- Projections from the colonic mucosal surface
- Usually asymptomatic
- Neoplastic polyps
- Adneomas – most common, risk progression to carcinoma
- (includes tubular, tubulovillous, villous, serrated adenomas/serrated polyps)
- Polypoid adenocarcinomas
- Lipomas, leiomyomas, lymphomatous polyps (less common carcinoid tumours)
- Non neoplastic polyps
- hyperplastic (always benign)
- Inflammatory polyps (seen in UC and occasionally Crohn’s)
- Lymphoid polyps
- Hamartomas – benign overgrowth of tissues normally found at the site e.g. Peutz Jeghers
- Risk factors – age, male, family history
- Removing adenomas reduces risk of colorectal cancer
- If the polyp is confirmed malignant – need to proceed to surgical resection of the segment of bowel
- Risk of malignancy associated with –
- Features or tubulovillous or villous architecture
- Increasing numbers or size
- Dysplasia
- Ongoing recommendations for polyp surveillance is based on these factors
- Inherited disorders
- Familial adenomatous polyposis (FAP)
- Germline APC mutation
- 100s to 1000s of adenomas
- Guaranteed CRC by age 40 unless prophylactic colectomy
- Other features – duodenal and periampullary cancers, hypertrophy of retinal pigments, osteomas, epidermoid cysts, other cancer
- Gardner syndrome
- A sub-set of FAP
- Frequent gastrointestinal polyps
- patients develop osteomas, supernumerary teeth, desmoid tumours
- Peutz-Jegher syndrome
- Harmatomatous polyps
- Featuers – mucocutaneous pigmentation, gatrointestinal polyposis
- High risk breast, colorectal and pancreatic malignancies
Hereditary non-polyposis colorectal cancer (Lynch syndrome)
- Most common cause of hereditary colon cancer
- Lynch associated cancers – colorectal, small bowel, endometrial, ovarian, gastric, brain, urothelial
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