Polyps of the colon and hereditary syndromes with intestinal polyposis: clinic, diagnosis, differential diagnosis, conducting tactics
Polyps of the colon- These are pathological formations on the inner wall of the intestine, which can have a different clinical meaning, from harmless benign growths to harvesting colorectal cancer. This is one of the most common diseases of the gastrointestinal tract, especially in people over 50 years old. In most cases, polyps are asymptomatic and can remain unnoticed for many years, discovering by accident in preventive studies such as colonoscopy. However, their presence is associated with an increased risk of malignancy, especially when it comes to adenomatous polyps.
A separate place among the causes of polyposis is occupied by hereditary syndromes, such as:
- Family adenomatous polyposis
- Lynch's syndrome (hereditary non -closed colorectal cancer). These genetic diseases are characterized by the development of a large number of polyps already at a young age and are associated with a high risk of developing cancer of not only the colon, but also other organs. Without timely intervention, such patients practically inevitably face the malignancy of polyps and the development of cancer. In the case of family adenomatous polyposis, the risk of cancer develops to 40 years approaches 100%, which requires early surgical prevention.
The tactics of patients with the polyps of the colon depends on their type, size, quantity and presence of signs of malignancy.
In most cases, preference is given to endoscopic removal of polyps, which helps to prevent their further development and possible transformation into malignant tumors.
In the case of multiple or large polyps, surgical intervention may be required. For patients with hereditary syndromes such as family adenomatous polyposis, preventive coloactomy is often a necessary stage of treatment that prevents cancer.
Thus, the polyps of the colon and hereditary polyposis syndromes require an integrated approach, including early diagnosis, regular monitoring and timely treatment, which significantly reduces the risk of colorectal cancer and improves the prognosis for patients.
Clinic
The polyps of the colon and hereditary syndromes associated with the polyposis of the intestine have a variety of clinical manifestations. Depending on the type of polyps, their size, quantity and the presence of related conditions, the clinical picture can vary from the asymptomatic current to serious complications, such as:
- Bleeding
- Intestinal obstruction
- Malignant transformation.
Diagnostics
Diagnosis of the polyps of the colon and hereditary syndromes with intestinal polyposis is a multi-stage process, including both visualization research methods and laboratory and molecular genetic tests. Complex diagnosis allows not only to identify polyps, but also to evaluate their morphological features, the degree of risk of malignant degeneration and the need for further treatment. Of particular importance is the diagnosis of hereditary polypose syndromes, since the timely detection of these conditions allows for preventive measures and reduce the risk of developing colorectal cancer.
Colonoscopy
Colonoscopy is a gold standard in the diagnosis of colon polyps. This method is an endoscopic examination that allows you to visualize the inner surface of the colon using a flexible probe equipped with a camera.
Visualization of polyps. During colonoscopy, the doctor can see polyps, determine their size, shape and localization. This is an important step in the diagnosis, since the form of polyps (for example, the presence of a leg or a flat form) and their sizes can be indirect signs of risk of malignant degeneration. Adenomatous polyps have a greater risk of malignancy compared to hyperplastic or inflammatory.
Figure 1. Visualization of the polyp in an endoscopic examination
- Biopsy and removal of polyps. During the procedure, a fence of biopsy material for further histological examination is possible, which allows us to establish an accurate diagnosis. Also, with colonoscopy, you can remove small polyps using polypectomy. This is both a diagnostic and therapeutic procedure, since removal of polyps prevents their further development and malignancy.
- Colonoscopy is recommended as a preventive examination to all persons over 50 years old, as well as persons with burdened heredity (for example, with suspected family adenomatous polyposis or linch syndrome) for early detection of precancerous conditions.
- Histological study
- After removing polyps or taking biopsy material, they must be directed to histological examination. This stage allows you to accurately determine the morphological type of polyps and their potential threat of malignant degeneration.
- Determination of the nature of polyps. A histological examination reveals the type of cells that consist of polyps, as well as the presence or absence of dysplasia (precancerous changes). Adenomatous polyps have a high risk of malignancy, especially if they have a high degree dysplasia. Hyperplastic and inflammatory polyps, on the contrary, usually are benign and do not require active treatment.
