Are colon polyps a cause for concern?

The diagnosis of colon polyps, also known as colorectal polyps, often strikes panic in patients. Colon polyps are abnormal growths that develop in the lining of your colon. These growths vary in size and shape and typically start as small, benign clumps of cells on the inner surface of the colon. 

colon polyps
Colon polyps are small lumps of cells that grow in the lining of the colon.

Frequently affiliated with cancer, colon polyps are usually detected during routine colonoscopy screening or when patients actively seek remedies for issues such as bloating, rectal bleeding, changes in bowel habits, and stool colour. In this article, we take a deep dive into colon polyps and whether the concern surrounding the subject is warranted. 

Myth 1: Colon Polyps = Colorectal Cancer  

The common misconception is that colon polyps will inevitably progress into colorectal cancer. Whilst 95% [1] of colon cancer begins with colon polyps, only an estimated 5% [2] will eventually progress into colorectal cancer [3]. Nonetheless,  given that colorectal cancer is the predominant cancer in Singapore [4], it is unsurprising that many Singaporeans are concerned about polyps.

Unbeknownst to many, the actual determinant of colon polyps becoming cancerous is the size of the polyps [5] during discovery. Below, we discuss the estimated prevalence of cancerous polyps out of 550,811 polyps studied.

Polyp size Percentage of cancer 

1–5 mm 0.6%

6–9 mm 2.1%

10 mm+ 13.4%

** It has been noted from prior studies [6] that polyps of size 30 mm or more have the highest risks of cancer progression. 

Colon polyp size
The size of a colon polyp determines the likelihood of the growth progressing into colon cancer.

Additionally, the type of polyps is another factor that significantly determines the likelihood of cancer progression. There are two primary categories of colon polyps: adenomatous [7] and hyperplastic [8]. 

Adenomatous polyps, specifically, tend to raise concern as they have a higher likelihood of cancer progression. These are further divided into three subtypes:

Hyperplastic polyps, on the other hand, are typically benign and rarely become cancerous. They often occur on the left side of your colon and do not raise concern. The most promising preventative care one can practice is to detect and remove polyps regardless of the type of polyp. This sentiment is echoed unanimously [12] by medical professionals in Singapore. 

Myth 2: Only symptomatic patients should be screened

This myth is not only inaccurate but rather dangerous. Most patients with colon polyps are asymptomatic, so if you are stalling screening because there are no concerning signs at sight yet, you may be missing the opportunity to introduce intervention at early stages. As mentioned, when polyps grow to a certain size, the risk of cancer progression increases concurrently. Thus, conducting health screening at the prescribed frequency is in your best interest. 

Colon polyp removal
Regular screening allows for detecting and removing colon polyps at early stages. 

Additionally, patients tend to consider their risk factors less. Where risk factors are present, the standard recommendations will no longer apply. It is recommended to discuss screening and surveillance with your doctor, depending on your risk factors.

Myth 3: Colon polyps are only prevalent among older men 

While colon polyps are more prevalent in men than women (66.2% vs 33.8%) [14] and are generally of higher concern in seniors [15], this statement is not necessarily true. Children, too, may be at risk of polyp growth, known as juvenile polyposis [16]. These are usually detected when children present symptoms such as rectal bleeding. 

In some Asian countries, the prevalence of colon polyps in younger age groups has been growing [17]. For instance, in India, one out of six people [18] over 40 has a polyp, increasing the risk of colorectal adenoma fivefold after age 40. A recent study [19] also projected an increased incidence rate for colon and rectal cancers by 90% and 124%, respectively, for patients between 20 and 34 years of age based on increased findings of colon polyps in younger adults. 

The verdict

So, should colon polyps be a cause for concern? The studies mentioned above indicate that more adults may have colon polyps. Additionally, even younger age groups adults are now vulnerable to colon polyp growth. Given the pervasiveness, we can safely deduce colon polyps growth is not an unusually unique health concern. 

Yes, colon polyps do increase the risk of cancer. However, patients are not doomed to have cancer in their lifetime invariably. The takeaway from the recent statistics about colon polyp growth signals an immediate need for change in lifestyle and proactiveness in health. Patients must take more accountability for their health where risk factors are present. 

Stay tuned for the next article, where we discuss lifestyles and behaviours that increase the risks of colon polyps and colorectal cancer, ways to prevent them, and how to retake autonomy of your health. 

