Adenomatous polyp
The content of the article:
-
Causes and risk factors
- Gastrointestinal polyps
- Endometrial polyps
- Forms of the disease
- Disease stages
-
Symptoms
- Gastrointestinal polyps
- Endometrial polyps
- Features of the course of the disease in children
-
Diagnostics
- Polyps of the stomach and intestines
- Endometrial polyps
-
Treatment
- Gastrointestinal polyps
- Endometrial polyps
- Possible complications and consequences
- Forecast
- Prevention
Adenomatous polyp is a hyperplastic pathological formation of a spherical, mushroom or branched form, rising above the surface of the inner shell of the organ and consisting of uncharacteristically growing glandular cells, sometimes with inclusions of atypical elements.
Adenomatous polyps are polyps that grow on the surface of the colon
Adenomatous polyps are considered a precancerous pathology. The likelihood of malignant transformation (malignancy) of a polyp directly depends on its size. The minimum probability of malignancy is noted with a polyp size of less than 1.5 cm (less than 2%), with a size of 1.5–2.5 cm - from 2 to 10% and exceeds 10% with a polyp size of more than 2.5–3 cm. Also there is a high risk of malignancy in sessile polyps.
Most often, adenomatous polyps are localized on the mucous membrane of the large intestine, stomach and uterus.
Synonyms: adenoma, glandular polyp.
Causes and risk factors
This pathology is most often acquired in nature; the likelihood of a glandular polyp forming increases with age.
The reasons for the development of adenomatous polyps:
- genetic predisposition;
- neurohormonal pathology, endocrinopathy;
- chronic injury to the mucous membrane of the organ.
It has been scientifically proven that a hereditary factor plays an important role in the development of adenomatous polyp
Currently, a hereditary predisposition to the formation of polyps has been confirmed: about half of all cases of the disease are reflected in a family history. The presence of chromosomal aberration has been proven: changes in the structure of some chromosomes associated with the gene responsible for the formation of polyps have been found.
Gastrointestinal polyps
The main risk factors for the development of adenomatous polyps of the gastrointestinal tract:
- a high content of refined foods that contribute to the stagnation of intestinal contents (high-calorie, fatty and protein foods with a small amount of fiber cause a decrease in the effectiveness of peristalsis, provoke the processes of putrefaction and fermentation in the intestines, the development of intoxication);
- an imbalance of the gastrointestinal microflora, leading to a decrease in local immunity, a change in the differentiation and regeneration of cells in the mucous membrane of the stomach and intestines;
- concomitant diseases of the biliary system and impaired production of bile acids, which have a mutagenic effect on the intestinal mucosa.
What polyps of the gastrointestinal tract look like
Endometrial polyps
The main risk factors for the development of adenomatous polyps of the inner layer (endometrium) of the uterus:
- infectious and inflammatory diseases during puberty and associated menstrual and (subsequently) reproductive disorders;
- climacteric and premenopausal hormonal changes;
- mastopathy;
- surgical interventions (diagnostic or therapeutic curettage of the uterine cavity, probing of the uterine cavity);
- long-term use of an intrauterine device for contraception (endometrial trauma).
What endometrial polyps look like
Common non-specific risk factors:
- immunodeficiency states;
- hypovitaminosis (vitamins C and E);
- hereditary burden (uterine fibroids, oncological diseases of the genitals and mammary glands, digestive tract organs);
- active chronic inflammation and dysplasia of the intestinal mucosa or organs of the reproductive system (chronic colitis, ulcerative colitis, Crohn's disease, endometriosis, uterine fibroids, cervical erosion, sexually transmitted diseases);
- some chronic diseases (diabetes mellitus, obesity, thyroid pathology, etc.);
- chronic neuropsychic stress.
Forms of the disease
Depending on the histological structure, according to the classification of the World Health Organization, adenomatous polyps are:
- glandular (or tubular), which consist of a network of complex branching glands. This is the most common type of colon polyps;
- villous, which are characterized by a significant shortening of the leg or its absence. Polypous growths are similar to cauliflower inflorescences. They are found both in the digestive tract and on the uterine lining;
- mixed, which have the characteristics of the two previous varieties. They are found in various organs.
Most villous polyps have a wide base; their malignancy index is the highest at 40%. After removal of villous polyps, a relapse occurs in about 1/3 of cases.
Less often, a tubular polyp undergoes malignant transformation.
On the basis of multiplicity, such adenomatous polyps are distinguished:
- single;
- multiple (group and scattered);
- diffuse (familial) polyposis.
The number of polyposis formations is extremely important in prognostic terms. Solitary polyps become malignant in 1-4% of cases and have a favorable prognosis. Multiple polyps are malignant in about 20% of cases. Diffuse polyposis is usually characterized by a massive lesion (there are hundreds and thousands of polyps, and sometimes there are no areas of unaffected mucous membrane at all) and has a significant tendency to malignancy - from 80 to 100%.
