Most of us would be a bit troubled if we were told that a polyp had been discovered somewhere in our body. They do not follow the normal growth patterns of healthy tissues, so of course the presence of a polyp is not good news. However, the majority of polyps are not cancerous, although some may turn into cancer over time. Knowledge is power, as they say, so let’s learn what we can about polyps in order to best understand and deal with them if the situation arises.
What Are Polyps?
The term polyp refers to an abnormal overgrowth of tissue (neoplasm or “new growth”) protruding from the surface of a mucous membrane. They are generally classified as either pedunculated (attached by an elongated stalk) or sessile (flattened), and can take a variety of shapes, the most common being round, droplet, or irregular. Polyps may form anywhere in the body where mucosal tissues are present, but are most commonly found in the colon, stomach, rectum, uterus, and nose. Polyps are collections of tissue cells that keep growing beyond normal limits. A mass of cells that compose any overgrowth is called a “tumor,” and like all tumors, polyps can be benign (they stop growing), or malignant (also called cancerous because they do not stop growing and can spread to other parts of the body). Most types of polyps are of concern because a small percentage of them will start out benign, and may at some point become malignant if not removed.
Perhaps the best way to approach our study of polyps is to look in more detail at the most common types that are typically found in the body.
Colon polyps, one of the most common types, can grow at various places within the intestinal tract, and the vast majority of them are harmless. However, they should not be ignored because statistical studies have shown that approximately 1% of colon polyps will at some point turn malignant.
Colon polyps are relatively common, affecting about 30% of the population over 50 years of age. They can range in size from that of a pea up to that of a golf ball. They arise from the mucosal lining of the intestinal wall. Most of them, up to 95%, occur in the large intestine, with the remainder found in the small intestine. Those in the large intestine generally cause more problems and have a greater chance of being or becoming malignant.
Most colon polyps will not show significant symptoms, and are often discovered during routine screenings or exams. However, there are some possible signs that can occur. Some of the most common include:
- Rectal bleeding: Look for consistency here, over a period of weeks. Bright red blood on toilet paper after a bowel movement may indicate a colon polyp, but it is also associated with hemorrhoids or harmless tears in the anus. On the other hand, it can also be a sign of colon cancer, so if it persists, get it checked out.
- Blood in the stool: If blood is present, it can be an indicator of colon polyps. Bloody stools will often appear black or dark red. Be aware that certain medications and things that you eat can color your stool as well. Beets, for example, tend to cause your stool to appear as if there is blood present.
- Changes in bowel habits: Again, look for persistency. If you have unexplained diarrhea or constipation for over a week, it may be a sign of colon polyps.
- Bowel pain or obstruction: Larger colon polyps can obstruct part or all of your colon, which can be a painful and critical situation that needs immediate emergency care.
The three main types of colon polyps are:
- Adenomatous, which can grow quite large. Once they get larger than about ¼ inch in diameter, there is an increased risk that they may become malignant, and those over ½ inch are even at greater risk of being cancerous. Most malignant colon polyps are of this variety.
- Hyperplastic, most often found in the descending (left) colon, are rarely cancerous and typically remain small.
- Inflammatory, often the result of ulcerative colitis or Crohn’s disease. They are usually harmless, but be aware that having ulcerative colitis or Crohn’s disease does increase your risk of colon cancer.
Certain hereditary conditions can greatly increase your risk for colon polyps, and colon cancer as well:
- Familial adenomatous polyposis (FAP) is relatively rare. FAP patients develop hundreds or thousands of colon polyps in their teen and young adult years, and their risk of colon cancer later in life is extremely high. If FAP runs in your family, genetic testing is advised to determine if you have the disorder. A variant of FAP called Gardner’s syndrome also causes a greater incidence of colon polyps, as well as benign tumors in other parts of the body such as the skin, bones, and abdomen.
- Hereditary nonpolyposis colorectal cancer (HNPCC): Unlike FAP, HNPCC patients develop fewer numbers of polyps, but they may quickly become malignant. Some HNPCC patients also tend to more easily develop tumors in other parts of the body, such as the ovaries, breast, and urinary tract.
This type of polyp is rare, with less than one per cent of the general population ever experiencing them. The three most common types are:
- Hyperplastic stomach polyps: Often associated with gastritis, inflammation of the stomach lining, more than 50% of all stomach polyps are of this type. Less than 3% become cancerous.
