Colonic Polyps Clinical Presentation

  • Author: Gregory H Enders, MD, PhD; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 10, 2011
 

History

  • History of present illness
    • Most patients with colonic polyps are asymptomatic.
    • In symptomatic patients, the most common presenting symptom is rectal bleeding. Other symptoms include diarrhea or constipation, often with decreased stool caliber.
    • Villous adenomas of the rectum and distal colon can occasionally manifest as a syndrome of severe diarrhea with massive fluid and electrolyte loss.
    • Chronic bleeding from colonic polyps may cause iron deficiency anemia.
  • Family history: Although colonic polyps are a disease of older individuals, a positive family history of polyposis should prompt referral for screening in younger individuals and, in some cases, at more frequent intervals. A common practice is to begin screening in a patient 5 years earlier than the age at which colonic polyps were diagnosed in a first-degree relative.
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Physical

  • Distal rectal polyps can be detected by digital rectal examination. Otherwise, physical examination findings are typically normal.
  • Occult blood in stools (detected by guaiac and antibody-based tests) may be found in a minority of patients with colonic polyps.
    • Although nonspecific, this finding should prompt a colon evaluation in most patients.
    • Such evaluations have had similar yields of clinically significant findings whether the stool sample was obtained by digital rectal examination or was retrieved from spontaneously passed stools.
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Causes

  • Epidemiologic studies suggest that environmental causes contribute to differences in colonic polyp incidence in geographically distinct populations, but the responsible factors have remained elusive.
  • Differences in consumption of dietary fiber and antioxidants have been hypothesized to play a role in the development of colonic polyps, but these proposals have not been substantiated in recent studies. There is limited, circumstantial evidence that consumption of meat, fat, and alcohol may be risk factors. Conversely, consumption of calcium and folate may confer a modest protective effect, particularly in patients with a history of colonic polyps and low basal consumption levels.
  • Genetics
    • A number of polyposis syndromes have been described. These can be associated with specific extraintestinal manifestations as well as extraintestinal tumors.
    • Identification and characterization of the genetic factors leading to the various syndromes is progressing. Most of the mutant genes in these syndromes have been identified.
    • At the genetic level, FAP is understood best. This is an autosomal dominant disorder caused by truncating mutations in the adenomatous polyposis coli (APC) gene.
    • Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant disorder caused by mutations in DNA mismatch repair proteins.
    • Cowden disease is associated with mutations in the phosphatase and tensin homology on chromosome 10 (PTEN) protein phophatase.
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Contributor Information and Disclosures
Author

Gregory H Enders, MD, PhD  Associate Professor, Fox Chase Cancer Center

Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Gastroenterological Association, American Medical Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Wafik S El-Deiry, MD, PhD  Professor of Medicine, Department of Hematology/Oncology; Co-Program Leader, Radiation Biology Program, Abramson Comprehensive Cancer Center, University of Pennsylvania School of Medicine

Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, and American Society of Gene Therapy

Disclosure: Nothing to disclose.

Specialty Editor Board

Manoop S Bhutani, MD  Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

BS Anand, MD  Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.

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