Colon polyps natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Colon polyps are very common in general population. They are usually found during screening colonoscopy. Polyps might grow gradually and cause symptoms including obstruction, bleeding, and changes in bowel habits. Some of them might progress to colorectal cancer. Therefore, it is advisable to resect all polyps that are found during colonoscopy and send the tissue biopsy for pathology. Prognosis of colon polyps is generally excellent. The presence of multiple polyps is associated with genetic disorders with a particularly poor prognosis.

Natural History, Complications, and Prognosis

Natural History

  • Colon polyps are very common in general population.[1]
  • They are usually found during screening colonoscopy.[2]
  • Polyps might grow gradually and cause symptoms including obstruction, bleeding, and changes in bowel habits.
  • Some of them might have malignant potential.
  • If left untreated, it may progress to develop colorectal cancer. The progression from an adenomatous polyp to colorectal cancer may take 10-15 years. 
  • All polyps are recommended to be resected.

Complications

Sporadic Colon Cancer3.jpg

Prognosis

  • Prognosis of colon polyps is generally excellent.[1]
  • The presence of multiple polyps is associated with genetic disorders with a particularly poor prognosis.
  • Colon polyps that are associated with BRAF and KRAS mutations have a poor prognosis.[4] This study also found no increase in mortality if 3 or more adenomas (RR = 1.4 [95% CI, 0.6 to 3.0]) or polyps larger than 1 cm
Risk of cancer over time after initial polypectomy in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer randomized clinical trial[5] In addition, the study found no difference in cancer risk among "participants with 3 or more nonadvanced adenomas and those with no adenomas (RR, 1.4 [95% CI, 0.6 to 3.0]" and no difference based on polyp size great than 1 cm.
Cancer cases after 13 years

% (n)

Cancer incidence rates

(per 10 000 person-years of observation)

Cancer mortality compared to

persons with no adenoma (relative risk)

No adenoma

n = 94,248

< 0.1% (71) 7.1 NA
Nonadvanced adenoma

n = 65,650

< 0.1% (55) 9.1 1.2

(95% CI, 0.5-2.7)

Advanced adenoma

n = 34,993 (≥1 cm, high-grade dysplasia, or tubulovillous or villous histology)

0.2% (70) 20 2.6

(95% CI, 1.2-5.7)

References

  1. 1.0 1.1 Huang, Christopher S; Farraye, Francis A; Yang, Shi; O'Brien, Michael J (2010). "The Clinical Significance of Serrated Polyps". The American Journal of Gastroenterology. 106 (2): 229–240. doi:10.1038/ajg.2010.429. ISSN 0002-9270.
  2. 2.0 2.1 Bonnington, Stewart N (2016). "Surveillance of colonic polyps: Are we getting it right?". World Journal of Gastroenterology. 22 (6): 1925. doi:10.3748/wjg.v22.i6.1925. ISSN 1007-9327.
  3. Shussman, N.; Wexner, S. D. (2014). "Colorectal polyps and polyposis syndromes". Gastroenterology Report. 2 (1): 1–15. doi:10.1093/gastro/got041. ISSN 2052-0034.
  4. Bettington, Mark; Walker, Neal; Clouston, Andrew; Brown, Ian; Leggett, Barbara; Whitehall, Vicki (2013). "The serrated pathway to colorectal carcinoma: current concepts and challenges". Histopathology. 62 (3): 367–386. doi:10.1111/his.12055. ISSN 0309-0167.
  5. Click B, Pinsky PF, Hickey T, Doroudi M, Schoen RE (2018). "Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence". JAMA. 319 (19): 2021–2031. doi:10.1001/jama.2018.5809. PMID 29800214.

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