Nowadays, everyone is paying more and more attention to their health, and many people find that the words "polyps" appear on the physical examination report: intestinal polyps, gallbladder polyps, cervical polyps, endometrial polyps...
At first glance, it is inevitable to worry about nervousness, what is this "polyp"? Does it have anything to do with cancer? Do you have to have surgery?
Today, let's get closer to the true face of "polyps" in Lushan!
In addition to the surface of the human body relative to the outside world , the skin , there is also the inner surface of the organ - the mucous membrane.
The polyp refers to the vegetation that grows on the surface of the human mucosa, up to the nasal cavity, vocal cords, down to the rectum, cervix, can appear, medically generally named according to its growth site.
Polyps themselves are a benign lesion, but some of them may become cancerous, so which polyps can be assured and which should be paid attention to?
Image source: Stand Cool Helo
1
Intestinal polyps: part of it is a "time bomb"
Intestinal polyps do not necessarily become cancerous.
Intestinal polyps are relatively common diseases, they are protruding abnormal growth tissues on the surface of the intestinal mucosa, before there is no pathological typing, collectively referred to as "polyps".
Whether there is a risk of cancerous disease in intestinal polyps and whether there are benefits to removal should be judged according to the connection between intestinal polyps and the intestinal wall, size, range, quantity, morphology, pathological typing, and family history of intestinal tumors [1,2].
For example, inflammatory polyps, together with proliferative polyps, are non-neoplastic polyps, which are generally caused by inflammation irritating the mucous membranes and have almost no malignant tendencies [3].
Treatment of primary intestinal disorders (e.g., ulcerative colitis, Crohn's disease) is usually done with regular follow-up and not necessarily removed.
Neoplastic polyps include adenomatous polyps and serrated polyps [3].
They are divided into many types, in simple terms, the larger the diameter, the more villi contained in it, the higher the risk of malignancy [4], which generally needs to be removed.
No matter what kind of polyps, it is recommended that you go to the gastroenterology department in time to see, choose the appropriate treatment, and review according to the doctor's orders.
If you've recently detected the tumoric intestinal polyps mentioned above, don't worry too much, because cancer usually has some time to go.
It is estimated that most visible polyps become cancerous, taking 5-10 years [3].
But the sooner it is detected and treated aggressively, the more likely it is to kill the cancer in its cradle.
Of course, this requires timely colonoscopic screening, especially for high-risk groups.
Because relatively speaking, this part of the population may have polyps in the intestines at a younger age.
It is recommended that people over 45 years of age, even if there is no discomfort, do it once, and determine the frequency of follow-up examination based on the results of the examination and the relevant medical history [5].
High-risk groups should start screening early and increase the frequency of examinations according to doctors' recommendations.
2
Gallbladder polyps: the vast majority are benign
(Source: Cleveland Clinic)
The vast majority of gallbladder polyps are benign.
Gallbladder polyps are common, with Chinese occurring in about 6.9% to 9.6%, of which only about 5% are malignant polyps [9,10].
About 60% of gallbladder polyps are cholesterol polyps[10], mainly due to the phagocytic cells of the gallbladder mucosa engulfing excess cholesterol, and the relationship with blood lipid levels and a high-cholesterol diet is unclear.
Inflammatory polyps are associated with tissue hyperplasia caused by inflammatory stimuli (eg, cholecystitis, gallstones).
Cholesterol polyps and inflammatory polyps generally do not change malignantly, and can be reviewed regularly, but it is worth noting that adenomatous polyps and gallbladder adenomyosis (controversial) may be at risk of cancer [11,12].
Relatively large, fast-growing, broad basal, co-stone, patients are older (>50 years old), and have a greater risk of gallbladder polyps with obvious symptoms such as biliary colic, and doctors may recommend surgical intervention to prevent polyps from becoming cancerous and alleviate clinical symptoms [13].
