eMedicine Specialties > Gastroenterology > Colon

Colonic Polyps: Treatment & Medication

Author: Gregory H Enders, MD, PhD, Member, Fox Chase Cancer Center
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
Contributor Information and Disclosures

Updated: Aug 22, 2008

Treatment

Medical Care

Some studies have demonstrated that medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) decreases the number and the size of colonic polyps. However, NSAIDs, such as sulindac, do not prevent cancer development. These drugs do not yet constitute established therapies or chemopreventives for colonic polyps.

A recent study suggests that aspirin may be beneficial in reducing the incidence of recurrent colonic polyps, particularly advanced colonic polyps1 in select patients with a high risk of colon cancer and an acceptably low risk of gastrointestinal bleeding or hemorrhagic stroke.

Surgical Care

  • Polypectomy
    • In the case of a solitary pedunculated polyp, colonoscopic removal can be performed concurrently with the search for other lesions.
    • Removal of a solitary colonic polyp is usually curative for that lesion. However, a complete colonoscopic examination should be performed because the finding of a single adenomatous polyp confers an increased risk for the development of others. The rate of colonic polyp recurrence (discovered at follow-up colonoscopy) at 1-year postpolypectomy is small, and recurrence may in fact represent missed synchronous lesions. Repeat colonoscopy at 3-12 months is sometimes advocated if there is substantial doubt whether a colonic polyp has been completely resected and/or contains high-grade dysplasia.
  • Colonic resection
    • In the case of multiple intestinal polyps associated with FAP, resection remains the only feasible option.
    • Colonic resection is also advocated for patients with long-standing ulcerative colitis who have developed high-grade dysplasia or a dysplasia-associated lesion or mass (DALM).
    • Surgical resection may be advocated for large, sessile polyps that are difficult to remove or for advanced colonic polyps that recur despite adequate initial endoscopic treatment.
    • Several surgical options should be discussed with the patient, including total colectomy, subtotal colectomy with rectal sparing, or segmental resection.

Consultations

  • Surgical consultation
    • Consultation with a surgeon is critical in patients with multiple polyps, including patients with FAP.
    • Explain and discuss the type and timing of surgery with the patient.

Diet

A regular diet may be continued. The patient can consider calcium and folate supplements to decrease the risk of colonic polyp recurrence.

Activity

Activities may be maintained as tolerated.

Medication

No drug therapy is proven or recommended for colonic polyps. More studies are required to assess the potential use of NSAIDs in order to elucidate their mechanism of action in causing colonic polyp regression and to determine why they do not appear to prevent cancer development.

More on Colonic Polyps

Overview: Colonic Polyps
Differential Diagnoses & Workup: Colonic Polyps
Treatment & Medication: Colonic Polyps
Follow-up: Colonic Polyps
References
[ CLOSE WINDOW ]

References

  1. Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology. Nov 1987;93(5):1009-13. [Medline].

  2. Powell SM, Petersen GM, Krush AJ, Booker S, Jen J, Giardiello FM, et al. Molecular diagnosis of familial adenomatous polyposis. N Engl J Med. Dec 30 1993;329(27):1982-7. [Medline].

  3. Powell SM. Direct analysis for familial adenomatous polyposis mutations. Mol Biotechnol. Feb 2002;20(2):197-207. [Medline].

  4. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. Oct 4 2007;357(14):1403-12. [Medline].

  5. Itzkowitz SH, Jandorf L, Brand R, et al. Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol. Jan 2007;5(1):111-7. [Medline].

  6. Beach R, Chan AO, Wu TT, et al. BRAF mutations in aberrant crypt foci and hyperplastic polyposis. Am J Pathol. Apr 2005;166(4):1069-75. [Medline].

  7. Bussey HJ, DeCosse JJ, Deschner EE, et al. A randomized trial of ascorbic acid in polyposis coli. Cancer. Oct 1 1982;50(7):1434-9. [Medline].

  8. Cohen LB. A color atlas of colorectal lesions. In: Pazdur R, Hoskins WJ, Wagman L, Coia LR, eds. Cancer Management: A Multidisciplinary Approach. Huntington, NY: Publisher Research & Representation, Inc; 2000:301-305.

  9. Coia LR, Ellenhorn JDI, Ayoub JP. Colorectal and anal cancers. In: Pazdur R, Hoskins WJ, Wagman L, Coia LR, eds. Cancer Management: A Multidisciplinary Approach. Huntington, NY: Publisher Research & Representation, Inc; 2000:273-299.

  10. Cotran RS, Kumar V, Robbins SL. Tumors of the small and large intestines. In: Cotran R, Kumar V, Robbins S, eds. Pathologic Basis of Disease. 5th ed. Huntington, NY: WB Saunders Company; 1994:809-822.

  11. Giardiello FM, Offerhaus GJ, DuBois RN. The role of nonsteroidal anti-inflammatory drugs in colorectal cancer prevention. Eur J Cancer. Jul-Aug 1995;31A(7-8):1071-6. [Medline].

  12. Itzkowitz SH, Kim YS. Colonic polyps and polyposis syndromes. In: Feldman M, Sleisenger MH, Scharschmidt BF, eds. Sleisinger & Fordtran's Gastrointestinal and Liver Disease; Pathophysiology, Diagnosis, Management. Vol 2. 6th ed. Philadelphia, Pa: WB Saunders Company; 1998:1865-1905.

  13. Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. Mar 2007;132(3):874-82. [Medline].

  14. Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell. Oct 18 1996;87(2):159-70. [Medline].

  15. Ladabaum U, Song K. Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand. Gastroenterology. Oct 2005;129(4):1151-62. [Medline].

  16. [Best Evidence] Logan RF, Grainge MJ, Shepherd VC, et al. Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterology. Jan 2008;134(1):29-38. [Medline].

  17. Regueiro CR. AGA future trends committee report. Colorectal cancer: a qualitative review of emerging screening and diagnostic technologies. Gastroenterology. Sep 2005;129(3):1083-103. [Medline].

  18. Rex DK, Kahi CJ, Levin B, et al. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. May 2006;130(6):1865-71. [Medline].

  19. Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. May 2006;130(6):1872-85. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

colonic polyps, colonic polyp, colon polyp, colon polyps, colon cancer, colon cancer polyp, colon, colonoscopy, colonoscopy polyp, polyps in colon, polyps in the colon, adenomas, hyperplastic polyps, benign epithelial neoplasms, polyposis syndromes, familial adenomatous polyposis, FAP, Gardner syndrome, Turcot syndrome, Peutz-Jeghers syndrome, Cowden disease, familial juvenile polyposis, hereditary nonpolyposis colorectal cancer, HNPCC, dysplasia-associated lesion or mass, DALM, sulindac, polypectomy, colectomy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Gregory H Enders, MD, PhD, Member, 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.

Medical Editor

Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Manoop S Bhutani, MD, FACG, FACP 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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

CME Editor

Alex J Mechaber, MD, FACP, 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; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.