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Colon polyps

From MayoClinic.com
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Your digestive tract stretches from your mouth to your anus. As food travels along this 30-foot passageway, nutrients are broken down into a form that can be absorbed by your body and used to build cells and produce energy.

The last part of your digestive tract is a long muscular tube called the large intestine. The upper of the large intestine make up the colon, and the lower make up the rectum. The colon's main function is to absorb water, salt and other minerals from digested food. Your rectum stores waste until it's eliminated from your body.

Polyps can develop anywhere in your large intestine. They can be large or small and may be flat (sessile) or mushroom shaped and attached to a stalk (pedunculated). In Greek, polyp means "many feet," a reference to mushroom-shaped polyps, which have been described as resembling toes. Small and mushroom-shaped polyps are much less likely to become malignant than are flat or large ones. In general, the larger a polyp, the greater the likelihood of cancer.

The three main types of colon polyps are:

  • Adenomatous. Once these polyps grow beyond the size of a pencil eraser — about 5 millimeters (mm) — there's a small but increasing chance they'll become cancerous. This is especially true when their diameter exceeds 10 mm. For that reason doctors normally take a tissue sample (biopsy) from larger polyps during flexible sigmoidoscopy and either biopsy or remove most polyps during colonoscopy. Adenomas are divided into three sub-types — villous, tubular and tubulovillous. Villous adenomas tend to be larger than the other types and are the most likely to become malignant.

  • Hyperplastic. These polyps occur most often in your left (descending) colon and rectum. Usually less than 5 mm in size, they're rarely malignant.

  • Inflammatory. These polyps may follow a bout of ulcerative colitis. Although the polyps themselves are not a significant threat, having ulcerative colitis increases your overall risk of colon cancer.

Cancer affects your cells, the basic units of life. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes this growth gets out of control — cells continue dividing even when new cells aren't needed. In the colon and rectum, this exaggerated growth may cause polyps to form in the lining of your intestine. Over a long period of time, some of these polyps may become malignant.

Risk factors

Although no one knows exactly what triggers abnormal cell growth, researchers have identified a number of factors that may contribute to the formation of colorectal polyps. They include:

  • Age. About 90 percent of people with colorectal cancer are 50 or older. Your risk generally starts increasing around age 40, and the average age at which colorectal cancer is diagnosed is 62. Even so, if you're older than 50 and have no other risk factors, you're considered to be at average risk.

  • Inflammatory intestinal conditions. Long-standing inflammatory diseases of the colon such as ulcerative colitis and Crohn's disease can increase your risk.

  • Family history. You're more likely to develop colorectal cancer if you have a parent, sibling or child with the disease. If many family members have colon or rectal cancer, your risk is even greater. In some cases this connection isn't hereditary or genetic. Instead, cancers within the same family may result from shared exposure to an environmental carcinogen or from similar diet or lifestyle factors. About 10 percent to 30 percent of colorectal cancers are familial.

  • Inherited gene mutations. Approximately 5 percent of colorectal cancers result from identified inherited gene mutations. Inherited colorectal cancers are autosomal dominant, meaning you only need to inherit one defective gene from either of your parents. If one parent has the mutated gene, you have a 50 percent chance of inheriting the mutation. Although inheriting a defective gene greatly increases your risk, not everyone with a mutated gene develops cancer.

  • One genetic defect that plays a key role in colorectal cancer occurs in the adenomatous polyposis coli (APC) gene. When the APC gene is normal, it helps control cell growth. But if it's defective, cell growth accelerates, leading to the formation of multiple adenomatous polyps in your intestinal lining.

  • Familial adenomatous polyposis (FAP) is a rare, hereditary disorder that results from an APC gene defect. FAP causes you to develop hundreds, even thousands, of polyps in the lining of your colon and often in your upper intestine, beginning in your teenage years. If these go untreated, your risk of developing colon cancer by age 45 is nearly 100 percent. The encouraging news about FAP is that in some cases, genetic testing can help determine whether you're at risk of the disease.

  • Gardner's syndrome, a variant of FAP, is a condition that causes polyps to develop throughout your colon and upper intestine. You may also develop noncancerous tumors in other parts of your body, including your skin (sebaceous cysts and lipomas), bone (osteomas) and abdomen (desmoids).

  • Hereditary non-polyposis colon cancer is the most common form of inherited colon cancer. It, too, results from a defect in the APC gene, but unlike people with FAP or Gardner's syndrome, people with hereditary non-polyposis colon cancer tend to develop relatively few colon polyps. They do, however, often have tumors in other organs. Hereditary non-polyposis colon cancer includes Lynch I and Lynch II syndromes. People with Lynch I syndrome usually develop a small number of polyps that quickly become malignant. Those with Lynch II syndrome also tend to develop tumors in the breast, stomach, small intestine, urinary tract and ovaries.

  • Some Jewish people of Eastern European descent have an inherited tendency to develop colorectal cancer, but the risk is much smaller than that caused by FAP, Gardner's syndrome or hereditary non-polyposis colon cancer.

  • Diet. For years, the relationship between a reduced risk of colon cancer and a high-fiber diet — one plentiful in fruits, vegetables and whole grains — was a matter of debate. Although some major studies showed that a fiber-rich diet cut the risk of colon cancer, other studies didn't demonstrate as clear a link.

  • Fiber seems protective against colorectal cancer because it provides bulk that moves your stool more quickly through your bowel. This means that cancer-causing substances (carcinogens) in the foods you eat aren't in contact with your bowel wall as long as they might be if you ate a low-fiber diet. Fruits and vegetables are also rich in antioxidants — substances that protect cells from damage caused by unstable molecules (free radicals) that may lead to cancer.

  • On the other hand, a diet high in fats, especially the saturated fats found in red meat, butter, dairy foods, and coconut and palm oils, appears to increase your risk of colon cancer as well as your risk of heart disease. To decrease your risk, limit the total amount of fat you eat to no more than 35 percent of your calories every day.

  • Smoking and alcohol. Smoking increases your risk of colon cancer, and drinking alcohol in excess also appears to increase your risk. The combination of smoking and excessive drinking makes it even more likely you'll develop colon cancer.

  • A sedentary lifestyle. If you're inactive, you're more likely to develop colon cancer, although not rectal cancer. This may be because when you're inactive, waste stays in your colon longer. Getting regular physical activity may actually cut your risk of colon cancer in half, according to researchers at the Harvard School of Public Health.

  • Obesity. Being significantly overweight — has been linked to an increased risk of several types of cancer, including colorectal cancer. Extra fat appears to encourage the growth of cells in the colon and rectum and this is even more likely if the excess weight occurs in your waist rather than in your hips or thighs. Weighing more than is healthy increases the risk in men of all ages and doubles the risk in premenopausal women.

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