About multiple polyposis of the colon

What is multiple polyposis of the colon?

Familial adenomatous polyposis (FAP) is a rare inherited cancer predisposition syndrome characterized by hundreds to thousands of precancerous colorectal polyps (adenomatous polyps). If left untreated, affected individuals inevitably develop cancer of the colon and/or rectum. FAP is inherited in an autosomal dominant manner and caused by abnormalities (mutations) in the APC gene. Mutations in the APC gene cause a group of polyposis conditions that have overlapping features: familial adenomatous polyposis, Gardner syndrome, Turcot syndrome and attenuated FAP.

What are the symptoms for multiple polyposis of the colon?

However, some people with colon polyps may experience:

  • Rectal bleeding. This can be a sign of colon polyps or cancer or other conditions, such as hemorrhoids or minor tears of the anus.
  • Change in stool color. Blood can show up as red streaks in your stool or make stool appear black. A change in color may also be caused by certain foods, medications or dietary supplements.
  • Change in bowel habits. Constipation or Diarrhea that lasts longer than a week may indicate the presence of a larger colon polyp or cancer. However, a number of other conditions also can cause changes in bowel habits.
  • Pain. A large colon polyp can partially obstruct your bowel, leading to crampy abdominal pain.
  • Iron deficiency anemia. Bleeding from polyps can occur slowly over time, without visible blood in your stool. Chronic bleeding robs your body of the iron needed to produce the substance that allows red blood cells to carry oxygen to your body (hemoglobin). The result is iron deficiency anemia, which can make you feel tired and short of breath.

What are the causes for multiple polyposis of the colon?

Healthy cells grow and divide in an orderly way. Mutations in certain genes can cause cells to continue dividing even when new cells aren't needed. In the colon and rectum, this unregulated growth can cause polyps to form. Polyps can develop anywhere in your large intestine.

There are two main categories of polyps, nonneoplastic and neoplastic. Nonneoplastic polyps include hyperplastic polyps, inflammatory polyps and hamartomatous polyps. Nonneoplastic polyps typically do not become cancerous.

Neoplastic polyps include adenomas and serrated types. These polyps have the potential to become cancer if given enough time to grow. Most of these colon polyps are called adenomas. Serrated polyps may also become cancerous, depending on their size and location in the colon. In general, the larger a polyp, the greater the risk of cancer, especially with neoplastic polyps.

What are the treatments for multiple polyposis of the colon?

Your doctor is likely to remove all polyps discovered during a bowel examination. The options for removal include:

  • Removal with forceps or a wire loop (polypectomy). If a polyp is too large to remove with this method, a liquid may be injected under it to lift and isolate the polyp from surrounding tissue so that it can be removed.
  • Minimally invasive surgery. Polyps that are too large or that can't be removed safely during screening are usually removed surgically, which is often performed by inserting an instrument called a laparoscope into the abdomen to remove the diseased portion of the bowel.
  • Colon and rectum removal (total proctocolectomy). If you have a rare inherited syndrome, such as FAP, you may need surgery to remove your colon and rectum to protect you from developing a life-threatening cancer.

Some types of colon polyps are more likely to become cancerous than others. A doctor who specializes in analyzing tissue samples (pathologist) will examine your polyp tissue under a microscope to determine whether it is potentially cancerous.

Follow-up care

If you have had an adenomatous polyp or a serrated polyp, you are at increased risk of colon cancer. The level of risk depends on the size, number and characteristics of the adenomatous polyps that were removed.

You'll need follow-up screenings for polyps. Your doctor is likely to recommend a colonoscopy:

  • In 5 to 10 years if you had only one or two small adenomas
  • In 3 to 5 years if you had three or four adenomas
  • In three years if you had 5 to 10 adenomas, adenomas larger than 10 millimeters, or certain types of adenomas
  • Within six months if you had multiple adenomas, a very large adenoma or an adenoma that had to be removed in pieces

Preparing for your colonoscopy

It's very important to fully prepare (clean out) your colon before a colonoscopy. If stool remains in the colon and obstructs your doctor's view of the colon wall, you will likely need a follow-up colonoscopy sooner than usual to ensure that all polyps are discovered.

After a good colon preparation, bowel movements should appear as clear liquid, which may be slightly yellow or green-tinged, depending on the color of any liquids consumed during the preparation. If you experience trouble with your colon preparation, or feel that you have not been cleaned out by the preparation, you should discuss this with your doctor before beginning your colonoscopy, as some people require additional steps in preparation before attempting colonoscopy.

