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Colon Polyps. JAMA: Journal of the American Medical Association. 300(12): 1480. September 2008.

This brief patient education fact sheet provides information about colon polyps, which are abnormal growths that can occur on the inner surface of the colon. Benign growths are called polyps or adenomas. Polyps can become cancerous, although not all will. Because colon polyps do not usually cause symptoms, people with polyps may not know they have them until they are found during colonoscopy. The fact sheet reviews risk factors, treatment, and prevention strategies for colon polyps. The author describes the use of colonoscopy for diagnosis and treatment—that is, removal—of polyps. Readers are referred to the National Cancer Institute at www.cancer.gov, the American Cancer Society at www.cancer.org, and the American Gastroenterological Association at www.gastro.org for more information. Readers are advised to find other patient education pages on the Journal of the American Medical Association’s website at www.jama.com. One illustration depicts the colonoscopy procedure. The fact sheet is also available in Spanish. 2 figures.

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What I Need to Know About Colon Polyps. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 10 p.

This brochure describes colon polyps, which are growths on the surface of the colon, also called the large intestine. Colon polyps can be raised or flat and a person can have more than one colon polyp. Written in nontechnical language, with a pronunciation guide, the brochure answers common questions about colon polyps, including the risk of polyps being cancerous, who gets colon polyps, the symptoms of colon polyps, diagnostic testing for colon polyps, treatment options, and how to prevent colon polyps. Some types of polyps may already be cancerous or can become cancerous. Flat polyps can be smaller and harder to detect and are more likely to be cancerous than raised polyps. Most people with colon polyps do not have symptoms. However, symptoms may include constipation or diarrhea for more than a week or blood on the underwear, on toilet paper, or in stool. Doctors remove most polyps and test them for cancer. Readers are encouraged to speak with their health care provider about getting tested for colon polyps if they are 50 years of age or older, or earlier when symptoms are present or someone in their family has had polyps or colon cancer. Readers are referred to four resource organizations for more information: the American College of Gastroenterology (www.acg.gi.org or 301–263–9000), the American Gastroenterological Association (www.gastro.org or 301–654–2055), the American Society for Gastrointestinal Endoscopy (www.asge.org or 1–866–353–2743), and the National Cancer Institute (www.nci.nih.gov or 1–800–422–6237). The brochure is illustrated with line drawings of some of the concepts discussed. The inside back cover briefly describes the work of the National Digestive Diseases Information Clearinghouse, which provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. 8 figures.

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Adenoma-Adenocarcinoma (Excluding Adenomatous Polyposis). IN: Wexner, S.; Stollman, N., eds. New York, NY: Informa Healthcare USA. 2007. pp 477-516.

This chapter about adenoma and adenocarcinoma is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors discuss epidemiology, specific environmental associations, other risk factors, the pathogenesis of colonic neoplasms, screening for colorectal neoplasia, chemoprevention, clinical presentation and diagnosis, adenomatous polyps, colorectal cancer (CRC) staging, the surgical management of colon cancer, surgical resection, chemotherapy for CRC, and postoperative surveillance for CRC. The authors stress that through the identification and removal of adenomatous colorectal polyps, opportunities exist not just for early detection but also for prevention of CRC. Most CRCs develop in previously benign adenomas. Surgery remains the mainstay of curative therapy. The authors note that, unfortunately, neither screening nor chemoprevention is at present widely used in the general population. The chapter includes black-and-white illustrations and concludes with an extensive list of references. 8 figures. 9 tables. 249 references.

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Colon Polyps: What You Need to Know. Polipos En El Colon: Lo Que Usted Debe Saber. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2007. 4 p.

This fact sheet familiarizes readers with colon polyps, small clumps of extra tissue that grow inside the large intestine, also called the colon. Most polyps are benign, which means they are not cancerous. Written in a question-and-answer format, the fact sheet covers the risk factors for colon polyps, the symptoms of colon polyps, how to know if one should be tested for colon polyps, treatment options, and how to contact the National Digestive Diseases Information Clearinghouse (NIDDK) for more information. This fact sheet is from the NIDDK Awareness and Prevention Series. The fact sheet is presented in English and Spanish (2 pages each).

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Colonic Polyps in Children and Adolescents. Canadian Journal of Gastroenterology. 21(4): 233-239. April 2007.

This review article considers colonic polyps in children and adolescents, covering isolated juvenile polyps, juvenile polyposis syndrome (JPS), familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP), and mutY homologue (MYH)-associated polyposis (MAP). The author notes that colonic polyps most commonly present with rectal bleeding in children; juvenile refers to the histological type of polyp and not the patient’s age at onset of the polyp. Adolescents and adults with multiple juvenile polyps are at a significant risk of intestinal cancer. Both adult and pediatric gastroenterologists must try to determine the risk of colorectal cancer in people with juvenile polyposis syndrome. AFAP can occur either by a mutation at the extreme ends of the adenomatous polyposis coli gene or by biallelic mutations in the MYH gene. The identification of MYH-associated polyposis as an autosomal recessive condition has important implications for screening and management strategies. The authors conclude with a brief discussion about compliance with surveillance recommendations and future directions. 5 figures. 2 tables. 47 references.

