Hyperplastic and adenomatous polyps of the large intestine: symptoms, treatment, removal, diet

The widespread opinion in medical circles about the ability of polyps not to be malignant for a long time has been refuted by scientific research of recent years.

They eloquently testify that in the overwhelming majority of cases the polyps of the large intestine are malignant, turning into malignant tumors, within 8-10 years.

Concept of the disease

At the initial stage of its development, polyps of the large intestine are benign neoplasms formed from cells of glandular epithelium lining the inner surface of the walls of this organ.

Polyps of the large intestine can be branched, spherical and mushroom-shaped, of different size, single and multiple character, thin stem or broad base. The only unifying factor is the probability of malignancy, which allows them to be considered a precancerous condition.

80% of cases of child polyposis( boys are more likely than girls) are noted in children 3-6 years old, with 96% of all neoplasms being localized in the distal part of the large intestine.

The risk of polyps in adult patients increases as they move from one age category to another. In any case, their presence is noted in half of patients who have crossed the line of sixty years of age.

Types of Polyposis Formations

Benign neoplasms of the large intestine, classified as one of four forms, can be:

  1. Adenomatous. These polyps are more often subjected to malignancy processes. Since the histological structure of their tissues differs significantly from the structure of glandular epithelial cells, which were originally the basis of these tumors, adenomatous polyps belong to the category of precancerous conditions. Characterized by a large variety of cell structure, adenomatous tumors are divided into several types, represented by:
  • . Tubular polyps - dense and smooth neoplasms, at the initial stages of their development having a pinkish color. Over time, neoplasms of this type become red, large and lobed.
  • Inaxic polyps, the surface of which is provided with a huge number of branch-like outgrowths similar to villi. Filled with a multitude of blood vessels that give them a red color, villous tumors, which constitute 15% of the total number of intestinal tumors, are extremely easily traumatized and bleed. Considering their large size and susceptibility to damage and ulceration, experts consider villous tumors as a precancerous condition.
  • Tubular-villous neoplasms consisting of elements characteristic of tubular and villous polyps with a rough surface. Tubular-villous polyps can acquire quite large sizes and eventually become serious complications. Having a color of the mucous lining of the intestine, they are characterized by a more dense consistency and a tendency to bleeding and ulceration. No more than 5% of new growths of this type are affected by malignancy.

2. Hyperplastic. Neoplasms of this form, having small dimensions, only slightly rise above the surface of the mucosa and represent soft growths of natural coloration. Hyperplastic polyps, with a tendency to cystic enlargement and never reaching a large size, most often affect people of older age. The cases of their malignancy are extremely rare.

3. Gamartromnymi. The basis for the formation of polyps, having a white and pink color, are normal tissues of glandular epithelium, one of the elements of which, for unidentified reasons, began to develop disproportionately.

4. Inflammatory. An impetus to the development of new growths of this type in the intestine of the patient is any intestinal disease transferred to them in an acute form.

There is a classification of polyps based on the multiplicity factor. According to her polyps of the large intestine are:

  • single;
  • multiple;
  • diffuse. There is a whole group of diseases in which hundreds( and even thousands) of rapidly growing neoplasms are revealed in the patient's body. This group includes a family diffuse polyposis and a whole series of syndromes( Gardner, Lynch, Cowden, Türko, Peitz-Egers).All these ailments are hereditary in nature and are transmitted only by inheritance.

Causes of the emergence of

Given the impossibility of establishing the true reasons for the appearance of colon polyps, specialists suggest that this is due to fault:

  • Chronic intestinal diseases of inflammatory etiology: colitis, Crohn's disease, ulcerative colitis, dyskinesia of the colon, leading to rapid aging of epithelialtissues lining the walls of the colon.
  • Bad habits: addiction to overeating, smoking and drinking alcohol.
  • The heredity factor. It is established that in the presence of cases of polyposis in a family history, the risk of developing the disease in close relatives is great, not excluding small children.
  • Insufficient physical activity. This disease affects people who are sedentary or engaged in sedentary work.
  • Perennial chronic constipation, the elimination of which requires taking medications that irritate the intestinal mucosa.
  • Connections of the age factor. Patients belonging to the age group over 50 years of age, the risk of polyps is significantly increased.
  • Unhealthy eating with high-caloric refined foods, poor plant fiber and abundant animal fats, as well as excessive consumption of meat. Overweight or obesity.

Symptoms of colonic polyps

Since the polyposis does not manifest itself at the initial stages of the onset, it can be detected quite accidentally only during endoscopic examinations performed for other ailments.

