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Colorectal Polyps

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What are Colorectal Polyps?

Colorectal polyps are usually developed along the internal walls of the colon (also known as the large intestine) or rectum in Singapore. The colon is the longest part of the intestines, and it is responsible for the absorption of water. The remaining waste products are then stored as stools in the rectum where it will then be excreted by the anus. 

The prevalence of colorectal polyps is increasing worldwide. They can occur in varying sizes and there are 3 main types:

  • Adenomatous polyps: most common type and is often a precursor to colorectal/colon cancer. The larger an adenomatous polyp, the more likely it is to develop into colon cancer. 
  • Hyperplastic polyps: harmless and do not develop to colon cancer.

Malignant polyps: have microscopic cancer cells in them, they are the earliest forms of colorectal/colon cancer.

What are the common causes?

Cells all throughout our body are constantly being replaced by new cells. This is usually a very well-controlled mechanism, however, there are certain instances where this process occurs a little out of control due to genetic changes. When new cells are produced before the old cells can die off, excess growth occurs, and this is how polyps are formed.
There are various factors that increase your risk of polyps, but we will look into that later.

What are the symptoms of Colorectal Polyps?

Most of the time, colorectal polyps and early-stage colon cancer do not cause any symptoms. They are usually discovered during routine colonoscopies that screen for colorectal/colon cancer. 

This is why yearly screenings are important so that these colorectal polyps can be discovered early and be removed before they develop into colorectal/colon cancer. 

Symptoms that could develop include:

  • Bloody stools: this can be seen either in the toilet bowl or on the toilet paper after wiping.
  • Black or streaked stools: this could mean there is blood in your stools.
  • Abdominal pain and discomfort: if you feel any pain in your abdomen, it could signify something serious like colorectal/colon cancer.
  • Fatigue: feeling exhausted throughout the day even after getting a good night’s sleep.
  • Shortness of breath: this can happen even though you are not exercising or exerting yourself.
  • Constipation or diarrhoea: if either one of these lasts more than a week, it could mean something is wrong.

Colorectal polyps may also start to bleed internally which may result in iron deficiency anaemia, characterised by fatigue and shortness of breath. 

Are Colorectal Polyps painful?

In the early stages, colorectal polyps are not painful. However, if left untreated, they can start to cause abdominal pain and discomfort. 

Who is at risk of Colorectal Polyps in Singapore?

While the main causes of colorectal polyps are still unknown and poorly understood, there are several factors that could increase your risk of colorectal polyps, these are:

  • Age: individuals over the age of 50 are more likely to develop colorectal polyps
  • Weight: overweight individuals are at a higher risk of colorectal polyps, including more fibre and exercise in your lifestyle can help reduce your risk.
  • Family history: having a relative with colorectal polyps will increase your risk, the more family members affected, the higher your risk increases. 
  • Smoking and drinking: studies have shown that being a regular smoker and drinker can increase your risk of colorectal polyps.
  • Inflammatory Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS): having either one or both IBD and IBS can increase your risk of developing colorectal polyps.
  • Type 2 diabetes: uncontrolled type 2 diabetes increases your risk.
  • Genetic conditions: these conditions include, familial adenomatous polyposis (FAP), Gardner’s syndrome, Lynch syndrome, MYH-associated polyposis (MAP), Peutz-Jeghers syndrome, and serrated polyposis syndrome.

If you have any of the above risk factors, regular colonoscopies can help you to monitor for any colorectal polyps. Early detection and treatment are key to the prevention or reversal of cancer. 

How are Colorectal Polyps diagnosed?

Colorectal polyps are diagnosed using the following methods:

  • Colonoscopy: a thin and flexible tube with a camera and light attached at one end, is inserted into the anus and led up through the rectum and large intestine for a proper examination. 
  • Computed tomography scan (CT-scan): is a non-invasive diagnostic imaging tool that uses a combination of x-rays and computer technology to produce cross-sectional, horizontal, or axial images of our body. This helps your gastroenterologist to identify any abnormalities.
  • Sigmoidoscopy: used to examine the insides of the rectum and anus.
  • Stool test: checks for any other causes for your symptoms such as a viral or bacterial infection. It is also used to check for microscopic traces of blood.
  • Lower gastrointestinal enema: also called a barium enema, your colon will be filled with a liquid called barium. This will make your colon easier to see during an x-ray.

What are the treatment options for Colorectal Polyps in Singapore?

The types of treatment for colorectal polyps are:

  • Endoscopic mucosal resection: minimally invasive procedure that removes precancerous lesions and early-stage gastrointestinal tumours; it uses a thin, long, and flexible tube called an endoscope that has an electrical snare, video camera, and light at one end. The video camera and light enable your doctor to have a good view of your gastrointestinal tract, while the electrical snare loops around any lesions or polyps, and essentially removes them while also cauterising the wound. 
  • Polypectomy: removal of the colorectal polyps with forceps or a wire loop. 
  • Laproscopic surgery: if the polyps are too large to be removed by the above to methods, surgery will be performed to remove them.
  • Total proctocolectomy: recommended if you have genetic conditions such as FAP. It is the complete removal of the colon and rectum.

Once the colorectal polyps are removed, they are sent for a biopsy to check if they are cancerous. 

Frequently asked questions

Do colorectal polyps go away on their own?
Sometimes they do but it is still advisable to remove the colorectal polyps using the treatment options mentioned above.
Can a doctor tell if a colorectal polyp is cancer during a colonoscopy?
No, your gastroenterologist will only know if it is cancerous after it has been sent for a biopsy.

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