|
|
| (13 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| {{Infobox_Disease |
| |
| Name = {{PAGENAME}} |
| |
| Image = tvp_enface.jpg |
| |
| Caption = Tubulovillous polyp of the colon. <br> The polyp viewed "down" from "above" its head, looking down toward the out-of-focus native mucosa from which it arises. This polyp is usually dark because of the bleeding into the mucosa and submucosa caused by the abortive attempts at endoscopic removal. (Courtesy of Ed Uthman MD)|
| |
| DiseasesDB = |
| |
| ICD10 = |
| |
| ICD9 = |
| |
| ICDO = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = |
| |
| eMedicineTopic = |
| |
| MeshID = |
| |
| }}
| |
| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Colon polyps}} |
| {{CMG}}
| | '''For patient information, click [[Colon polyps (patient information)|here]]''' |
|
| |
|
| ==Overview==
| | {{CMG}}; {{AE}} {{SSH}} |
| A [[polyp]] can be defined as lining of mucosa which projects out in a mushroom shape. If they have a stalk they are called pendulated if there is no stalk present they are called [[sessile]]. They are commonly found in the colon.
| |
|
| |
|
| A '''colonic polyp''' is a [[polyp]] found in the colon. They are mostly benign but have the potential to become malignant.
| | {{SK}} Colonic polyps; intestinal polyps; colorectal polyps; adenomatous polyps; hyperplastic polyps; villous adenomas; serrated polyp; serrated adenoma; precancerous polyps |
|
| |
|
| There are many causes which can be neatly broken down into categories.
| | ==[[Colon polyps overview|Overview]]== |
|
| |
|
| ==Historical Perspective== | | ==[[Colon polyps historical perspective|Historical Perspective]]== |
|
| |
|
| ==Classification== | | ==[[Colon polyps classification|Classification]]== |
| Neoplastic, Hamartomatous, inflammatory, metaplastic.
| |
|
| |
|
| === Neoplastic polyp === | | ==[[Colon polyps pathophysiology|Pathophysiology]]== |
|
| |
|
| A [[neoplasm]] is a tissue whose cells have lost its normal differentiation. They can be either benign growths or malignant growths. The malignant growths can either have primary or secondary causes.
| | ==[[Colon polyps causes|Causes]]== |
|
| |
|
| Neoplastic polyps of the bowel are often benign hence called adenomas. An adenoma is tumour of columnar cells or glandular tissue.
| | ==[[Colon polyps differential diagnosis|Differentiating Colon Polyps from other Diseases]]== |
|
| |
|
| Neoplastic polyps can be further broken down into [[tubular]], tubularvillous or villous. They are all broken down into these categories by histology.
| | ==[[Colon polyps epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| The villous subdivision is the worse one to have because the have the most malignant potential. The reason for this is because the villous are projections into the lumen and hence has a bigger surface area and therefore they have a greater potential for malignant change.
| | ==[[Colon polyps risk factors|Risk Factors]]== |
|
| |
|
| === Metaplastic polyp === | | ==[[Colon polyps screening|Screening]]== |
|
| |
|
| [[Metaplasia]] is defined as when the cells of the epithelia change from one type to another like in Barrett’s oesophagus, where the cells change from squamous to columnar.
| | ==[[Colon polyps natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| | |
| Metaplastic polyps are an overgrowth of tissue of normal mucosa. The name "metaplastic polyp" is actually a misnomer as there is no change in epithelia. Metaplastic polyps are the most common type of colonic polyp followed by adenoma polyps. But unlike adenomas they have no malignant potential and rarely grow larger than 5mm.
| |
| | |
| === Hamartomatous polyp ===
| |
| | |
| They are growths, like tumours found in organs as a result of faulty development. They are normally made up of a mixture of tissues. They grow at the normal rate of the host tissue and rarely cause problems such as compression. A common example of a hamartomatous lesion is a strawberry naevus. Hamartomatous polyps are often found by chance; occurring in syndromes such as Peutz-Jegher or Juvenile Polyposis Syndrome.
| |
| | |
| [[Peutz-Jeghers syndrome]] is associated with polyps of the GI tract and also increased pigmentation around the lips, genitalia, buccal mucosa feet and hands. People are often diagnosed with Peutz-Jegher after presenting at around the age of 9 with an intussusception. The polyps themselves carry little malignant potential but because of potential coexisting adenomas there is a 15% chance of colonic malignancy. | |
| | |
| [[Juvenile polyposis syndrome]] are polyps which often present when the patient is young hence called juvenile. Patients normally present young with rectal bleeding. Polyps can be solitary or multiple (>5). If there are multiple the condition is then referred to as Juvenile Polyposis. This condition may have a genetic association. Patients require upper and lower endoscopic screening with removal of polyps. If you fear adenomatous tissue developing then you can offer surgery, namely colectomy and ileorectal anastomosis
| |
| | |
| === Inflammatory polyp ===
| |
| | |
| These are polyps which are associated with inflammatory conditions such as [[Ulcerative Colitis]] and [[Crohns disease]].