References

  1. Meseeha, M. and Attia, M. (2023) Colon polyps , Colon Polyps. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430761/ (Accessed: 10 October 2023).
  2. Turner, K., Genta, R. and Sonnenberg, A. (2018) Lesions of all types exist in colon polyps of all sizes : Official Journal of the American College of Gastroenterology: ACG. Available at: https://journals.lww.com/ajg/Abstract/2018/02000/Lesions_of_All_Types_Exist_in_Colon_Polyps_of_All.25.aspx (Accessed: 10 October 2023). 
  3. American Cancer Society (2020) What is colorectal cancer?: How does colorectal cancer start?, Colorectal Cancer. Available at: https://www.cancer.org/cancer/types/colon-rectal-cancer/about/what-is-colorectal-cancer.html#:~:text=Most%20colorectal%20cancers%20start%20as,type%20of%20polyp%20it%20is. (Accessed: 10 October 2023).
  4. National University Cancer Institute, Singapore (2022) Cancer information, Colorectal Cancer. Available at: https://www.ncis.com.sg/Cancer-Information/About-Cancer/Pages/Colorectal-Cancer.aspx (Accessed: 10 October 2023).
  5. Selchick, F. (2022) Colon polyp size and cancer risk, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/colon-polyp-size-and-cancer-risk#polyp-size-and-cancer-risk (Accessed: 10 October 2023).
  6. Hossain, E. et al. (2019) PWE-040 cancers in colonic polyps: Size matters, BMJ Journals . Available at: https://gut.bmj.com/content/68/Suppl_2/A191.1 (Accessed: 10 October 2023).
  7. Sethi, S. (2023) Adenomatous polyps: Causes, risk factors, and treatment, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/adenomatous-polyps (Accessed: 11 October 2023).
  8. Chun, C. (2018) Everything You Need to Know About Hyperplastic Polyps, Healthline. Available at: https://www.healthline.com/health/hyperplastic-polyp (Accessed: 10 October 2023).
  9. Cleveland Clinic Medical Professional (2022) Tubular adenoma in colon: Causes, treatment, outlook & what it is, Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/22713-tubular-adenomas#:~:text=Tubular%20adenomas%20are%20precancerous%20polyps,of%20tubular%20adenomas%20become%20cancerous. (Accessed: 10 October 2023).
  10. Ramji, A. (2022) Villous adenoma, Drugs and Diseases . Available at: https://emedicine.medscape.com/article/170283-overview (Accessed: 10 October 2023).
  11. Ciarpaglini, C.M. (2022) Tubulovillous / Villous Adenoma, Pathology Outlines . Available at: https://www.pathologyoutlines.com/topic/colontumortvadenoma.html (Accessed: 10 October 2023).
  12. Rani, T. (2022) Get them out, cancer or not, Singapore Health. Available at: https://www.nccs.com.sg/news/singapore-health/get-them-out-cancer-or-not (Accessed: 10 October 2023).
  13. Ministry of Health Singapore (2010) Cancer screening; Ministry of Health Clinical Practice Guidelines. Available at: https://www.moh.gov.sg/docs/librariesprovider4/guidelines/cpg_cancer-screening.pdf (Accessed: 10 October 2023).
  14. Shahmoradi, M.K., Soleimaninejad, M. and Sharifian, M. (2020) Evaluation of colonoscopy data for colorectal polyps and associated histopathological findings, Science Direct . Available at: https://www.sciencedirect.com/science/article/pii/S2049080120301904#:~:text=Furthermore%2C%20the%20incidence%20of%20polyps,statistically%20significant%2C%20p%20%3C%200.001.\ (Accessed: 11 October 2023).
  15. Brooks, M. (no date) Seniors with few years left often advised to get colonoscopy, WebMD. Available at: https://www.webmd.com/colorectal-cancer/news/20230321/seniors-with-few-years-left-often-advised-to-get-colonoscopy (Accessed: 10 October 2023).
  16. Calva, D. and Howe, J. (2009) Juvenile polyposis - cancer syndromes, National Library of Medicine . Available at: https://www.ncbi.nlm.nih.gov/books/NBK51310/ (Accessed: 10 October 2023).
  17. Pan, J. et al. (2020) Prevalence and risk factors for colorectal polyps in a Chinese population: A retrospective study, Nature.com. Available at: https://www.nature.com/articles/s41598-020-63827-6 (Accessed: 10 October 2023). 
  18. Jayadevan, R. et al. (2016) Prevalence of Colorectal Polyps: A Retrospective Study to Determine the Cut-Off Age for Screening, Symbiosis. Available at: https://symbiosisonlinepublishing.com/gastroenterology-pancreatology-liverdisorders/gastroenterology-pancreatology-liverdisorders56.php (Accessed: 10 October 2023).
  19. Bailey, C.E. et al. (2014) Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers in the United States, 1975-2010, JAMA Surgery. Available at: https://jamanetwork.com/journals/jamasurgery/fullarticle/1920838 (Accessed: 10 October 2023). 

