Colorectal polyps (adenomas) are predominantly asymptomatic.
Adenomas are highly prevalent and incidence is related to older age, male sex, and family history (first-degree relatives with colorectal cancer).
Most colorectal cancers arise in an adenoma (adenoma-carcinoma sequence).
Colonoscopic polypectomy is diagnostic and therapeutic. Polypectomy reduces the incidence of colorectal cancer by up to 90%.
Surveillance after polypectomy is based upon polyp size, number, and histopathology.
Familial polyposis syndromes should be considered if many polyps are found, particularly in younger patients.
Colorectal polyps are projections arising from the mucosal surface of the colon and rectum. Polyps may be neoplastic or non-neoplastic; histopathology is required to confirm the nature of the polyp. The two main classes of pre-cancerous colorectal polyps are conventional colorectal adenomas and serrated lesions.
This topic covers diagnosis and treatment of sporadic colonic polyps.
History and exam
Key diagnostic factors
- presence of risk factors
- family history
Other diagnostic factors
- rectal bleeding
- mucus discharge
- weight loss
- change in bowel habit
- symptoms and signs of anaemia
- increasing age
- family history of colorectal cancer or colorectal polyps
- previous history of polyps
- male sex
1st investigations to order
- CT colonography
Investigations to consider
- flexible sigmoidoscopy
- cap-assisted colonoscopy
- virtual chromoendoscopy techniques
suitable for endoscopic resection
unsuitable for endoscopic resection
- Colorectal cancer
- Anal fissure
- Updates on age to start and stop colorectal cancer screening
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
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