| |
| | |
| ==Pathophysiology==
| |
| Malignant potential is associated with
| |
| * degree of [[dysplasia]]
| |
| *Type of polyp (e.g. [[villous adenoma]])
| |
| * Size of polyp:
| |
| ** <1cm =<1 risk of cancer
| |
| ** 1cm=10%risk of cancer
| |
| ** 2cm=15%risk of cancer
| |
| | |
| Normally an adenoma which is greater than 0.5cm is treated
| |
| | |
| ===Pathological Images===
| |
| | |
| <gallery>
| |
| Image:Adenomatous polyp of colon 1.jpg|Adenomatous polyp of colon: This 2.5 cm adenomatous polyp was serendipitously found in a right colectomy specimen. The colon was removed to bypass an extrinsic obstruction caused by metastatic ovarian cancer. In the picture above, the long axis of the opened bowel is horizontal, and the mucosa is viewed en face.
| |
| Image:Adenomatous polyp of colon 2.jpg|Adenomatous polyp of colon: Longitudinal section of the same polyp
| |
| Image:tvp_enface.jpg|Tubulovillous polyp of the colon: The polyp viewed "down" from "above" its head, looking down toward the out-of-focus native mucosa from which it arises. This polyp is usually dark because of the bleeding into the mucosa and submucosa caused by the abortive attempts at endoscopic removal.
| |
| Image:Tubulovillous polyp of the colon.jpg|The polyp is shown in longitudinal section
| |
| </gallery>
| |
| | |
| | |
| ==Causes==
| |
| | |
| ==Differentiating {{PAGENAME}} from Other Diseases==
| |
| | |
| ==Epidemiology and Demographics==
| |
| | |
| ==Risk Factors==
| |
| | |
| ==Screening==
| |
| | |
| ==Natural History, Complications, and Prognosis==
| |
| ===Natural History===
| |
| | |
| ===Complications===
| |
| | |
| ===Prognosis===
| |
|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| ===Diagnostic Criteria===
| | [[Colon polyps diagnostic study of choice|Diagnostic study of choice]] | [[Colon polyps history and symptoms|History and Symptoms]] | [[Colon polyps physical examination|Physical Examination]] | [[Colon polyps electrocardiogram|Electrocardiogram]] | [[Colon polyps laboratory findings|Laboratory Findings]] | [[Colon polyps x ray|X-Ray Findings]] | [[Colon polyps echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Colon polyps CT scan|CT-Scan Findings]] | [[Colon polyps MRI|MRI Findings]] | [[Colon polyps other diagnostic studies|Other Diagnostic Studies]] | [[Colon polyps other imaging findings|Other Imaging Findings]] |
| | |
| ===History and Symptoms===
| |
| | |
| ===Physical Examination===
| |
| | |
| | |
| Patients normally present with rectal bleeding. But can also present with cramp abdominal pain with altered bowel habits. With profuse bleeding you can present with [[Iron deficiency anaemia]].
| |
| ===Laboratory Findings===
| |
| | |
| ===Imaging Findings===
| |
| | |
| ===Other Diagnostic Studies===
| |
|
| |
|
| ==Treatment== | | ==Treatment== |
| ===Medical Therapy===
| | [[Colon polyps medical therapy|Medical Therapy]] | [[Colon polyps surgery|Surgery]] | [[Colon polyps primary prevention|Primary Prevention]] | [[Colon polyps secondary prevention|Secondary Prevention]] | [[Colon polyps cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Colon polyps future or investigational therapies|Future or Investigational Therapies]] |
| | |
| Patients require [[flexible sigmoidoscopy]] or [[Colonoscopy]] to diagnose. Polyps can just be removed during these procedures. The patient will require regular screening via endoscopy to monitor progress of disease.
| |
| | |
| Severe disease can be treated with colonic resection.
| |
| | |
| ===Surgery===
| |
| | |
| ===Prevention===
| |
|
| |
|
| ==External links== | | ==Case Studies== |
| * http://www.netdoctor.co.uk/diseases/facts/colonpolyps.htm
| | [[Colon polyps case study one|Case #1]] |
| * http://www.clevelandclinic.org/registries/inherited/jp.htm
| |
|
| |
|
| ==References==
| | |
| {{reflist|2}}
| |
|
| |
|
| | [[Category:Medicine]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Surgery]] | | [[Category:Up-To-Date]] |
| | |
| | |
| {{WH}}
| |
| {{WS}}
| |