Is it IBS, or just an upset tummy? Here’s how to tell

Stomach pains can hit you at any moment; unfortunately, it usually happens when you least expect it. Whether your stomach pains are caused by food poisoning, irritable bowel syndrome, or just regular stomach aches, it is inconvenient and often embarrassing.

But it is important to understand the cause of your stomach pains; having an upset tummy, though inconvenient, is curable and not long-term. On the other hand, irritable bowel syndrome (IBS) is a chronic condition that, while not curable, is treatable through the management of symptoms.

stomach pains
Stomach pains can sometimes be ambiguous, with causes ranging from food poisoning, lactose intolerance, to irritable bowel syndrome.

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome, commonly referred to as IBS, is a gastrointestinal disorder that is relatively common, affecting 6-18% of people worldwide [1]. Although IBS comprises a variety of symptoms that affect the gastrointestinal tract, a recent study conducted in 2022 found that it does not increase your risk of gastrointestinal cancer [2].

IBS is a functional gastrointestinal disorder or a disorder of the gut-brain interaction. This means there is a problem with how the gut and brain work together, causing the gastrointestinal tract to be highly sensitive, thus affecting the contraction of the bowel muscle, resulting in bloating, constipation, abdominal pain, and diarrhoea.

The main cause of IBS is still unknown and poorly misunderstood. However, several factors have been linked to the development of IBS. These are:

IBS
Irritable bowel syndrome occurs due to abnormal contractions in the gastrointestinal tract.

What are the symptoms of IBS?

IBS has many symptoms, but it varies from person to person. These symptoms include:

These symptoms come and go for varying durations. For example, bloating or gas tends to disappear after a bowel movement. Therefore, IBS is often misdiagnosed as other conditions, such as an upset tummy or even lactose intolerance.

Differences between IBS and upset tummy

While they may have some similar symptoms, there are a few clear-cut ways to tell if you have IBS or just an upset tummy.

Irritable bowel syndromeUpset tummy
It happens frequently and with greater severity.It occurs rarely, and symptoms are not as severe.
Pain does not wake you up at night.Pain is more severe at night and can wake you up, especially in cases of food poisoning.
Pain may affect the whole gastrointestinal tract.Pain is generalised.
Symptoms usually include constipation, diarrhoea, or both, and lower abdominal pain.Symptoms usually include nausea, vomiting, and upper abdominal pain.
The intestinal lining appears normal.The intestinal lining is inflamed.
There are no known causes, but they have been linked to several factors.It is known to be caused by various bacteria, viruses, food, medication, etc.
irritable bowel syndrome
IBS differs from an upset tummy in various ways, such as pain location – upper abdomen for IBS and lower abdomen for an upset stomach.

How is IBS diagnosed?

If you suspect that you might be experiencing IBS, you should consult with a gastroenterologist who will help you manage your symptoms. IBS is diagnosed if you fulfil the following criteria:

The following diagnostic tests can be conducted if IBS is suspected:

gastroscopy IBS
A gastroscopy can be used to diagnose causes of abdominal pain.

What is the best treatment for IBS?

The best treatment for IBS depends on what works for you; IBS treatment for you may be different from IBS treatment for someone else. Here are some treatment options that you may try to help yourself with IBS:

Your gastroenterologist can prescribe several medications:

The first line of treatment for IBS would be remedies you can try at home, such as lifestyle changes. However, if severe symptoms persist, medications can be prescribed to help manage them.

In conclusion, IBS is very different from an upset tummy. IBS is a chronic, incurable condition, while an upset stomach is an acute, curable condition. There are no known causes of IBS, but several causes of an upset tummy, such as gastroenteritis, food poisoning, etc. 

So, next time you have any stomach pains, remember when it happens, how frequently it happens, and what the symptoms are. If it happens again within the next few days, weeks, or months, you could be developing IBS. 

If you suspect you have IBS, book an appointment with us today, and we can help you manage your symptoms.

References

  1. Ami D Sperber, D. D.-Y. (2017). The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut, 1075-1082.
  2. Shanshan Wu, C. Y. (2022). Irritable Bowel Syndrome and Long-Term Risk of Cancer: A Prospective Cohort Study Among 0.5 Million Adults in UK Biobank. The American Journal of Gastroenterology, 785-793.

Lactose intolerance versus milk allergy: What’s the difference?

