Colon Cancer and Polyps

Key points to know

Colonic polyps are small growths that occur inside the lining of the large bowel.

There are two kinds of polyps. One polyp is called hyperplastic polyp.

This polyp is currently thought NOT to turn into cancer. However, special consideration is given to hyperplastic polyps especially in the right side that are larger than 1 cm. If multiple they carry the same risk as adenomatous polyp. This is where an astute pathologist should be involved especially to look at the deeper layers of the polyp since some of these polyps maybe serrated adenomas

The other polyp is called adenomatous polyp.

This polyp can turn into colon cancer.

Polyps tend to recur either in the same location or different locations. That is why patients often need repeat evaluation with a colonoscopy every 2 to 5 years.

Polyps are detected by doing a test called flexible sigmoidoscopy (which is an incomplete evaluation of the colon) or a colonoscopy. If you have a polyp detected on a flexible sigmoidoscopy, then you will require a complete evaluation with a colonoscopy.

Polyps and Colon cancer run in families. If you have a family history of colon cancer or colonic polyps, then you should consult your doctor for further evaluation.

Polyps typically are thought to occur more frequently after 40 years of age. Patients who have passed the age of 40 are often sent to a gastroenterologist (GI specialist) for evaluation. The purpose is to remove the polyps before they turn into cancer. The newer guidelines by some cancer society have recommended screening at 40 and not 50. This is because there is an increasing trend for colon cancer even in the younger age group.

Another consideration is African American patients are at a higher risk of colon cancer at a younger age. In Mayo clinic they are evaluated at 45 but this could be considered even earlier with newer guidelines.

Most often patients DO NOT have symptoms with polyp or cancer. This is similar to women undergoing pap smears and mammograms and men having a prostate examination although they do not have any symptoms.

Some patients may have blood detected by a rectal examination or by the "slide" (guaic slide) test.

Thus the concept of Screening colonoscopy came out. Since most patients are ASYMPTOMATIC, all patients should undergo a routine colonoscopy. Generally the recommended age is 50. However this can vary. In African american patients the recommended age for screening colonoscopy is 45 (they tend to get cancers earlier). If you have a family history of HNPCC or Lynch Syndrome, screening starts at 20 and if you have a family history o f Gardners Syndrome, screening starts at age 10.

Reducing your risk of colon cancer:

  • Alcohol and smoking are carcinogenic even for colon cancer
  • Eat a high-fiber diet (20-30g fiber daily)
  • Avoid red meats and processed meats (lunch meats, cured meats)—Lancet Oncology has reported that processed meats are carcinogenic (can cause colorectal cancer)
  • Exercise is helpful and drinking coffee maybe of help
  • Regular aspirin use may prevent a substantial proportion of colorectal cancers and complement the benefits of screening.