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The diagnosis of "polyp" is often a cause for concern because it is commonly associated with cancer, but it is not really a rule. It is worth finding out what polyps are, whether each of them is cancer and in which organs they occur most often.
Polyp(Latinpolypus ) can occur in any organ, most often it is diagnosed in the large intestine. Its presence should not be a cause for concern, because often polyps are lipomas, fibroids or adenomas, which are harmless if they have not been transformed.
Some of the polyps are malignant neoplasms, therefore histological evaluation is necessary to exclude the proliferative process, and if it is found, to immediately start appropriate treatment.
It is worth remembering that if the cancer is detected in the stage of a small polyp without distant metastases, the cancer is usually curable.
Polyps: types
Due to the external appearance, polyps are divided into:
- sessile polypsthat have a wide base,
- pedunculated polyps- "attached" to the mucosa are a peduncle in which blood vessels run.
Where are the polyps?
Polyps can occur in any organ that has light, except for blood vessels, and most often appear within the following structures:
Polyps in the larynx
Polyps / nodules of the vocal cordsare smooth semicircular protrusions located on the vocal cords, they are non-malignant changes, with the histological structure unchanged compared to the normal mucosa. Their cause is chronic irritation from tobacco smoke or intensive use of the speech organ, e.g. in singers.
Polyps in the nose
Polyps resemble a bunch of grapes, smooth, soft, and the paranasal sinuses are usually the sites where they begin to grow and attach. Nasal polyps are most common in people with allergic rhinitis and asthma.
Polyps in the stomach
In the case of the stomach, polyps are always changes originating in the mucosa, this structure takes on:
- hyperplastic polyp , i.e. the structure formed as a result of an increase in the number of stomach cells, with no tendency to malignancy,
- polyp from the glands of the stomach fundus- mild increase in their number,
- gastric adenoma ,the only change prone to malignant transformation.
Read also: What causes intestinal inflammation?
Polyps in the large intestine
The presence of polyps in the large intestine is very common, it is estimated that every second person over 60 has them. Most often they are asymptomatic, rarely polyps cause bleeding, anemia or pressure on the stool.
The vast majority of them arehyperplastic polyps . Usually located in the rectum and sigmoid colon, they are small, smooth but numerous, have a histological structure like normal colon epithelium, so they are not malignant but have little tendency to malignant.
The next group arejuvenile polyps , they usually arise up to the age of 5, their spontaneous rupture quite often leads to gastrointestinal bleeding, but these changes do not develop into malignant neoplasms. Structurally, it is a hamartoma, i.e. a developmental disorder composed of mature tissues of the large intestine, but they are distributed chaotically within the polyp.
Inflammatory polypsoccur in the significantly altered intestinal mucosa of people suffering from ulcerative colitis.
Adenomasare neoplasms in the form of polyps. They occur equally often in women and men, and there is also a strong family predisposition, especially in the first line.
Of course, not all adenomas are malignant, that is, most of them do not metastasize or invade adjacent organs. Unfortunately, each of them can turn into a malignant process, and this transformation is evidenced by the passage of dysplastic (abnormal) cells from the mucosa to the deeper layers of the intestinal wall.
The risk of this process depends on several factors: first of all, the size of the polyp, the histological structure and the degree of dysplasia, i.e. deformation of the correct structure. It is estimated that sedentary villous adenomas over 4 cm have the highest risk of cancer.
Histologically, there are three types of adenomas:
- tubular adenomasless malignant, the most common, and structurally usually pedunculated;
- villous adenomasare larger and more dangerous, malignant transformation is observed in 40% of these polyps, fortunately they constitute approx. 1% of all polyps
- tubulo-villous adenomaswith intermediate features
Colon polyps are usually diagnosed by accident during screening colonoscopy, and a biopsy orremoval of the entire polyp and histopathological evaluation.
Rectal enema and X-ray examination are very rarely performed today.
The finding of a polyp is an indication for its removal and it is most often done during the examination, unless it is technically impossible, e.g. due to the large size of the lesion.
If the polyp was malignant and not completely removed, it should be resected within he althy tissue, sometimes along with part of the intestine and lymph nodes.
The follow-up examination after polypectomy is performed depending on the risk factors for cancer. If found to be small (1 or 2 polyps up to 1 cm in size), no further screening is needed, but another 10-year screening colonoscopy may be indicated.
Intermediate risk, i.e. 3 or 4 adenomas or more than 1 cm or significantly changed histologically require a follow-up examination after 3 years.
In the case of numerous - over 5 adenomas or over 2 cm, the control colonoscopy is performed after one year.
Read also: Colonoscopy. The course of the examination and preparation for the colonoscopy
Polyps in the small intestine
Within it, the most common arePeutz and Jeghers polyps , structurally it is a hamartoma, they occur in young people.
Cervical polyps
Intracervical polypsare changes caused by the inflammatory process, they are small and smooth. They do not pose a risk of cancer, but sometimes ulceration occurs within them, which causes bleeding.
Uterine polyps
Endometrial polyps have the correct histological structure of the endometrium, so the risk of neoplastic transformation is minimal, the risk associated with their occurrence is bleeding, most often in postmenopausal women.
In familial polyposis syndromes the number of polyps in the large intestine is hundreds or thousands, if they are adenomatous polyps, the risk of neoplastic transformation is estimated at 100% at the age of 40.
Adenomatous polypsin familial polyps are not only very numerous, but also have a much greater tendency to malignancy due to inherited mutations (e.g. in the APC or MUTYH gene).
The diagnosis of such a syndrome requires frequent checks, i.e. colonoscopy every year after the age of 10-12, and at the age of 20-30, prophylactic colon extraction is performed, and gastroscopy is performed every 1-2 years, as the risk of the occurrence of gastric adenomas may also be increased.
Examples of polyposis syndromes are:
- familyAdenomatous polyposis (FAP).
- Gardner's syndrome.
- Turcot's team.
In some syndromes, the resulting polyps do not malignant, e.g. in juvenile polyposis, Peutz-Jeghers syndrome, so so often control and such radical preventive measures are not necessary.
