Hyperplastic Polyp - An Overview

Introduction

Colon polyps are benign. Some polyps can develop into cancer, which can be in later stages. Anyone has the chance of developing colon polyps. Colon polyps are mostly symptomless. It is necessary to have routine screening tests and colonoscopy, as polyps can be removed safely at this stage. The best prevention option is regular screening and removal of polyps.

What Are the Symptoms of a Hyperplastic Polyp?

People with colon polyps experience the following symptoms:

• Rectal bleeding.

• Change in stool color.

• Pain or crampy abdominal pain.

• Iron deficiency anemia: Chronic bleeding decreases the iron required for red blood cells to carry oxygen to the body, causing iron deficiency anemia.

• Abdominal pain

• Bloody stool.

• A change in the bowel habits for more than a week.

Regular screening for polyps should be done in people:

• 50 years or older.

• Family history of colon cancer.

What Are the Causes of a Hyperplastic Polyp?

Cells grow and divide in a particular manner. Mutations in some genes cause cell division even when not needed. This unregulated growth in the colon and rectum causes the formation of polyps.

There are two categories of polyps.

• Nonneoplastic Polyps - Hyperplastic polyps, inflammatory polyps, and hamartomatous polyps. Nonneoplastic polyps do not turn cancerous.

• Neoplastic Polyps - Adenomas and serrated types. These polyps can turn cancerous.

Most colon polyps are adenomas.

What Are the Risk Factors for the Development of Hyperplastic Polyps?

Factors leading to the formation of colon polyps are as follows.

• Age: 50 years or older individuals are at higher risk.

• Inflammatory Intestinal Conditions: Ulcerative colitis or Crohn's disease.

• Family History: A parent, sibling, or child with a polyp history.

• Smoking and Alcohol Use: An increased risk of colon polyps for people with three or more alcoholic drinks per day and smoking.

• Obesity, Lack of Exercise, and Fat Consumption: Including more fiber in the diet and exercising regularly reduce the risk.

• Race: Black Americans have a higher risk of colon cancer.

• Genetic Mutations: These can cause colon polyp formation.

Hereditary disorders causing colon polyps include the following:

• Lynch syndrome, hereditary nonpolyposis colorectal cancer, tends to develop a few colon polyps, but polyps can turn malignant. Lynch syndrome is a commonly inherited colon cancer and is associated with tumors.

• Familial adenomatous polyposis (FAP) is a rare disorder causing multiple polyps in the colon's lining. If these polyps are not treated, the risk of colon cancer increases. Genetic testing determines the risk of FAP.

• Gardner's syndrome is a type of FAP leading to polyps throughout the colon and small intestine. It can also lead to noncancerous skin, bones, and abdomen tumors.

• MUTYH-associated polyposis is like FAP, caused by mutations in the MYH gene. People with MAP develop multiple adenomatous polyps and colon cancer. Genetic testing can determine the risk of MAP.

• Peutz-Jeghers syndrome is a condition that presents with freckles all over the body, lips, gums, and feet, followed by noncancerous polyps in the intestines. These polyps can turn cancerous, increasing the risk of colon cancer.

• Serrated polyposis syndrome causes multiple serrated adenomatous polyps in the colon. These polyps can become cancerous.

What Are the Complications of Hyperplastic Polyps?

Colon polyps can turn cancerous. Therefore, the earlier polyps are removed, the lesser the chance of polyps turning cancerous.

How to Prevent Hyperplastic Polyps?

• Regular screenings and specific lifestyle changes decrease the risk of polyp formation.

• Adopting healthy habits.

• Consumption of fruits, vegetables, and whole grains in the diet and reduction of fat intake.

• Limiting alcohol consumption and quitting tobacco use.

• Being physically active and maintaining of healthy body weight.

• Increase calcium and vitamin D intake. Increasing calcium consumption prevents colon adenoma recurrence.

• With a family history of colon polyps, genetic counseling is important. Consider regular colonoscopies in young adulthood in cases of a hereditary disorder that causes colon polyps.

How to Diagnose Hyperplastic Polyps?

Screening tests are important to detect polyps before they turn cancerous. These tests also detect colorectal cancer in its early stages with a good chance of recovery.

Screening methods are as follows:

• A colonoscopy is a sensitive test for colorectal polyps and cancer. If polyps are found, polyp removal should be done immediately, or consider biopsy for analysis.

• Virtual colonoscopy, a minimally invasive test, uses a CT scan to visualize the colon. A virtual colonoscopy needs bowel preparation, similar to a colonoscopy. Repeat the bowel preparation and go for a colonoscopy to examine and remove the polyp if a polyp is noticed during the CT scan.

• Flexible sigmoidoscopy is a procedure that uses a slender tube having a light and camera. This tube is inserted in the rectum in order to examine the last part of the colon, called the sigmoid, along with the rectum. The major part of the colon is not examined with flexible sigmoidoscopy, so some polyps and cancers are sometimes not detected.

• Stool-based tests work by evaluating the presence of blood in the stool or assessing the stool DNA for the presence of colon polyps or cancer. If the stool test is positive, a colonoscopy should be considered soon.

How to Treat Hyperplastic Polyps?

The doctor will remove all polyps seen during a bowel examination. The options for polyp removal include the following:

• Polypectomy is the removal of the polyp with forceps and a wire loop. If a polyp is large to remove with force, a liquid can be injected under the polyp to lift and isolate the polyp from the neighboring tissue, and it can be removed.

• Minimally invasive surgery for the polyps that are too large or cannot be removed in total during screening are removed surgically. This procedure is performed by inserting an instrument called a laparoscope in the abdomen to remove the diseased portion of the bowel.

• Total proctocolectomy is the colon and rectum removal. In the case of a rare inherited syndrome, FAP, surgery is required to remove the colon and rectum to prevent the development of life-threatening cancer.

• Some colon polyps have a higher chance of developing cancer than others. A pathologist will examine the polyp tissue under a microscope and determine if it is potentially cancerous or not.

• Follow-up care is required in cases of an adenomatous polyp or a serrated polyp, as they increase the risk of colon cancer.

• The intensity of risk depends on the size, number, and characteristics of the adenomatous polyps.

• Follow-up screenings for the polyps are needed. A colonoscopy might be recommended.

Conclusion

The histopathological diagnosis of hyperplastic polyps is difficult. Most polyps are generally hyperplastic, but serrated and classic adenomas can also be present. These adenomatous injuries can cause malignant transformation. There is no appropriate treatment; a colectomy procedure may help in cases of hyperplastic polyps, serrated adenomas, or multiple adenomatous lesions.