Be careful if you have polyps in these places! This type of polyp is almost 100% likely to turn into cancer.

One of the most confusing words on a physical examination report may be "polyp".

Gastric polyps, intestinal polyps, gallbladder polyps... just seeing the names makes people wonder: "Is this thing serious?" "Does it need to be removed?" "Will it turn into cancer?"

Today, let’s talk about various types of polyps and those that we must be careful about, especially one type of intestinal polyp, which has an almost 100% chance of becoming cancerous.

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What exactly are polyps?

Simply put, polyps are small bumps that grow on the surface of the mucous membrane, just like small moles on the skin, but they grow inside the body, such as the stomach, intestines, gallbladder, uterus, nasal cavity, etc.

Medically speaking, polyps are not a specific disease, but the result of abnormal tissue proliferation. It may be caused by inflammation or gene mutation.

Most polyps are benign and do not require immediate treatment. However, since polyps grow outward, they may block the lumen and cause symptoms, and some polyps may become malignant, so we need to distinguish which polyps can continue to be observed and which polyps need to be treated in time.

The things that require attention for polyps in different parts of the body are also different. Here we will talk about the characteristics and precautions of polyps in different parts of the body respectively.

Intestinal polyps

Small intestinal polyps are relatively rare. Polyps mainly occur in the large intestine (colorectum). The most commonly used classification method is the Paris classification, which divides colorectal polyps into 6 categories based on their morphology, corresponding to different malignant risks:

0-Ip (pedunculated): low risk of malignancy.

0-Is (wide-based): higher risk of malignancy.

0-IIa (shallow raised type): low risk of malignancy.

0-IIb (flat): low risk of malignancy.

0-IIc (shallow depressed): The risk of malignancy is higher, with a risk of more than 40% for lesions 6 to 10 mm and about 90% for lesions larger than 20 mm.

0-III (ulcerative or pitting type): Almost all lesions of this type contain high-grade cancer.

From reference [3]: M = mucosa; SM = submucosa

If more than 100 polyps are found at the same time, this condition is called polyposis. At this time, you should pay attention to several very dangerous conditions. Genetic diagnosis can be performed to rule out:

Familial adenomatous polyposis (FAP): caused by mutations in the APC gene on chromosome 5q, 100% of cases will develop into colon cancer. Most untreated patients develop cancer at the age of 35 to 40.

MUTYH-associated-polyposis (MAP): caused by biallelic mutations in the MUTYH gene, the cumulative risk of colorectal cancer in untreated patients is estimated to be 80% by age 70 years.

Peutz-Jeghers syndrome: caused by mutation of the STK11 gene on chromosome 19p. Polyps may occur in the entire digestive tract, including the small intestine, and significantly increase the risk of colorectal cancer, breast cancer, pancreatic cancer and other cancers.

Familial juvenile polyposis: caused by mutations in genes such as SMAD4 and BMPR1A, where multiple juvenile polyps are found in the digestive tract, greatly increasing the risk of colon cancer.

If polyps are found during colonoscopy, a colorectal cancer risk assessment is recommended. People at low and medium risk are recommended to undergo colorectal cancer screening between the ages of 50 and 75; people at high risk are recommended to start screening at the age of 40, or 10 years earlier than the age of onset of the youngest patient in the family.

Gastric polyps

Gastric polyps are usually found during gastroscopy. By evaluating the shape, size and location of the polyps, they can be divided into three categories:

Benign polyps

Benign polyps are those that are unlikely to develop into cancer. For example, fundic gland polyps are the most common type, usually related to long-term use of stomach medications (such as proton pump inhibitors), and most of them can disappear after stopping the medication; they also include inflammatory fibrous polyps and ectopic pancreas. They usually do not cause serious health problems and only require regular follow-up as recommended by the doctor.

Neutral polyps

Neutral polyps have a higher risk of canceration and require special attention. Hyperplastic polyps are a common type and are usually associated with Helicobacter pylori infection or chronic gastritis. Some of them can be eliminated automatically after eradication of Helicobacter pylori; they also include adenomas and neuroendocrine tumors (type 1 and type 2). Hyperplastic polyps > 5 mm, all adenomas, and neuroendocrine tumors > 1 cm (type 1 and type 2) should be removed, and follow-up should be performed according to the advice of gastroenterologists and gastrointestinal surgeons.

Malignant polyps

Finally, malignant polyps have a very high risk of becoming cancerous and require urgent treatment. Neuroendocrine tumor (G-NET) type 3 is usually a single large polyp with a high risk of metastasis, requiring surgical removal and further treatment. Early gastric cancer (EGC) means that the cancer is limited to the lining of the stomach. Although the risk of metastasis is low, it may develop into a more serious stomach cancer if not treated promptly, so early detection and treatment are crucial.

Gastric polyps. Copyrighted images from the gallery. Reproduction and use may lead to copyright disputes.