3
Cervical polyps: small polyps do not worry
The vast majority of cervical polyps are caused by chronic inflammation and long-term stimulation, most of which have no obvious symptoms, and a few will have abnormal vaginal discharge, irregular vaginal bleeding, bleeding after sexual intercourse, and menstrual inexhaustibility [14,15].
The vast majority of cervical polyps are benign, with only about 0.2% to 1.5% at risk of malignancy [16].
Asymptomatic cervical polyps do not have to be treated, but if the polyps are too large (basal base diameter ≥1 cm), have obvious symptoms, and have fertility needs, surgical resection can be performed, and pathological examinations are performed to rule out malignancy [17].
4
Endometrial polyps: part of it will disappear on its own
Endometrial polyps are a common disease in gynecology, caused by excessive endometrial hyperplasia, the cause and pathogenesis are still unclear, can be found at all ages, most commonly between 40 and 50 years old.
About 25% of endometrial polyps smaller than 10 mm may resolve spontaneously [18] and the smaller they are, the easier they are to disappear, and may disappear with the exfoliation of the endometrium after several menstrual periods.
Most endometrial polyps are benign, with only about 0 to 12.9 percent of endometrial polyps having the potential for malignancy [21,22].
Usually, the risk of dystrophy of endometrial polyps before menopause is lower, and the risk of malignancy is higher after menopause, especially with vaginal bleeding.
In addition, advanced age, obesity, hypertension, polyp size (>15 mm), and the use of hormone replacement therapy are also high risk factors, so treatment is generally recommended [21,22].
Now that we know, not all polyps become cancerous.
Regular physical examinations, scientific treatment of polyps, and listening to the advice of specialists are the best health protection for us!
Reviewer
Gao Pengji | Chief Physician of General Surgery Department of Beijing Jishuitan Hospital
Liu Haiphong | Deputy Chief Physician of the Department of Obstetrics and Gynecology, Huashan Hospital, Fudan University
Wang Dong | Chief Physician of the Department of Hepatobiliary Surgery, Peking University People's Hospital
Qu Mouwen | Chief Physician of the Department of Proctology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences
bibliography
[1] Haumaier F, Sterlacci W, Vieth M. Histological and molecular classification of gastrointestinal polyps. Best Pract Res Clin Gastroenterol. 2017 Aug;31(4):369-379. doi: 10.1016/j.bpg.2017.06.005. Epub 2017 Jun 27. PMID: 28842046.
[2] Tanaka S, Saitoh Y, Matsuda T, Igarashi M, Matsumoto T, Iwao Y, Suzuki Y, Nozaki R, Sugai T, Oka S, Itabashi M, Sugihara KI, Tsuruta O, Hirata I, Nishida H, Miwa H, Enomoto N, Shimosegawa T, Koike K. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2021 Apr;56(4):323-335. doi: 10.1007/s00535-021-01776-1. Epub 2021 Mar 12. PMID: 33710392; PMCID: PMC8005396.
[3] Shussman N, Wexner SD. Colorectal polyps and polyposis syndromes. Gastroenterol Rep (Oxf). 2014;2(1):1-15. doi:10.1093/gastro/got041
[4] Kim NH，Jung YS，Park JH，et al. Risk of developing metachronous advanced colorectal neoplasia after colonoscopic polypectomy in patients aged 30 to 39 and 40 to 49 years［J］.Gastrointest Endosc，2018，88（4）：71 5.
Shanghai Anti-Cancer Association, Affiliated Cancer Hospital of Fudan University. Recommendations for screening and prevention of common malignant tumors in residents[J]. Health Guide, 2019(6): 48-49.
[6] Provenzale D, Gupta S, Ahnen D J, et al. NCCN guidelines insights: colorectal cancer screening, version 1.2018[J]. Journal of the National Comprehensive Cancer Network, 2018, 16(8): 939-949.