- Risk assessment of malignant degeneration. A histological examination allows not only to confirm the benignity or malignancy of the polyps, but also to determine the risk of their further malignancy. Polyps with a high level of dysplasia require more frequent observation and, possibly, surgical intervention.
- Thus, histological examination is a key stage of diagnosis, since it determines the further tactics of the patient’s treatment.
Diagnosis of the polyps of the colon includes a number of methods, among which the leading is a colonoscopy with a biopsy of suspicious sites. Genetic studies also play an important role, especially in the case of hereditary syndromes, which allows you to timely identify the disease in family members and begin early observation or treatment. The introduction of modern molecular genetic technologies into clinical practice has significantly increased the possibilities of early diagnosis and forecasting of the course of the disease.
Diagnosis of the polyps of the colon includes a number of methods, among which the leading is a colonoscopy with a biopsy of suspicious sites. Genetic studies also play an important role, especially in the case of hereditary syndromes, which allows you to timely identify the disease in family members and begin early observation or treatment. The introduction of modern molecular genetic technologies into clinical practice has significantly increased the possibilities of early diagnosis and forecasting of the course of the disease.
Tactics of management
The tactics of patients with the polyps of the colon and hereditary syndromes of polyposis depends on the nature of the formations, their morphological characteristics, as well as on the presence or absence of concomitant diseases. Since polyps can have both benign and malignant nature, the approach to treatment should be individualized and taken into account the risks associated with the malignancy of polyps.
Observation
Criteria for observation. Usually, in such cases, it is recommended to carry out colonoscopy every 5-10 years, depending on the age of the patient and risk factors.
Regular colonoscopy. When observing, it is important to plan regular colonoscopy to control the state of polyps and identify new formations. This allows you to respond in time to changes and conduct the necessary interventions when new polyps appear or a change in the state of existing ones.
Endoscopic removal
For most polyps found during colonoscopy, endoscopic removal, known as polypectomy, is recommended.
Polypectomy procedure. Polypectomy is carried out during colonoscopy using special tools. This can be done both with the help of traditional polypectomy (using a loop electric), and with the help of new technologies, such as endoscopic submucous dissection, which allows you to remove larger or complex polyps.
Advantages of removal. Endoscopic removal of polyps reduces the risk of their malignancy and eliminates the need for more invasive surgical interventions. After removing the polyps, their histological examination helps to determine the nature of the formations and the need for further observation or treatment.
Surgical treatment
With multiple polyposis or suspicion of malignant transformation of polyps, surgical treatment may be required. Intestinal resection. In cases where the patient has many adenomatous polyps, for example, with family adenomatous polyposis, a resection of the affected part of the intestine can be recommended. This allows not only to remove polyps, but also to reduce the risk of developing colorectal cancer.
Active intervention
Effective tactics for conducting patients with polyps include not only observation, but also active intervention. Endoscopic removal of polyps is a minimum invasive procedure that allows you to remove both benign and potentially malignant formations without the need for more radical surgical interventions. Polypectomy reduces the risk of malignancy.
Forecast for patients
Compliance with the recommended tactics of management and regular observation significantly improve the prognosis for patients. The use of modern methods of diagnosis and treatment allows not only to identify and eliminate polyps in a timely manner, but also to significantly reduce the incidence and mortality from colorectal cancer. It is important that patients are aware of their individual risk group and actively participate in the observation process, undergoing regular examinations and following the recommendations of doctors.
Polyps of the colon and hereditary syndromes with polyposis require an active and integrated approach, including early diagnosis, endoscopic removal and, if necessary, surgical treatment.
Timely intervention and regular observation not only reduce the risk of developing colorectal cancer, but also help improve the quality of life of patients.
Thus, the effective management of this pathology is crucial for the health and well -being of the population as a whole.
Head of the Department of Gastroenterology Oleinik Nikolay Vasilievich