Nasal polyps

Nasal polyps are generally believed to be caused by chronic inflammation mainly caused by T cell type 2 immune response (eosinophilic inflammation) such as allergic rhinitis and asthma. However, studies have now found that in Asia, especially in China and South Korea, nasal polyps often manifest as neutrophilic inflammation.

These are two different types of nasal polyps. The former has a low risk of malignancy and mainly causes symptoms such as nasal congestion and weakened or lost sense of smell. It can be improved by medication, surgery and other methods, and the existing chronic diseases should be actively controlled. The latter has a lower risk of malignancy, especially for patients with nasal polyps who are >50 years old, have a history of smoking, and have neutrophilic chronic inflammation. They should go to the otolaryngology and ENT departments to take measures such as early screening, strengthening inflammation management and quitting smoking.

Vocal cord polyps

Vocal cord polyps are generally considered to be benign lesions and do not have a tendency to become malignant. They are mainly caused by incorrect speaking tone, talking too much, shouting or screaming, which damages the vocal cords and may cause hoarseness and vocal fatigue. In rare cases, larger polyps may cause symptoms such as airway obstruction. Therefore, if vocal cord polyps are found, medication, speech therapy, laser therapy, surgery, etc. can be used for treatment.

Although vocal cord polyps themselves will not become malignant, their risk factors, such as smoking, gastroesophageal reflux, and chronic vocal cord injury, may simultaneously cause other pathological changes with the risk of malignancy. Therefore, regular follow-up is still necessary to rule out other possible lesions, such as vocal cord leukoplakia or atypical hyperplasia.

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Uterine polyps

Endometrial polyps are a common gynecological disease that affects about 25% of women. The vast majority are benign lesions, and very few have the risk of malignancy.

For premenopausal endometrial polyps who are asymptomatic, have no high-risk factors for malignant transformation, and have a polyp diameter of less than 1 cm, an ultrasound re-examination can be performed once every 3 to 6 months. If the condition is stable, follow-up can be performed once a year. Some polyps may naturally disappear during the follow-up process. If endometrial polyps cause menstrual changes, infertility, miscarriage, and malignant lesions cannot be ruled out, timely surgical treatment is recommended.

Gallbladder polyps

Gallbladder polyps are usually benign and have no symptoms. If they are discovered accidentally during a physical examination, annual ultrasound examinations are sufficient to observe changes. However, if the following three situations occur, you should go to the hepatobiliary surgery or general surgery department for treatment:

(1) Consider malignant transformation: polyp with a diameter greater than 1 cm, solitary, wide base, rich blood supply, progressive enlargement, elevated tumor markers, etc.;

(2) Obvious symptoms: right upper abdominal distension and pain, diarrhea, nausea, vomiting, etc.;

(3) Combined with other gallbladder diseases: combined with gallstones, cholecystitis and other diseases that require cholecystectomy.

Polyps do not necessarily mean they will turn into cancer. Most polyps are benign, and only a few may develop into cancer under certain conditions. Don't panic after discovering polyps. The key is to judge the risk and adopt appropriate response strategies. For high-risk polyps, they should be removed as soon as possible; for low-risk polyps, you can observe them regularly under the doctor's advice to avoid unnecessary surgery.

References

[1]https://www.cancer.org.au/polyps

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[5] This kind of physical examination that can detect cancer should be done by everyone over 40 years old! Otherwise, it will be in the middle or late stages. https://mp.weixin.qq.com/s/OqeJPbNhgciBG4wh5InPzA

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[7]EloyP,MusatGC.WhatWeKnowaboutNasalPolyposis:TheClinician'sPointofView.Sinusitis.2024;8(2):37-50.

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[9]KimHJ,AhnHS,KangT,etal.Nasalpolypsandfutureriskofheadandneckcancer:Anationwidepopulation-basedcohortstudy.JAllergyClinImmunol.2019;144(4):1004-1010.e4.

[10]VasconcelosD,GomesAOC,AraújoCMT.VocalFoldPolyps:LiteratureReview.IntArchOtorhinolaryngol.2019;23(1):116-124.

[11]BerceanuC,CerneaN,CăpitănescuRG,etal.Endometrialpolyps.RomJMorpholEmbryol.2022;63(2):323-334.

[12] Chinese Eugenics Association, Reproductive Tract Diseases Diagnosis and Treatment Branch, Chinese Medical Doctor Association Minimally Invasive Medicine Committee, Gynecologic Oncology Group. Chinese Expert Consensus on the Diagnosis and Treatment of Endometrial Polyps (2022 Edition). Chinese Journal of Practical Gynecology and Obstetrics, 2022, 38(8): 809-813.

[13] LiuH, LuY, ShenK, etal. Advances in the management of gallbladder polyps: establishment of predictive models and the rise of gallbladder-preserving polypectomy procedures. BMC Gastroenterol. 2024;24(1):7.

Planning and production

Author: Jiang Yongyuan, Master of Internal Medicine, Third Military Medical University

Review丨Sun Yifei Director of the Medical Education History Research Office of Hebei Medical University

Lan Yibing, deputy chief physician, Department of Obstetrics and Gynecology, Zhejiang University School of Medicine