Clinical symptomatology, which brings a lot of suffering to a sick person, appears either with multiple proliferation of benign neoplasms, or when they reach significant dimensions.

Polyps of the large intestine provoke:

  • The appearance of painful sensations during the act of defecation.
  • Pain in the abdominal cavity, arising in the lateral parts and in the anal canal area. Possessing a bursting, cramping and aching character, they tend to intensify before emptying the intestine and subside after the act of defecation.
  • Irregular character of the stool, manifested in the alternation of diarrhea and constipation.
  • Abundant mucus secretion from the anus.
  • Regular rectal bleeding.
  • Symptomatic of severe anemia and exhaustion.

From all this list the most characteristic and indicative manifestation of polyposis are insignificant discharges of blood from the rectum.

Active proliferation of polyps in the large intestine leads to an abundant release of mucus from the anus, leading to constant wetting of the skin, their irritation and the occurrence of severe itching.

Diagnosis

The presence of anxiety symptoms is the basis for referring to specialists: coloproctology and gastroenterologist.

  • The first step to detecting polyposis is to collect an anamnesis and question the patient. In the course of the survey, the specialist will necessarily collect information on the presence of complaints, eating habits, the lifestyle of the sick person and the illnesses he had previously suffered. Extremely important information is about the diseases of the colon, suffered by close relatives of the patient.
  • Given that the place of localization of most of the large intestine neoplasms is the sigmoid and rectum, the coloproctologist will definitely use the finger research method .With the help of this technique, it is possible to probe the portion of the rectum removed from the anal anus by ten centimeters and verify the presence or absence of neoplasms. In the case of detection of polyps, a specialist can determine their number, parameters, consistency, method of attachment to the intestinal wall( location on a wide base or on a thin stem), displacement and presence of ulceration.
  • If the patient suspects a polyposis of the intestine, the patient must pass a general blood test. Indirect confirmation of the presence of hidden bleeding - the inevitable companions of damaged polyps - will be a decreased level of hemoglobin. Another mandatory analysis, confirming these suspicions, is the analysis of feces for latent blood.

The next step in the diagnosis is instrumental examination.

  • An informative diagnostic method is an irrigoscopy - an X-ray examination performed by introducing a radiocontrast substance - a barium suspension - into the cavity of the large intestine followed by a series of X-ray photographs. To improve the quality of radiographs and obtain more reliable results, irrigoscopy can be performed by the method of double contrasting, consisting in simultaneous administration of barium sulfate and air injection into the lumen of the large intestine. Thanks to the air, which helps spread the folds of the mucous membranes of the intestine, it is possible to examine the condition of its walls more carefully.
  • The most comprehensive information about the state of the colon throughout its length allows you to get a very complicated and extremely painful procedure for colonoscopy, which requires mandatory anesthesia. Visual examination of the intestine is carried out using a flexible probe - a colonoscope that has a light fixture and a miniature video camera( the picture obtained during the examination is displayed on the monitor), as well as an air injection tube and biopsy forceps. With their help, a specialist can pinch a small piece from the detected tumor for later laboratory testing. Colonoscopy can be performed not only for the purpose of diagnostic examination. During this procedure, the doctor can remove small polyps, expand the areas of the intestines that have narrowed as a result of scarring processes and take a picture of its internal space.
  • The procedure of sigmoidoscopy, which is almost the same as the endoscopic examination, allows visual examination of the large intestine to a depth not exceeding thirty centimeters. For its implementation, use a special device - a sigmoidoscope, which has a fiber optic system, illumination and forceps for taking a biopsy sample.
  • Magnetic resonance or computed tomography procedures are the most modern, extremely informative and completely painless methods for diagnosing large intestine polyposis. They make it possible to obtain very clear and detailed images of the organ under investigation, made in a three-dimensional format. This is the best way to visualize the ailment, allowing you to make an accurate diagnosis.

Methods for treatment of large intestine polyps

Because the methods of conservative drug therapy can not cope with polyposis of the colon, the only effective way to solve this problem is surgical treatment.

Methods of surgical intervention, carried out by modern specialists, are extremely diverse.

When considering the tactics of surgical treatment, a specialist will necessarily take into account the totality of the data obtained as a result of a diagnostic examination of the patient: the type of neoplasms detected, their number, parameters, condition and method of attachment to the intestinal wall.

