Rectal Polyps

Rectal Polyps

 

Definition

Rectal polyps are tissue growths that arise from the wall of the rectum and protrude into it. They may be either benign or malignant (cancerous).

Description

The rectum is the last segment of the large intestine, ending in the anus, the opening to the exterior of the body. Rectal polyps are quite common. They occur in 7-50% of all people, and in two thirds of people over age 60.
Rectal polyps can be either benign or malignant, large or small. There are several different types of polyps. The type is determined by taking a sample of the polyp and examining it microscopically. Most polyps are benign. They are of concern, however, because 90% of colon and rectal cancers arise from polyps that are initially benign. For this reason, rectal polyps are usually removed when they are discovered.

Causes and symptoms

The cause of most rectal polyps is unknown, however a diet high in animal fat and red meat, and low in fiber, is thought to encourage polyp formation. Some types of polyps are hereditary. In an inherited disease called familial polyposis, hundreds of small, malignant and pre-malignant polyps are produced before the age of 40. Also, inflammatory bowel disease may cause growth of polyps and pseudo-polyps. Juvenile polyps (polyps in children) are usually benign and often outgrow their blood supply and disappear at puberty.
Most rectal polyps produce no symptoms and are discovered on routine digital or endoscopic examination of the rectum. Rectal bleeding is the most common complaint when symptoms do occur. Abdominal cramps, pain, or obstruction of the intestine occur with some large polyps. Certain types of polyps cause mucous-filled or watery diarrhea.

Diagnosis

Rectal polyps are commonly found by sigmoidoscopy (visual inspection with an instrument consisting of a tube and a light) or colonoscopy. If polyps are found in the rectum, a complete examination of the large intestine is done, as multiple polyps are common. Polyps do not show up on regular x rays, but they do appear on barium enema x rays.

Treatment

Normally polyps are removed when they are found. Polypectomy is the name for the surgery that removes these growths. Polypectomy is performed at a hospital, outpatient surgical facility or in a doctor's office, depending on the number and type of polyps to be removed, and the age and health of the patient. The procedure can be done by a surgeon, gastroenterologist, or family practitioner.
Before the operation, a colonoscopy (examination of the intestine with an endoscope) is performed, and standard pre-operative blood and urine studies are done. The patient is also given medicated enemas to cleanse the bowel.
The patient is given a sedative and a narcotic pain killer. A colonoscope is inserted into the rectum. The polyps are located and removed with a wire snare, ultrasound, or laser beam. After they are removed, the polyps are examined to determine if they are malignant or benign. When polyps are malignant, it may be necessary to remove a portion of the rectum or colon to completely remove cancerous tissue.

Alternative treatment

In addition to a diet low in animal fat and high in fiber, nutritionists recommend anitoxidant supplements (including vitamins A, C, and E, selenium, and zinc) to reduce rectal polyps.

Prognosis

For most people, the removal of polyps is an uncomplicated procedure. Benign polyps that are left in place can give rise to rectal cancer. People who have had rectal polyps once are more likely to have them again and should have regular screening examinations.

Prevention

Eating a diet low in red meat and animal fat, and high in fiber, is thought to help prevent rectal polyps.

Resources

Organizations

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org.
National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 422-6237. http://www.nci.nih.gov.

Key terms

Colon — The part of the large intestine that extends from the cecum to the rectum. The sigmoid colon is the area of the intestine just above the rectum; linking the descending colon with the rectum. It is shaped like the letter S.
Rectum — The final part of the large intestine, ending in the anus.
Sigmoidoscopy — A procedure where a thin tube containing a camera and a light is inserted into the lower section of the large intestine so that the doctor can visually inspect the lower (sigmoid) colon and rectum. Colonoscopy examines the entire large intestine using the same techniques.
References in periodicals archive ?
During her stay in hospital the patient had a colonoscopy for rectal bleeding, revealing multiple colonic and rectal polyps.
Questionnaires completed every two years by the participants beginning in 1991 provided information on the use of multivitamin supplements and whether colon or rectal polyps had been diagnosed.
Recurrence of rectal polyps in his rectal stump necessitated revision of the lower rectal stump and fashioning of a pouch.
The patients all had their colons removed years earlier, so the study looked at rectal polyps.
LONDON--A small, randomized trial suggests that fish oil given in tablet form as eicosapentaenoic acid may have chemopreventive effects, reducing the number and size of precancerous rectal polyps in patients with familial adenomatous polyposis.
A 69-year-old Hispanic man was referred for colonoscopy because of rectal polyps that were seen on a screening sigmoidoscopy.
Patients who took 81 milligrams daily - the equivalent of one baby aspirin - reduced their risk of colon and rectal polyps by 19 percent.
Ronald Reagan had his rectal polyps, which--at least in diagram form--were solemnly displayed in the newspapers.
As it turned out, 564 of the 15,984 women and 331 of the 9,940 men had colon or rectal polyps.
One in every 20 Americans over age 40 will get CRC, with the higher risk groups including people over 50; blacks; those with a personal or family history of cancer, colon or rectal polyps, or chronic, inflammatory bowel disease (such as colitis and Crohn's disease); and those with high-fat, low-fiber diets.
These patients receive 600 mg of Aptosyn(TM), total daily dose, and investigators count and remove all rectal polyps at six-month intervals.
Specifically, today's issue of The New England Journal of Medicine features reports of two randomized clinical trials(1,2) in which aspirin was found to reduce the risk of colon and rectal polyps, the precursors to the vast majority of colorectal cancers.