 Ma C, Teriaky A, Sheh S, et al. Morbidity and mortality after surgery for nonmalignant colorectal polyps: A 10-year nationwide analysis. Am J Gastroenterol 2019 Oct 11; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31634261
- ↑ 11.0 11.1 Emilsson L, Bozorg SR et al Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol. 2020 Mar 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32192628 Free Article
Meester RGS, Ladabaum U Sessile serrated polyps and colorectal cancer mortality. Gastroenterology. 2020 Mar 18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32199884