[7] Song M, Emilsson L, Roelstraete B, Ludvigsson JF. Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden. BMJ. 2021 May 4;373:n877. doi: 10.1136/bmj.n877. PMID: 33947661; PMCID: PMC8083372.
[8] Colorectal cancer screening (PDQ) — Health professional version. National Cancer Institute. https://www.cancer.gov/types/colorectal/hp/colorectal-screening-pdq. Accessed Feb. 18, 2022.
[9] Chen C Y, Lu C L, Chang F Y, et al. Risk factors for gallbladder polyps in the Chinese population[J]. American Journal of Gastroenterology (Springer Nature), 1997, 92(11).
[10] Xu A, Hu H. The gallbladder polypoid-lesions conundrum: moving forward with controversy by looking back[J]. Expert Rev Gastroenterol Hepatol, 2017, 11(11):1071-1080
[11] Liu Kai, Lu Yi, Mustapa Maimaitreimu, Dou Ningxin, Xu Xingxing, Lin Nan, Xu Ruiyun. Rethinking the surgical indications for cholecyst polypoid lesions: A retrospective study of 388 cases of cholecystectomy[J].Chinese Journal of Liver Surgery Electronics,2021,10(02):147-152.
[12] Wiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 2017;27(9):3856-3866. doi:10.1007/s00330-017-4742-y
[13] Foley KG, Lahaye MJ, Thoeni RF, Soltes M, Dewhurst C, Barbu ST, Vashist YK, Rafaelsen SR, Arvanitakis M, Perinel J, Wiles R, Roberts SA. Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol. 2021 Dec 17. doi: 10.1007/s00330-021-08384-w. Epub ahead of print. PMID: 34918177.
[14] Schnatz PF,Ricci S, O′Sullivan DM．Cervical polyps in postmenopausal women:is there a difference in risk? [J]． Menopause,２ ００ ９,１ ６(３):５ ２４-５ ２ ８．
[15] Stamatellos I, Stamatopoulos P, Bontis J．The role of hysteroscopy in the current management of the cervical polyps [J]．Arch Gynecol Obstet,２ ００ ７,２ ７ ６(４):２ ９ ９-３ ０ ３．
[16] Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, Sleiman Z, Campo R, Gordts S. The management of polyps in female reproductive organs. Int J Surg. 2017 Jul;43:7-16. doi: 10.1016/j.ijsu.2017.05.012. Epub 2017 May 5. PMID: 28483662.
[17] Alkilani YG, Apodaca-Ramos I. Cervical Polyps. [Updated 2021 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562185/
[18] McIlwaine P, McElhinney B, Karthigasu K A, et al. A prospective study of the use of the M yosure resectoscope to manage endometrial polyps in an outpatient setting[J]. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2015, 55(5): 482-486.
[19] McIlwaine P, McElhinney B, Karthigasu K A, et al. A prospective study of the use of the M yosure resectoscope to manage endometrial polyps in an outpatient setting[J]. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2015, 55(5): 482-486.
[20] Antunes Jr A, Costa-Paiva L, Arthuso M, et al. Endometrial polyps in pre-and postmenopausal women: factors associated with malignancy[J]. Maturitas, 2007, 57(4): 415-421.
[21] Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019 May 2;7:2050312119848247. doi: 10.1177/2050312119848247. PMID: 31105939; PMCID: PMC6501471.
[22] American Association of Kim NH，Jung YS，Park JH，et al. Risk of developing metachronous advanced colorectal neoplasia after colonoscopic polypectomy in patients aged 30 to 39 and 40 to 49 years［J］.Gastrointest Endosc，2018，88（4）：71 5.. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):3-10. doi: 10.1016/j.jmig.2011.09.003. PMID: 22196255.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
*The copyright of this article belongs to Tencent Medical Code, unauthorized media reprinting is prohibited, and illegal reprinting will be investigated for legal responsibility according to law. Individuals are welcome to forward to the circle of friends.