[Fat Bear Science] How far is polyp from cancer? Experts remind: Regularly doing this check can effectively prevent the occurrence of colorectal cancer!

Colon polyps, also known as colorectal polyps, are common benign intestinal lesions. However, if not treated in time, they may develop into colorectal cancer over time. It can be said that the treatment of colorectal polyps is, to a certain extent, the treatment of precancerous lesions of colorectal cancer. Many patients have had polyps in their intestines for a long time before colorectal cancer occurs. If intestinal polyps can be recognized early, early diagnosis and early treatment can be achieved, the occurrence of colorectal cancer can be effectively prevented.

What are intestinal polyps?

Intestinal polyps are small growths formed when the intestinal mucosa is stimulated and begins to proliferate. In layman's terms, it is a small growth on the intestine, including tumorous and non-tumorous lesions. Polyps vary in size and shape. Before their pathological nature is determined, they are collectively called polyps. After the pathological nature is determined, they are directly given pathological diagnostic names according to their location, such as colon tubular adenoma, hyperplastic polyp, etc.

Why do healthy intestines develop polyps?

The formation of intestinal polyps is mainly due to the following reasons:

1. Inflammation and viral infection: Inflammatory polyps are related to chronic intestinal inflammation, and adenomatous polyps may be related to viruses;

2. Age: The incidence of colorectal polyps increases with age;

3. Embryonic abnormalities: Juvenile polyposis is often a hamartoma, which may be related to abnormal embryonic development;

4. Lifestyle habits: Low-fiber diet is related to colorectal polyps; smoking is closely related to adenomatous polyps;

5. Heredity: The occurrence of certain polyposis is related to heredity, such as familial non-polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP).

Are some people more likely to develop intestinal polyps?

Yes, there are. High-risk groups include those with family members with colon cancer or colon polyps, those who have long-term high-fat, high-animal protein, low-fiber and fried foods, etc. These people are recommended to undergo electronic colonoscopy, rectal digital examination, fecal occult blood examination and other examinations. In European and American countries where colorectal cancer is prevalent, it is recommended that everyone undergo fecal occult blood examination every year and complete colonoscopy every 5 to 10 years starting from the age of 40, so as to detect and treat early.

Can polyps become cancerous?

Generally speaking, we divide intestinal polyps into non-neoplastic polyps and adenomatous polyps. We must make it clear that not all polyps will become cancerous. Only ≤5% of adenomas will progress to cancer after 5-10 years. However, 85%~90% of colorectal cancers are transformed from colorectal adenomas, and about 2/3 of colon polyps are adenomas. Non-neoplastic polyps generally do not become cancerous.

Mainly include:

1. Juvenile polyps: Common in young children, mostly under 10 years old. Often occur in the rectum, spherical, mostly single, with pathological features of retention cysts of varying sizes, a type of hamartoma;

2. Inflammatory polyps: also known as pseudopolyps. They are formed when the ulcer of the colon mucosa undergoes fibrosis and submucosal edema between ulcers during the healing process, causing the normal mucosal surface to gradually bulge. They are common in intestinal diseases such as chronic ulcerative colitis, amoebic dysentery, schistosomiasis, and intestinal tuberculosis.

3. Adenomatous polyps: A precancerous lesion. Adenomatous polyps can be divided into three types, namely tubular adenoma, villous adenoma and tubulovillous adenoma, among which tubular adenoma is the most common;

In terms of the age of onset, adenomatous polyps occur 5 to 10 years earlier than colorectal cancer. According to the latest literature, it takes at least 5 years for adenomatous polyps to develop into cancer, and an average of 5 to 10 years. In addition, the canceration of adenomatous polyps is related to their size, morphology and pathological type. The canceration rate of broad-based adenomas is higher than that of pedunculated adenomas; the larger the adenoma, the greater the possibility of canceration; the more villous components in the adenoma structure, the greater the possibility of canceration.

What to do if polyps are found?

The simplest and most effective way to detect polyps is to do colonoscopy screening. In clinical work, the treatment plan is generally determined based on the size, number, presence or absence of complications and pathological properties of intestinal polyps:

1. Small polyps are usually removed during colonoscopy and sent for pathological examination;

2. Adenomas with a diameter > 3 cm, especially villous adenomas, should be surgically removed:

3. If the adenoma has penetrated the muscularis mucosa or invaded the submucosal layer, it is considered invasive cancer and should be treated according to the principles of colorectal cancer treatment. If the adenoma has not penetrated the muscularis mucosa, has not invaded small blood vessels and lymph nodes, has a good degree of differentiation, and has no residual margins, then no surgery is required after removal, but it is prone to recurrence and should be closely observed and regularly reviewed by colonoscopy;

4. The treatment of inflammatory polyps is mainly based on the primary intestinal disease. After the inflammatory stimulation disappears, the polyps will disappear on their own. The symptoms of hyperplastic polyps are not obvious and no special treatment is required.

Although intestinal polyps are not a serious disease, they should not be ignored. More than 80% of colorectal cancers are related to polyps. Colonoscopy is very important. If intestinal polyps are found, we should neither ignore them nor panic. The correct approach should be to consult a professional doctor and follow the doctor's advice to achieve early detection, early diagnosis, and timely treatment.

How to protect our large intestine?

1. Quit smoking and drinking;

2. Eat less spicy and stimulating food, eat three meals regularly, and eat less midnight snacks;

3. Increase fiber intake in your diet and eat more fruits and vegetables. Cellulose helps stimulate intestinal movement and reduce the retention of feces in the body, thereby reducing the long-term damage to the intestines caused by harmful substances;

4. Exercise more. A healthy body is the prerequisite and important part of resisting any disease.

So, what is a colonoscopy? What are the advantages? What should we pay attention to?