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Gastrointestinal Polyposes: Clinical, Pathological and Molecular Features. Gastroenterology Clinics of North America. 36(4): 927-946. December 2007.

This article on neoplastic precursor lesions related to the development of cancer in patients with inflammatory bowel disease (IBD) is from a special issue of Gastroenterology Clinics of North America that focuses on the pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system. The author focuses mainly on noninflammatory epithelial polyposes, particularly the diagnostically important morphological and molecular features of the more recently recognized or more poorly understood conditions. These include familial adenomatous polyposis, attenuated familial adenomatous polyposis, Lynch syndrome, flat adenomas, MUTYH-associated polyposis, multiple adenomas, Peutz-Jegher syndrome, Cowden and Bannayan-Riley-Ruvalcaba syndromes, juvenile polyposis, hereditary mixed polyposis syndrome, hyperplastic polyposis, and colorectal polyposis. The author concludes that the diagnosis of some forms of polyposis is straightforward; others may easily be confused with each other. The number and type of polyps are of utmost importance in achieving an accurate diagnosis, which in turn depends on adequate polyp sampling and knowledge of the morphology of each type. 5 figures. 1 table. 108 references.

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Hyperplastic and Serrated Polyps of the Colorectum. Gastroenterology Clinics of North America. 36(4): 947-968. December 2007.

This article on hyperplastic and serrated polyps of the colorectum is from a special issue of Gastroenterology Clinics of North America that focuses on the pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system. The author notes that the serrated polyp pathway is different from the traditional adenoma-carcinoma sequence. The serrated polyp pathway begins with a hyperplastic polyp, or precursor serrated aberrant crypt focus, and has the potential to end as a colonic adenocarcinoma. The author describes the markers for this pathway, the molecular process, and other serrated pathways. The author concludes by calling for clinical studies to determine the natural history of serrated neoplasia and provide evidence-based guidance for risk assessment and surveillance of patients with various serrated polyp precursors. 5 figures. 100 references.

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New Post-Polypectomy Surveillance Guidelines. Practical Gastroenterology. 31(8): 30, 35-42. August 2007.

People found to have adenomatous polyps usually undergo polypectomy and then are placed into a surveillance program of periodic colonoscopy to remove missed synchronous and new metachronous adenomas and cancers. This article reviews new postpolypectomy surveillance guidelines issued by the United States Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (USM-STF/ACS). The author outlines how this set of guidelines differs from earlier guidelines: They offer a consensus statement that strengthens the guidelines, they specifically examine predictors of advanced adenomas and incorporate them into the guidelines, and they emphasize the quality of baseline colonoscopy and its impact on detection of postpolypectomy colorectal cancer. The author maintains that risk stratification can reduce the intensity of follow-up evaluation in a substantial proportion of these patients, so limited colonoscopy resources could be shifted from surveillance to screening and diagnosis. The article includes the recommendations, addition surveillance considerations, and a discussion of their implications for clinical practice. 8 tables. 67 references.

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Other Benign and Malignant Colonic Tumors. IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 517-542.

This chapter about benign and malignant colonic tumors is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors discuss lipoma, colorectal lymphoma, leiomyomas, and carcinoids; adenocarcinoma is covered in a previous chapter. For each type, the authors consider epidemiology, presentation, pathogenesis and risk factors, diagnostic approaches, patient management, and expected outcome. Lipomas are the most common, benign, nonepithelial tumors found in the colon. Colorectal lymphoma is less common than primary lymphoma in the stomach and small bowel. The diagnosis of colorectal lymphoma is usually made at laparotomy. Leiomyomas are thought to be of smooth muscle origin and are rare colonic lesions; they are usually asymptomatic and discovered incidentally. Carcinoid tumors are those with malignant potential, and both rectal and colonic carcinoids are extremely rare. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 3 figures. 5 tables. 193 references.

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Pharmacological Prevention of Colorectal Cancer. Practical Gastroenterology. 31(10): 20-30, 35-36. October 2007.

This article reviews the current status of the pharmacological prevention of colorectal cancer (CRC). The authors note that CRC tends to develop through a multistep process that occurs over a period of years, permitting many opportunities for intervention and cancer prevention. The authors briefly discuss the natural history of adenomatous polyps and CRC, as well as the identification of individuals at risk for CRC, and address the use of chemoprevention. Chemoprevention involves the long-term use of nutritional or pharmaceutical agents that can delay, prevent, or even reverse the process of CRC development. The authors discuss the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as well as a new group of agents, the nitric-oxide-releasing NSAIDs (NO-NSAIDs). Other drugs discussed include HMG-CoA reductase inhibitors (statins), ursodeoxycholic acid, difluromethaylornitine (DMFO), and hormone replacement therapy (HRT). They note that, at present, the only approved drug for chemoprevention of CRC is celecoxib and that is indicated only in high-risk patients with familial adenomatous polyposis (FAP). Screening methods and surveillance continue to be the standard of care for high-risk patients with a history of CRC or adenomatous polyps and for the general population based on age. 64 references.

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