- Fundic gland stomach polyps: Mostly found in the upper part of the stomach (the “fundus”), they rarely cause problems. They are of concern if you have FAP, however, because in this case they can turn malignant.
- Adenomas: These arise from the glandular tissues of the stomach, and are also more common in folks who suffer from gastritis. About 10% of all stomach polyps are of this variety, but they present some of the greatest health concerns. Adenomas have a better chance of becoming malignant than other types, especially if they become large. They usually need to be surgically removed to avoid the risk of turning cancerous.
The rectum is the last section of the intestines, connecting the end of the large intestine with the anus, where waste exits the body. Rectal polyps are of similar concern as colon polyps because most colorectal cancers, up to 90%, form from initially benign polyps in the colon or rectum.
Like all polyps, the majority of rectal polyps are benign, especially in children and adults under 40. Typical signs that could indicate the presence of rectal polyps are bleeding from the anus, cramps and other abdominal discomfort. Large rectal polyps can cause total or partial blockage of the rectum, which is an emergency situation.
Also known as endometrial polyps, these form in the mucosal lining of the uterus (the “endometrium”). They are most commonly found in women between 40-50 years of age, both pre and post-menopausal. Typical symptoms include:
- Irregular menstrual periods, either at odd times or unusual amounts of bleeding.
- Bleeding between menstrual periods.
- Unusually heavy bleeding during menses.
- Post-menopausal vaginal bleeding.
Uterine polyps that advance into the cervix (opening of the uterus into the vagina) are called cervical polyps. Most uterine and cervical polyps are benign, but certain types of reproductive system cancers can appear as polyps, so it is important to determine if they are benign or not. Larger polyps can partially block the fallopian tubes, causing fertility difficulties in some women.
There are a lot of mucous membranes in the nasal passages, and sometimes polyps will form in this area. They are found most often in folks with chronic respiratory conditions such as hay fever (allergic rhinitis) or people who are exposed to abnormal amounts of pollutants such as dust or certain types of chemicals. Many people who have an allergic sensitivity to aspirin will also develop nasal polyps.
Nasal polyps are not malignant, but they can interfere with normal breathing and/or proper sense of smell, or contribute to chronic conditions such as sinusitis. Typical signs of nasal polyps include:
- Runny nose
- Chronic stuffy nose
- Decreased sense of smell
- Chronic sinus infections
How Can Polyps Be Treated or Prevented?
There are many types of polyps that need to be surgically removed, especially if they are pre-cancerous or the patient has a genetic disorder such as FAP that can greatly increase their chances of getting certain types of cancer. Generally, most polyps can be quite easily removed through minimally invasive procedures, as surgeries go. The greatest risk for intestinal polyps surgery is perforation of the colon, so be sure whomever you allow to do the procedure has a proven track record. This is also a risk you should be aware of when certain diagnostic tests used to check for polyps, such as a colonoscopy, are performed as well.
The majority of the most common and potentially dangerous polyps, such as intestinal polyps in the colon, stomach, and rectum, can be avoided by eliminating certain risks:
- Diet: What we eat and don’t eat is a huge factor for the incidence of intestinal polyps and related cancers as well. It is a proven fact that diets high in saturated fats (especially animal fats from meats and dairy foods), sugar, salt, and low in fiber increase your risk for intestinal polyps and cancers. A wholesome diet heavy on fruits and veggies, whole grains, and alternative forms of protein is the best defense against these types of conditions. Fruits and veggies also contain anti-oxidants that help prevent polyps and cancer. Load up on vegetables with deep-green, yellow, or orange colors, which are particularly high in antioxidants. Lycopene, found in tomatoes, peppers, and strawberries, among other red fruits and vegetables, is also an excellent preventative measure.
- Calcium: Speaking of diet, high amounts of calcium are excellent at preventing polyps and some forms of cancer as well. Dietary sources are best, including broccoli, kale, and salmon (especially the bones!).
- Watch your weight: Obesity increases risk for uterine, cervical, and intestinal polyps and cancers. A combination of eating well and getting plenty of regular exercise will help you to control your weight and reduce risks for many conditions, including polyps.
In a sense, most polyps are a warning sign given to us by our creator to let us know we are heading in the wrong direction health wise. With many types of polyps, it can take up to five years before they will turn from benign to malignant. In most cases, the same factors that cause polyps, like poor dietary and lifestyle choices, may eventually result in cancer. Consider polyps as a red flag signaling us to turn around and reform our foolish unhealthy patterns while there is still time.