When it comes to diagnosing colon cancer, neither traditional X-rays (barium meals, barium enema, air-barium double contrast), B-ultrasound, nor advanced CT, MRI, PET and other examination methods are as direct and accurate as colonoscopy.

Colonoscopy is a procedure that uses a flexible fiber tube about 140cm long with a light source and a miniature electronic camera at the end. It is slowly inserted into the large intestine through the anus to examine lesions, tumors or ulcers in the large intestine. If necessary, tissue examination or colon polypectomy can be performed.

What are the advantages of colonoscopy?

Colonoscopy has two huge advantages over other tests:

1. Once polyps or small tumors are found in the intestine, they can be removed immediately;

2. A biopsy can be taken to determine whether it is a malignant tumor;

If it can be detected in the early stage and removed by colonoscopy, the cure rate can reach over 95%. A large number of studies have shown that the screening sensitivity of colonoscopy is over 90%.

Is a colonoscopy painful?

There are two types of colonoscopy: normal and painless.

Painless colonoscopy. Painless, fast and safe. Painless colonoscopy means that the patient undergoes colonoscopy under intravenous anesthesia and is completely unconscious. The examination process is exactly the same as that of ordinary colonoscopy. Since anesthesia is administered before and during the operation, the patient does not feel any discomfort at all.

During the examination, with complete monitoring facilities and safety assurance measures, an experienced professional anesthesiologist will slowly inject anesthetic drugs intravenously. After about 1 minute, the subject will fall into a relaxed sleep state, and the endoscopist can carefully and calmly operate the colonoscope and examine various parts of the intestine. The subject will wake up 3-5 minutes after the examination and can leave the hospital accompanied by family members after lying quietly for 15 minutes.

Ordinary colonoscopy. With the development of medical equipment, ordinary colonoscopy is not as scary as before. There is some discomfort during the examination, but most examinees can tolerate it.

In contrast, painless colonoscopy is a more humane endoscopic treatment technique and a good choice for those who cannot tolerate the pain caused by ordinary colonoscopy.

Who is not suitable for painless colonoscopy?

In fact, not everyone is suitable for painless colonoscopy, for example:

Patients with contraindications to routine endoscopic procedures or who refuse sedation and anesthesia;

Those who are allergic to sedatives and/or anesthetic drugs or have other serious anesthesia risks;

Circulatory and respiratory diseases that are not properly controlled and may threaten life, such as uncontrolled severe hypertension, severe arrhythmia, unstable angina, acute respiratory tract infection, asthma attack, etc.

Patients with severe liver function abnormalities, acute upper gastrointestinal bleeding with shock, severe anemia, gastrointestinal obstruction with gastric content retention;

No escort or guardian.

Who needs a colonoscopy?

1. Changes in bowel habits: long-term increase in bowel movements or frequent urge to defecate, but no stool, or constipation;

2. Blood in stool: The color of blood is dark red;

3. Mucous stool: There is mucus or pus and blood in the stool;

4. Changes in stool shape: bloody stool becomes thinner and flatter;

5. Abdominal distension and abdominal pain: obstructive abdominal distension and abdominal pain may occur;

6. Diarrhea: recurrent diarrhea of ​​unknown cause;

7. People with unexplained weight loss or emaciation;

8. People with unexplained anemia;

9. Unexplained abdominal mass requiring a clear diagnosis;

10. Unexplained elevated CEA (carcinoembryonic antigen);

11. Regular colonoscopy is required after colorectal cancer or polyp surgery;

12. Those with a family history of colorectal cancer should undergo a colonoscopy screening: If someone in the family has colorectal cancer, his or her immediate family members (parents, children, siblings) should undergo a physical examination and a colonoscopy even if they do not have any symptoms or discomfort.

What preparations are needed for a colonoscopy?

In order to complete the colonoscopy examination safely and accurately, the colon needs to be cleaned before colonoscopy.

Before the test

Generally speaking, you should eat a low-residue semi-liquid diet, such as porridge, 2-3 days before the examination, avoid eating high-fiber vegetables and fruits, and avoid eating red or high-seeded foods, such as watermelon and tomato.

One day before the examination, eat liquid food without residue, such as rice soup, and do not drink milk.

On the day of the examination, those who are examined in the morning should fast for breakfast, those who are examined in the afternoon should have liquid breakfast and fast for lunch.

4-6 hours before the examination, take laxatives to excrete colorless watery stool to complete bowel preparation.

Checking

Relax and don't be nervous. The examination usually takes 20 minutes to complete.

If there is problematic tissue, the doctor will take a small piece for pathological biopsy.

After the inspection

After the routine colonoscopy, you can eat and drink.

Those who undergo painless colonoscopy and biopsy can only eat and drink 4 hours after the examination.

Those who undergo painless colonoscopy must be injected with anesthetic and cannot drive or do aerial work on the day of the examination.

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Zhang Shouru

Deputy Director of the Gastrointestinal Tumor Center, Affiliated Cancer Hospital of Chongqing University, Associate Chief Physician, Doctor of Medicine.

He has been engaged in clinical work and research in gastrointestinal surgery for a long time. He is good at the diagnosis, surgical treatment and comprehensive treatment of gastric cancer, colorectal cancer and gastrointestinal stromal tumors, especially laparoscopic gastrointestinal tumor surgery.

Clinic hours: Thursday morning

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Yellow

Nurse at the Gastrointestinal Tumor Center of the Affiliated Cancer Hospital of Chongqing University, endoscopy specialist nurse.

He has been engaged in endoscopy work for many years and is good at digestive endoscopy diagnosis and treatment coordination and nursing coordination of endoscopic treatment of gastrointestinal lesions.

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Text/Fat Bear

Audit/Gastrointestinal Cancer Center

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