Diagnosis

Colorectal polyp

Etiology

Cause [mts]

• Sporadic

• Genetic (FAP, HNPCC)

Pathophysiology [mts]

1. Chronic inflammation --> Hyperproliferation --> Polyps

2. Non-neoplastic polyps: hyperplastic, juvenile polyps, hamartomas, and inflammatory pseudopolyps

3. Neoplastic polyps --> inactivation of tumor suppressor genes (APC), or mismatch repair genes (MLH1) --> adenocarcinoma

4. . Genetics play a significant role; familial adenomatous polyposis (FAP) is autosomal dominant, and the majority of affected patients develop colorectal cancer (CRC) by age 40. Juvenile polyposis syndrome (JPS) is also autosomal dominant. Fifty to sixty percent of patients have a mutation in the SMAD4 or BMPR1A gene.

Types of polyps [mts]

• Hyperplastic (most common)

• Adenomatous (tubular >80%, villous 5-15%, tubulovillous 5-15%)

• Serrated (sessile or traditional)

• Hamartous

• Submucosal: Lymphoid, lipoma, carcinoid

Risk factors [mts]

• Advancing age

• Male gender

• High-fat, low-fiber diet

• Tobacco use

• Alcohol intake

• Family history of polyps

• Colorectal cancer

• Intestinal polyposis

Complication [mts]

• 95% of colon adenocarcinoma originate from polyps

Epidemiology

Incidence per 100.000 [tnv]

Approach

• Rectal exam

• Rectoscopy

• Sigmoideoscopy

• Colonoscopy: the gold standard of colorectal cancer screening

• Biopsy

Treatment

1. Coloscopy: Endoscopic polypectomy

2. Surgical removal

Differential diagnoses

Colorectal cancer, Crohn disease, Ulcerative colitis