Q: This makes me a bit nervous to ask about my medical problem on line. My doctor and surgeon are shaking their heads about this. I am a 66-year-old female in good health. Three months ago I finally agreed to a colon check. There were 37 polyps, all benign. Thank goodness! The surgeon scheduled another colon check last week. Once again, the polyps were “as the surgeon said” – many. Again, the lab says that they are all benign. My doctor and my surgeon are shaking their heads regarding this. They can’t say what is causing this but they believe it is not good.
They are great medical people but perhaps you have an idea as to why I am now “joking” the queen of the polyp forest. Thank you for considering this medical issue.
A: Colon polyps are growths on the surface of the large intestine which is at the end of the digestive tract. This is where the colon absorbs water from stool and changes it into solid material that is expelled from the body through the rectum and anus. Polyps can be raised or flat and more than one can be present. Flat polyps are generally smaller, more difficult to see, and have a greater association with cancer than are raised polyps. Some individuals are more prone to have polyps (single or numerous). Those known to be at higher risk include being 50 or older, those with a family history of the condition, and having had either uterine or ovarian cancer prior to the age of 50. Other factors that may cause an individual to get colon polyps include being obese, smokers, alcohol users, having a sedentary lifestyle, and ingesting a fair amount of fatty foods.
Most people are completely unaware they even have colon polyps because they remain symptom-free. When symptoms are present, individuals may have constipation and diarrhea lasting more than a week, have blood in the stool that may appear black or with red streaks in it, or bleeding from the anus.
There are several procedures that check for polyps – either a barium enema, sigmoidoscopy, CT known as a virtual colonoscopy, or colonoscopy. Stool sampling is easily performed at home, in a physician’s office or lab to test for blood which may stem from a gastrointestinal cancer. A barium enema X-rays the large intestine and can detect polyps. Sigmoidoscopy views only the lower third of the large intestine. Virtual colonoscopy views the large intestine and displays images on a screen that can be analyzed. Colonoscopy, the most widely used procedure, views the entire large intestine with a long, flexible tube. The tube has a camera attached and also has the capability of removing polyps during the procedure; those polyps are ultimately tested for cancer.
Some polpys are benign while others are cancerous so their presence is often very disturbing. Some known as adenomas have the potential to become cancerous, while hyperplastic or inflammatory polyps rarely turn cancerous. Those individuals with adenomatous polyps are at greater risk for developing more adenomatous polyps within a three year period following the first procedure. In actuality, some of the polyps seen on later testing may have been present initially but may have been too small to be seen. Appropriate follow up is highly recommended more frequently than with the average colonoscopy which is commonly performed every five years. I remain concerned since I don’t know the size of the polyps and if they were all removed, because the risk of cancer increases with the number of polyps found.
Familial adenomatous polyposis (FAP) is an inherited disorder. People may begin to develop benign growths while in their teens. Some individuals have a variant of the disorder, in which the growth of polyps is delayed until a person is in his or her mid 50s. In those with classic familial adenomatous polyposis, the number of polyps found increases as the patient ages and can present by the hundreds to thousands. Non-cancerous growths referred to as desmoid tumors generally present in tissue covering the intestines and may be provoked by surgery to remove the colon. These tumors tend to recur following surgical removal. Then there is still a milder form of FAP referred to as autosomal recessive familial adenomatous polyposis that presents with fewer than 100 polyps. The incidence of this latter form varies from one every 7,000 to one in every 22,000 cases.
Because your physician does not know the cause for your polyps, I would recommend a second opinion from an academic medical center to determine if you have FAP or another disorder that is causing this unusual number of polyps. Good luck.
Readers who are interested in more information can order Dr. Gott’s Health Report “An Informed Approach To Surgery” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