  • The removal of both single and multiple polyps of the large intestine can be performed by the method of operative colonoscopy using an operating colonoscope equipped with a loop electrode. Having grasped the leg of the polyp and tightly( to stop the blood flow) by tightening it with a loop, the lesion is exposed to a high frequency current for several seconds. As a result, the head of the polyp is cut off, and its foot is charred. The removed polyp is immediately removed by grasping forceps or suction to the endoscope, after which the burned wound is burned. Polyps on a thick leg are cut off gradually, changing the modes of shearing and coagulation. Electrocoagulation of large neoplasms having a wide base is carried out in parts, performing several operations with two-three-week pauses between them( for healing of wound surfaces).Samples of the removed polyps are necessarily subjected to laboratory research to be convinced of absence of their malignancy. The method of endoscopic removal of polyps is a category of sparing procedures that are well tolerated by patients and do not require a rehabilitation period. The operated patient can start working the next day after the operation.
  • Removal of small lesions produced by alternative methods of radio wave surgery and laser coagulation. In the course of performing these operations, the effect on neoplasms is carried out by high-power radio waves or by a narrow-beam laser beam. Due to the high accuracy of exposure, healthy tissues surrounding the polyp are not injured, and the cuts are performed at the cellular level. To prevent bleeding, simultaneously with the removal of polyps, coagulation( burning) of blood vessels is performed.
  • For the treatment of diffuse polyposis, a serious cavity operation( colotomy) of is required, performed under general anesthesia. The affected area of ​​the intestine is subjected to resection( removal), followed by the connection of the released end of the large intestine with the anus.

After the removal of villous tumors of any size, multiple and large polyps, the patient must undergo a follow-up endoscopy examination within one year and under constant medical supervision for two years. In the future, the procedure for colonoscopy should be at least once every three years.

After removal of malignant polyps, follow-up examinations should be carried out monthly for a whole year. During the following year, they are performed four times a year.

Diet after removal of noobrazovany

Dietotherapy after the operation of polypectomy takes on paramount importance. The diet of the operated patient must comply with the following rules:

  • The use of table salt in the patient's diet should be strictly limited.
  • The patient must completely refrain from sour, spicy, too hot or very cold food.
  • Take food in small portions, at least five times a day.
  • Only two methods of cooking products are allowed: cooking or steaming. To prevent injury to the operated area of ​​the intestine, all dishes( including porridges) are recommended to be wiped through a fine sieve.

The patient is strictly not allowed to use:

  • meat and fish fatty varieties;
  • any mushrooms;
  • radish and radish;
  • cabbage;
  • sauces and condiments;
  • black coffee;
  • of spicy and salty cheeses.

Complications of the disease

Polyposis of the large intestine can provoke:

  • Development of anorectal bleeding due to polyp damage.
  • Fertilization of benign neoplasms and their transformation into cancer tumors of the large intestine.
  • Development of intestinal obstruction due to complete or partial obstruction of intestinal lumen by tissue of large neoplasm.
  • Acute inflammation of the wall of the affected bowel( acute enterocolitis).This dangerous condition can develop in the absence of the necessary treatment. Characterized by the propensity for rapid progression, enterocolitis can result in a fatal outcome.
  • The formation of "stool" - a very hard stool, compressed in the process of prolonged constipation and unable to leave the intestine in a natural way.
  • The development of anemia( low levels of erythrocytes and hemoglobin in the blood).
  • In the course of polypectomy - surgery to remove polyps - an opening( the so-called perforation of the intestinal wall) can form in the wall of the operated organ. As a result of this complication, the contents of the intestine, which has fallen into the abdominal cavity, can lead to inflammation of the peritoneum - peritonitis.

Prevention

To protect yourself from the appearance of polyps in the large intestine and to prevent the occurrence of serious complications associated with them, it is necessary: ​​

  • To listen to your body sensitively and noticing the first alarming symptoms( especially the presence of blood and mucus in stool), contact a qualified coloproctologist, which will appoint a comprehensive survey.
  • Timely removal of detected benign neoplasms, without waiting for their malignancy and degeneration into colon cancer.
  • Completely refrain from smoking and drinking alcoholic beverages( beer also belongs to this category).
  • Revise your diet, completely eliminating spices, smoking, marinades, pickles, canned foods, carbonated drinks, very strong coffee and fast food. Also fat, high-calorie and fried dishes are undesirable. The use of confectionery and fresh baked goods should be significantly limited.
  • Include in your daily diet plenty of fresh herbs, fruits, vegetables, sour-milk products, cereals, meat and fish of low-fat varieties. Yeast bread should be preferred whole-grain, as useful bran, containing a large number of plant fibers. Instead of animal fats, it is recommended to use quality vegetable oil.
  • Observe the drinking regime, drinking during the day at least half a liter of liquid in the form of pure water, green tea, compotes, fruit drinks and juices.
  • Maintain a normal weight, preventing the development of obesity.

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