Disease stages
Despite the lack of a clear delineation of the stages of the disease, most adenomatous polyps go through successive stages of development from small to large, from a low manifestation of proliferative activity to a greater one, up to the transition to an invasive cancer process.
Stages of adenomatous polyposis
Symptoms
Gastrointestinal polyps
The bulk of cases of the formation of polyps of the stomach and large intestine are either asymptomatic or with minor nonspecific manifestations and are an accidental endoscopic finding. It is believed that at least 5 years pass from the moment a polyp appears on the mucous membrane to the first clinical manifestations.
As a rule, when a polyp reaches a significant size (2-3 cm), the following symptoms appear:
- gastric bleeding (tarry stools or "coffee grounds" vomit);
- the release of mucus and fresh red blood from the anus during bowel movements;
- frequent (possibly painful) urge to defecate;
- pain in the epigastrium, umbilical region, lower abdomen and in the anus;
- anal itching;
- stool disorders (constipation, diarrhea).
Frequent urge to defecate and upset stools can signal polyps in the gastrointestinal tract
Upon reaching a giant size, polyps can provoke intestinal obstruction.
Endometrial polyps
Adenomatous endometrial polyp, as in the previous case, often develops asymptomatically. Signs of pathology are manifested with an increase in polyposis growth to a significant size. Possibly germination of a polyp through the cervical canal into the lumen of the vagina.
The main signs of an endometrial polyp:
- periodic pulling pains in the lower abdomen, often radiating to the perineum, lumbar region;
- violations of the menstrual function of a different nature (prolonged painful bleeding, irregularity of the cycle, smearing or bloody intermenstrual discharge, etc.);
- metrorrhagia;
- discomfort or pain during intercourse;
- primary or secondary infertility.
Features of the course of the disease in children
Also, the juvenile form of polyps is distinguished. In this case, the patients are children. The first manifestations of the disease occur at an early age, the clinical picture unfolds by the age of 16-18.
Strictly speaking, juvenile polyps cannot be unambiguously classified as adenomatous, because they lack glandular hyperplasia and changes in the glandular epithelium. These are rather large formations, sometimes hanging into the lumen of an organ on a long stem, smooth, intensely colored (bright red, cherry-colored), located more often in the sigmoid or rectum, rarely malignant.
Diagnostics
Polyps of the stomach and intestines
Diagnostic measures include:
- general blood test (leukocytosis, increased ESR, possible signs of anemia - a decrease in the number of erythrocytes, hemoglobin, a change in the color indicator);
- biochemical blood test (for markers of inflammation);
- analysis of feces for occult blood;
- digital examination of the rectum;
- fibrogastroduodenoscopy;
- X-ray examination of the stomach with a contrast agent;
- colonoscopy;
- sigmoidoscopy;
- irrigoscopy with contrast agent.
Colonoscopy is one of the methods for diagnosing adenomatous polyp
Endometrial polyps
Diagnosis of endometrial polyps consists of the following activities:
- general blood test (leukocytosis, increased ESR, possible signs of anemia - a decrease in the number of erythrocytes, hemoglobin, a change in the color indicator);
- biochemical blood test (for markers of inflammation);
- vaginal smear;
- Ultrasound of the uterine cavity;
- diagnostic curettage followed by histological examination of the material;
- hysteroscopy with targeted biopsy.
Treatment
Conservative methods of therapy for adenomatous polyps are ineffective. For patients diagnosed with the disease, radical surgical treatment is recommended.
Gastrointestinal polyps
The most common methods of surgical treatment for gastrointestinal polyps are:
- endoscopic polypectomy with electrocoagulation of the leg or polyp bed;
- transanal excision of the neoplasm;
- colotomy or bowel resection with a polyp (in severe cases).
Endometrial polyps
Treatment of polyps localized in the uterus is done in the following ways:
- pharmacotherapy with hormonal drugs;
- endoscopic removal of polyps;
- ovarian resection, if necessary (hormone-dependent pathology);
- removal of the uterus with appendages (recommended for a massive process and in postmenopausal women).
Endoscopic surgery is one of the methods for removing polyps
Possible complications and consequences
Complications of polyps can be:
- bleeding;
- perforation of the wall of a hollow organ during surgery;
- malignancy of the polyp;
- infertility (uterine polyp);
- relapse of the disease.
Forecast
Taking into account the high likelihood of recurrence, patients who have undergone removal of adenomatous polyps are recommended dispensary observation for 2 years. Recurrences of polyps occur in 30-50% of cases in the interval from 1.5 to 6 months after treatment, while recurrent polyps often undergo malignant transformation.
After removal of benign polyps, the first examination is performed after 1.5-2 months, then every 3-6 months (depending on the type of polyp) for 1 year after removal. Further inspection is carried out once a year.
After removal of malignant polyps in the 1st year after surgery, a monthly examination is required, in the 2nd year of observation - every 3 months. Regular examinations every 6 months are possible only after 2 years.
Prevention
Prevention is as follows:
- Systematic preventive examinations.
- Immediate medical attention if warning symptoms appear.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
