Although cancer is known as a fatal disease, it is possible to get rid of cancer, even to get rid of it with early diagnosis, or not to get it at all. This can only be achieved by taking protective measures. One of these protective measures is screening methods. Especially in breast, colon, prostate and cervix (cervix) cancers, early diagnosis can be achieved through screening methods and recovery can be achieved by detecting pre-cancerous lesions.
A similar situation exists for colon and rectum cancers. The majority of colon and rectum (colorectal) cancers (85-90%) develop from polyps formed in the intestines. Intestinal polyps are very common, especially in people with high socio-economic status, who eat Western-style food and fiber-poor food, and who have constipation problems. In Western countries, 25-40% of people aged around 50 who have no complaints have polyps in their intestines. This rate is much higher in those who have a family history of cancer or risk factors such as colitis. These polyps can differentiate over time, first into intracellular formations, which we call in situ, and over time, they can turn into more aggressive formations, which we call invasive. In this transformation, the diameter and shape of the polyp are as important as the time factor. Additionally, as age increases, adenoma frequency, number, dysplasia and size also increase.
Adenomatous polyps do not cause symptoms until they reach a size of 1 cm or larger. Patients usually apply to the physician with complaints of weakness, fatigue or obvious bleeding related to anemia. Villous adenomas can cause diarrhea and associated fluid deficiency. They can rarely cause acute lower digestive system bleeding, constipation, abdominal bloating, and intestinal obstruction.
We divide polyps (adenomas) into three types (tubular, tubulovillous and villous) in appearance. The risk of cancer of villous adenomas is 4 times higher than tubular ones. The size of the polyp is also important in terms of transformation into cancer. For polyps smaller than 1 cm, the risk of cancer formation is 3% in the first 5 years after diagnosis, 8% in 10 years, and 24% in 20 years, while for polyps larger than 3 cm, the risk of cancer formation in 5 years is 30%. The risk of cancer varies depending on the degree of dysplasia, which shows pathological change in the biopsy taken from the polyp. Risk of cancer in polyps showing severe dysplasia The higher the risk of cancer, the shorter the time it takes to become cancerous. The transition from adenoma to cancer takes an average of 7 years, in those with severe dysplasia this decreases to 4 years, and in those with mild dysplasia it increases to 10 years.
When a polyp is detected in colonoscopy, the polyp is removed and sent for pathological examination either in the same session or in a separate session, depending on the condition of the polyp. Sometimes only a biopsy is taken and further treatment is planned according to the results of the pathological examination. Rarely, polyps may be attached to the intestinal wall with a base that is too wide to be removed colonoscopically. In this case, the polyp may be removed by laparoscopic (closed) bowel surgery. After pathological examination, if the polyp has poor differentiation, lymph or vascular involvement, has penetrated 2 mm within the polypectomy border, has gone into the deeper layers of the intestine, that part of the intestine is removed surgically, even though the polyp is removed.
After benign polyps are completely removed, first Colonoscopic control should be performed in the 2nd year and every 5 years if there is no problem here. It is known that polyps recur at a rate of 5-15% in 5 years. Figures such as 30-35% have also been reported. These high rates may be due to adenomas missed during colonoscopy.
Apart from adenomas, hyperplastic or juvenile polyps may also be seen during colonoscopy. Hyperplastic polyps are the most common polyps that do not have the potential to develop into a tumor. They are generally smaller than 5 mm. They are seen in 5% of cases in colonoscopic examinations. It constitutes more than 50% of all tiny polyps. However, adenomatous transformation occurs in 3% of hyperplastic polyps.
Juvenile polyps constitute 95% of polyps seen in children. They are stalked, flat, cherry red polyps. Sometimes it may shrink and be thrown away on its own. Generally, it is single and stalked. Its size can vary from a few millimeters to 1-2 cm. When isolated, they have no malignant potential. When they are large, they need to be monitored as there is a potential for cancer development.
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