What are the risk factors for multiple polyposis of the colon?

Factors that may contribute to the formation of colon polyps or cancer include:

  • Age. Most people with colon polyps are 50 or older.
  • Having inflammatory intestinal conditions, such as ulcerative colitis or Crohn's disease of the colon. Although the polyps themselves are not a significant threat, having ulcerative colitis or Crohn's disease of the colon increases your overall risk of colon cancer.
  • Family history. You're more likely to develop colon polyps or cancer if you have a parent, sibling or child with them. If many family members have them, your risk is even greater. In some people, this connection isn't hereditary.
  • Smoking and excess alcohol use. An analysis of eight studies showed an increased risk of developing colon polyps for people who consumed three or more alcoholic drinks per day. Alcohol intake combined with smoking also appears to increase the risk.
  • Obesity, lack of exercise and fat intake. Studies show that all of these factors can increase your risk of developing polyps. On the other hand, including more fiber in your diet and exercising regularly can reduce your risk.
  • Race. Black Americans have a higher risk of developing colon cancer.
Hereditary polyp disorders

Rarely, people inherit genetic mutations that cause colon polyps to form. If you have one of these genetic mutations, you are at a much higher risk of developing colon cancer. Screening and early detection can help prevent the development or spread of these cancers.

Hereditary disorders that cause colon polyps include:

  • Lynch syndrome, also called hereditary nonpolyposis colorectal cancer. People with Lynch syndrome tend to develop relatively few colon polyps, but those polyps can quickly become malignant. Lynch syndrome is the most common form of inherited colon cancer and is also associated with tumors in the breast, stomach, small intestine, urinary tract and ovaries.
  • Familial adenomatous polyposis (FAP), a rare disorder that causes hundreds or even thousands of polyps to develop in the lining of your colon beginning during your teenage years. If the polyps aren't treated, your risk of developing colon cancer is nearly 100%, usually before age 40. Genetic testing can help determine your risk of FAP.
  • Gardner's syndrome, a variant of FAP that causes polyps to develop throughout your colon and small intestine. You may also develop noncancerous tumors in other parts of your body, including your skin, bones and abdomen.
  • MUTYH-associated polyposis (MAP), a condition similar to FAP that is caused by mutations in the MYH gene. People with MAP often develop multiple adenomatous polyps and colon cancer at a young age. Genetic testing can help determine your risk of MAP.
  • Peutz-Jeghers syndrome, a condition that usually begins with freckles developing all over the body, including the lips, gums and feet. Then noncancerous polyps develop throughout the intestines. These polyps may become cancerous, so people with this condition do have an increased risk of colon cancer.
  • Serrated polyposis syndrome, a condition that leads to multiple serrated adenomatous polyps in the upper part (right side) of the colon. These polyps have the potential to become cancerous and require surveillance and removal.

Is there a cure/medications for multiple polyposis of the colon?

There is no effective or safe pharmacological treatment for the multiple polyposis of the colon.

1. Nonsteroidal anti-inflammatory medicines (NSAIDs) may be used to treat inflammation, but more research is needed to understand how they work to reduce colonic polyps and why they don't seem to stop the growth of cancer.
2. The endoscope can be used to remove the majority of polyps. Then a microscope is used to look at them.
3. The presence of cancer, the type of polyp they are, and whether or not they have traits that make them more likely to be associated with cancer, either in another polyp at the same time or in polyps that may grow in the future, are all important questions to answer (for example, are villous or serrated).

Abdominal bleeding: This might be a symptom of colon cancer, polyps, hemorrhoids, or mild anus rips, among other things,Color shift in the stool: Your feces may have red streaks or appear black if you have blood in it,A change in hue can also be brought on by specific meals, drugs, or nutritional supplements,Alteration in bowel habits: Long-lasting diarrhea or constipation may be an indication of a bigger colon polyp or cancer,Changes in bowel habits, however, can also be brought on by a number of other diseases,Pain: Your bowels may be partially obstructed by a large colon polyp, which can cause sharp stomach pain
Mutations in the MYH gene lead to MUTYH-associated polyposis (MAP), a disease related to FAP,Colon cancer and numerous adenomatous polyps are common early illnesses for people with MAP,Your risk of MAP can be determined by genetic testing

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