Treat intestinal polyps early to prevent them from turning into rectal cancer

Author: Tang Qin, Deputy Secretary-General and Researcher of the Science Popularization Expert Committee of the Chinese Medical Association

Reviewer: Wang Changyuan, Chief Physician, Xuanwu Hospital, Capital Medical University

Rectal cancer is a major "killer" of human health. Studies have shown that more than 50% of rectal cancers are caused by intestinal polyps. Therefore, early treatment of intestinal polyps is an important way to prevent rectal cancer.

In layman's terms, intestinal polyps are "lumps of flesh growing on the intestines." In medical terms, they are raised lesions on the intestinal mucosa. Before the pathology is determined, they are collectively called intestinal polyps.

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Intestinal polyps can be divided into tumor polyps and non-tumor polyps according to pathology. Tumor polyps include tubular adenocarcinoma, villous adenocarcinoma, and tubulovillous adenocarcinoma. The symptoms are relatively severe and more likely to become cancerous; non-tumor polyps include hyperplastic polyps, inflammatory polyps, and hamartomas. The symptoms are generally milder and less likely to become cancerous.

1. Manifestations and causes of intestinal polyps

Intestinal polyps occur most frequently in the colon and rectum, and small intestinal polyps are relatively rare. Most patients have no symptoms, but some may experience discomfort such as constipation, blood in the stool, and abdominal pain; a few patients have more and larger polyps, and may develop intussusception and intestinal obstruction. When bleeding is heavy, they may also be accompanied by symptoms of anemia.

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The occurrence of intestinal polyps is related to the following 6 factors.

1. Long-term consumption of a high-fat, high-protein, low-fiber diet, as well as smoking and drinking.

2. Sitting for long periods of time and lack of exercise.

3. People with chronic inflammation of the colon mucosa and a family history of intestinal polyps.

4. Patients with gastric and duodenal ulcers who have undergone gastrojejunostomy and cholecystectomy. After gastrojejunostomy and cholecystectomy, the content of bile acid in the large intestine will increase, which may induce adenocarcinoma polyps or cancer in the colorectal mucosa.

5. People with low immunity. When people’s immunity is low, they are prone to bacterial flora imbalance, which increases the rate of intestinal infection.

6. Long-term emotional repression and excessive stress can damage the body's internal environment and lead to cancer.

2. Not everyone is suitable for colonoscopy

In addition to observing whether there is bleeding, constipation, abdominal pain or other discomfort symptoms during bowel movements, colonoscopy is also a necessary means of diagnosis for intestinal polyps. However, colonoscopy is not suitable for everyone. Colonoscopy is not recommended for patients with the following contraindications.

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1. Patients with severe purulent infection or obvious pain in the anus and rectum, such as perianal abscess and anal fissure.

2. Patients in the active stage of various acute enteritis and radiation colitis, such as bacillary dysentery and acute stage of ulcerative colitis.

3. People with pelvic inflammatory disease, a history of pelvic surgery and pregnant women should be cautious. Colonoscopy is not recommended for menstruating women.

4. Patients with peritonitis, intestinal perforation, intestinal stenosis and extensive adhesions in the abdominal cavity.

5. Patients with abdominal aortic aneurysm, mesenteric inflammation, ascites due to cirrhosis, highly abnormal tortuosity of the intestine, and extensive abdominal metastasis secondary to advanced malignant tumors.

6. Elderly and frail patients or those with severe cardiovascular disease should be carefully examined.

7. Children and mentally ill patients who are unable to cooperate should not be examined. If necessary, the examination can be performed under general anesthesia.

In addition to ordinary colonoscopy, painless colonoscopy can reduce the discomfort caused by colonoscopy. Painless colonoscopy requires an intravenous injection of an anesthetic before the examination, which makes the patient fall asleep within a few seconds and wake up quickly after the examination is completed, without feeling pain or discomfort during the examination.

However, painless colonoscopy also has contraindications, and the anesthesiologist should be evaluated before the examination. Patients with liver failure, severe respiratory diseases, and cardiovascular diseases should not undergo this examination.

3. Do I need surgery for intestinal polyps? How to do a postoperative follow-up

If you find polyps in your intestine, do you need to have surgery to remove them immediately? The answer is not necessarily. Whether intestinal polyps require surgery and what treatment to take are determined by many factors, including the size of the polyps and whether they have become cancerous.

If the patient's intestinal polyps are small hyperplastic polyps or inflammatory polyps, no treatment is required.

If the patient's intestinal polyps are large or histologically confirmed to be adenocarcinoma polyps, they should be removed surgically immediately to avoid polyp bleeding, obstruction or cancer. Common removal surgeries include endoscopic polypectomy, mucosal resection, and laser vaporization therapy can also be used.

After removal of a larger polyp, hospitalization for observation is generally required to prevent complications such as bleeding and perforation. For patients with large mucosal wounds or suspected bleeding after polypectomy, the observation time should be appropriately extended.

After intestinal polyp surgery, patients need regular follow-up examinations, generally once every 6 months. If the polyp biopsy is negative, it can be rechecked once every 1 to 2 years.

For patients with severe atypical hyperplasia or adenocarcinoma, endoscopic polypectomy should be performed and followed up 3 months later. If no residue is found, follow-up should be performed within 6 months. If any residue is found, surgical treatment or further endoscopic treatment is recommended.

Other non-tumor polyps can generally be re-examined after 1 year. If the result of this re-examination is negative, it can be re-examined every 3 to 5 years. If there are multiple polyps, in order to prevent the omission of polyps, it is generally required to re-examine every 6 to 12 months.

If you experience intestinal discomfort, you should go to the hospital immediately for early detection and treatment.

References

[1]Xu Jin. Pay attention to small habits in life to protect intestinal health (Part 1)[J]. Chinese Medicine Health and Wellness. 2021 7(5): 62-64.