[vc_row row_type=”0″ row_id=”” blox_height=”” video_fullscreen=”true” blox_image=”” blox_bg_attachment=”false” blox_cover=”true” blox_repeat=”no-repeat” align_center=”” page_title=”” blox_padding_top=”” blox_padding_bottom=”” blox_dark=”false” blox_class=”” blox_bgcolor=”” parallax_speed=”6″ process_count=”3″ video_url=”” video_type=”video/youtube” video_pattern=”true” row_pattern=”” row_color=”” maxslider_image1=”” maxslider_image2=”” maxslider_image3=”” maxslider_image4=”” maxslider_image5=”” maxslider_parallax=”true” maxslider_pattern=”true”][vc_column width=”1/1″][vc_column_text]WHAT ARE
Intestinal polyps are soft rilevatezze that form on the mucosa of the intestine, especially in the colon and rectum. Although the name has very little inviting, in most cases these are benign tumors of origin. But be careful, because with the passage of time, some types of polyps can develop into a malignant form; for this reason the most effective work of the colon cancer prevention is early screening directed to the identification and eventual removal of intestinal polyps.
Since over 40% of those over 60 years old presents precancerous lesions (adenomatous polyps) is highly recommended to undergo a colonoscopy around 50-55 years of age. The diagnostic examination of the second choice is based on an x-ray of the colon, performed by injecting the blowing air and barium (barium enema with double contrast). Alternatively, the search for occult blood in the stool, even if such examination does not offer the same guarantees of diagnostic colonoscopy can be performed. Recently a new and innovative survey called virtual colonoscopy diagnostic was introduced, but its use is still limited.
If you registrassero cases of colon cancer or familial polyposis among first-degree relatives, screening should occur at an earlier age of two, three or even four decades.
Since the average age of onset of adenomas than ten years before that of the colorectal cancers, in case of failure it will be sufficient to repeat the examination every 3-5 years. If the contrary is observed and adenomatous polyps are removed, your doctor will advise you to repeat the exam in short time (within 6-12 months).
CLASSIFICATION
– Pedunculated polyps: protruding from the intestinal wall like a mushroom and can be removed easily.
– Polyps sessile: without stem dishes, so completely coated on the wall of the bowel; surgical removal is more difficult.
– Octopus single (single), multiple polyps (1-100), polyposis (& gt; 100). Polyposis can be sporadic or familial origin (related to a transmissible genetic defect); in the latter case the risk of degeneration in a colorectal cancer is rather high.
– Hyperplastic polyps and inflammatory: they are both for benign (not present increased risks of tumor development). Inflammatory polyps are often associated with ulcerative colitis, Crohn’s disease, diverticulosis, and infectious colitis.
– Hamartomatous polyps: they are often non-neoplastic lesions of the family home.
– Cancer or adenomatous polyps: Based on the macroscopic and histological features may be in a more or less advanced stage. They are divided into tubular polyps, villous polyps (at greatest risk of cancerous) and tubulo-villous polyps mixed.
Dimensions: varying from a few millimeters to 3:00 to 4:00 centimeters. The kindness of a polyp is inversely proportional to its size, but that does not mean that even small polyps can be potentially malignant. Statistically speaking, only by way of the incidence of mutation in cancer it is 1% for polyps with less than 1 cm diameter, 10% for those between 2 and 3 cm, and 30% for those with a diameter greater than 2 cm.
SYMPTOMS
Intestinal polyps are usually asymptomatic, and this characteristic subject to more danger. Often they are discovered by chance during an endoscopic examination or radiology; however sometimes may occur with mucus evacuation, mucous diarrhea or be indicated by rectal bleeding, possibly associated with anemic. These symptoms are so common, the bigger the size of the polyp and its subsequent malignant potential. Polyps of large size may also cause intestinal obstructions, resulting in the appearance of abdominal colic. Finally, if located in the rectum, they can be accompanied by tenesmus (feeling of urgent need to defecate).
RISK FACTORS
In the various articles dedicated to the promotion of a balanced diet, we have often had occasion to stress the importance of dietary fiber. The foods that contain (integral cereals and vegetables) have a protective role against several types of cancer, including that to the colon. This benefit is linked to several factors:
-the insoluble fiber (found in grains) retain water and increases stool bulk, diluting potential carcinogens and speeding their expulsion in the faeces;
-the soluble fiber (found in vegetables) form a gelatinous mass that “traps” acids and other secondary bile toxins present in the intestinal lumen;
-the fermentation of food made by the bacterial flora produces short chain fatty acids fiber which, in addition to reducing the proliferation of pathogens and to have properties antiputrefattive, are a great nourishment for the cells of the mucosa of the colon. All this results in a better absorption of nutrients at the expense of those toxic.
-in addition to fiber, plant foods provide the body a precious cargo of antioxidants and other substances that can contribute to the maintenance of human health (isoflavones, lycopene, anthocyanins, folic acid, isocyanates, etc.).
A high consumption of red meat and saturated fat instead encourages the development of intestinal polyps and their evolution in colorectal cancer; Analogously to obesity, physical inactivity, cigarette smoking and alcohol abuse.
As regards the non-modifiable factors, it is seen that the risk of polyps increases from two to four times to suffer if it is only one family and from 4 to 6 if the polyps are common to two first-degree relatives.
THERAPY
In many cases the colonoscopy allows not only an accurate diagnosis, even the immediate removal of the polyp (see informative article on polypectomy); The following histological investigation will assess the degree of tumor evolution, according to which the doctor will decide if the endoscopic removal was sufficient or if more radical action is required (removal of the intestine tract hit by polyps). In the case of familial adenomatous polyposis it is generally done with the total removal of the colon (total colectomy).
POLYPECTOMY
Polypectomy is a medical procedure that once the removal of polyps can develop into any of the digestive tract, including the colon, the most common site on which we will focus in the article. Today, in most cases the polypectomy occurs via endoscopy, often already during an exploratory colonoscopy. The alternative to this technique is surgery to open the abdomen.
WHY UNDERGO POLYPECTOMY
Intestinal polyps are of soft protuberances that are formed on the mucosa of the intestine, especially in the colon and rectum. Particularly following 50 years, some of these polyps, called adenomas, can go against a slow (typically 5-10 years) but inexorable malignancy, or otherwise cause various problems such as bleeding or bowel obstruction.
It is now established that the majority of malignant tumors derived from the intestine polyps. The odds that a polyp to turn into a malignant tumor can be quantified based on the characteristics of the same octopus, observed during the colonoscopy; if these features will require the removal, your doctor may decide to perform it immediately, without the need to repeat the endoscopy.
The choice to immediately make or minus polypectomy operations is influenced by the characteristics of the polyp and those of the patient, which together allow the quantification of the risk of bleeding. If this concrete appears, the patient will be asked to undergo polypectomy in a later session.
EXAM TIME
The polypectomy procedure usually takes place in the Day Hospital scheme, after carrying out of a limited number of laboratory tests and the implementation of a series of rules that analyze in detail in the next chapter.
Polypectomy
During the examination the patient is normally lying on his left side, more or less deeply sedated by oral or intravenous administration of drugs that help to make the examination less painful and more bearable. Based on the assessment of the individual case report, the Medical staff can determine the level of sedation needed or even propose the execution of the procedure under general anesthesia.
Just like during a normal colonoscopy exploration, the instrument (colonoscope) is introduced through the anus and traced back, if possible, up to the ileocecal valve and / or until the last ileal loops.[/vc_column_text][/vc_column][/vc_row]