Not many people know this, but lactose intolerance is not the same as a milk allergy – although they may sound the same. Lactose intolerance is not dangerous, but a milk allergy could be life-threatening. Read on to learn more about this modern-day conundrum.

lactose intolerance
Lactose intolerance and milk allergy are not the same thing.

What is lactose intolerance?

Lactose intolerance is an issue of the digestive system that occurs when an individual’s small intestine does not produce or does not produce enough lactase – an enzyme necessary for the breakdown of lactose. Lactose is a type of sugar specifically found in milk and other dairy products like chocolate, yoghurt, cheese, ice cream, and butter.

Digesting lactose does not pose any problem for most people because lactase breaks down lactose into glucose and glycogen, which are then absorbed into our bloodstream and transported to all body parts to be used as energy.

For people who are lactose intolerant, lactose cannot be broken down, so it travels down to the colon, where it gets fermented by bacteria, resulting in bloating, diarrhoea, and abdominal cramps.

Fortunately, although lactose intolerance is inconvenient and, at times, embarrassing, it is not a life-threatening condition.

What are the causes of lactose intolerance?

We already know that lactose intolerance is caused by insufficient or a complete lack of lactase. But why do some individuals lack this enzyme?

premature baby
Premature babies have been found to be more prone to lactose intolerance than full-term babies.

What are the symptoms of lactose intolerance?

Symptoms of lactose intolerance usually appear 30-60 minutes after consuming dairy products; symptoms include:

The severity of symptoms depends on two things:

These symptoms are brief and will be alleviated once the dairy products have been removed from your digestive system.

What is a milk allergy?

A milk allergy, like all types of allergies, is an issue of the immune system where the body over-reacts to one or more proteins present in milk and other dairy products. This results in an allergic reaction with symptoms ranging from mild (rashes) to severe/life-threatening (anaphylactic shock).

Milk allergies can affect anyone but are one of the most common allergies in children and babies, affecting approximately 0.5-2.5% of children [1],[2],[3],[4]. Milk allergies usually occur in response to dairy products that contain cow’s milk.

milk allergy
Milk allergy is an allergy to dairy products that contain cow’s milk.

What are the causes of a milk allergy?

For individuals with a milk allergy, their immune system recognises one or more proteins in milk as a foreign invader. As a response, the immune system releases the antibody – immunoglobulin E (IgE), which then signals the body to release histamine and other chemicals responsible for the allergic symptoms.

Two proteins in cow’s milk can trigger an allergic reaction:

Your likelihood of developing a food allergy such as a milk allergy significantly increases if one or both of your parents have allergies to food or other particles [5].

Types of milk allergies and their symptoms

 lgE-mediatedNon-IgE mediated
What is itIgE is an antibody the immune system produces when it recognises milk protein as a foreign invader. It causes immediate symptoms.Involves other aspects of the immune system other than IgE. Symptoms develop later and are usually confused with the symptoms of lactose intolerance.
SymptomsRashes or hivesWheezingCoughingBreathlessnessItching around the mouthSwelling of the lips, mouth, or tongue VomitingAbdominal crampsRunny noseWatery eyesDiarrhoea (may contain blood)Colic

Do I have lactose intolerance or a milk allergy?

Apart from identifying your symptoms, diagnostic tests must be carried out to confirm if you have lactose intolerance or a milk allergy.

abdominal pain
Testing must be conducted to identify whether your symptoms are due to lactose intolerance or a milk allergy.

Tests for lactose intolerance include:

Tests for a milk allergy include:

Conclusion

Lactose intolerance and milk allergy are different, even down to the way each one is diagnosed. Lactose intolerance is a digestive system issue, while milk allergy is an immune system issue. The former is not life-threatening, while the latter can be.

Fortunately, both can be treated, and symptoms can be avoided simply by steering clear of dairy products. It is essential to get properly tested so you can live comfortably and healthily.

References

  1. Julie D Flom, S. H. (2019). Epidemiology of Cow’s Milk Allergy. Nutrients, 1051.
  2. AA Schoemaker, A. S.-P. (2015). Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy, 963-972.
  3. Junichiro Tezuka, 1. M. (2021). Possible association between early formula and reduced risk of cow’s milk allergy: The Japan Environment and Children’s Study. Clinical and Experimental Allergy, 99-107.
  4. Rachel L Peters, J. J.-L. (2018). The Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart. The Journal of Allergy and Clinical Immunology in Practice, 440-448.
  5. Kanika Kanchan, S. C. (2021). Current insights into the genetics of food allergy. The Journal of Allergy and Clinical Immunology, DOI:https://doi.org/10.1016/j.jaci.2020.10.039.