Friday, 17 August 2018

Bowel polyps

Bowel polyps are small growths on the inner lining of the large intestine (colon) or rectum.

Bowel polyps are very common, affecting around 1 in 4 people at some point in their lives. They are slightly more common in men than women and are most common in people over the age of 60.

Some people develop just one polyp, while others may have a few.

Symptoms of bowel polyps
Bowel polyps don't usually cause any symptoms, so most people with polyps won't know they have them. They are often picked up during screening for bowel cancer.

However, some larger polyps can cause:

a small amount of slime (mucus) or blood in your poo (rectal bleeding)
diarrhoea or constipation
pain in your tummy (abdominal pain)
Bowel cancer risk
Polyps don't usually turn into cancer. But if some types of polyps (called adenomas) are not removed, there's a chance they may eventually become cancerous. Doctors believe that most bowel cancers develop from adenoma polyps.

However, very few polyps will turn into cancer, and it takes many years for this to happen.

Because of the risk of bowel polyps developing into cancer, your doctor will always recommend getting polyps treated.

Read more about bowel cancer.

Treatments for bowel polyps
There are several methods for treating polyps, but the most common procedure involves physically removing the polyp using a wire loop. This happens during a procedure called a colonoscopy.

The colonoscopy involves passing a flexible tube called a colonoscope through your bottom and up into your bowel. The colonoscope has a wire attached to it with an electric current through it. This wire is used to either burn off (cauterise) or cut off (snare) the polyp. Both of these methods are painless.

In rare cases, polyps may need to be treated by surgically removing part of the bowel. This is usually only done when the polyp has some cell changes, if it is particularly large, or if there are a lot of polyps.

After the polyp or polyps have been removed, they are sent to specialists in a laboratory, who will inform your consultant if:

the polyp has been completely removed
there is any risk of it regrowing
there is any cancerous change in the polyp
If there is a cancerous change in the polyp, you may need further treatment (depending on the degree and extent of change). Your specialist will be able to advise you on this.

Causes of bowel polyps
Doctors don't know the exact cause of bowel polyps. It is thought that they are caused by the body producing too many cells in the lining of the bowel. These extra cells then form into a bump, which is the polyp.

You may be more likely to develop bowel polyps if:

a member of your family has had bowel polyps or bowel cancer
you have a condition that affects your gut, such as colitis or Crohn's disease
you are overweight or smoke Bowen's disease is a very early form of skin cancer that's easily treatable. The main sign is a red, scaly patch on the skin.

It affects the squamous cells – which are in the outermost layer of skin – and is sometimes referred to as squamous cell carcinoma in situ.

The patch is usually very slow-growing, but there's a small chance it could turn into a more serious type of skin cancer if left untreated.

Is Bowen's disease serious?
Bowen's disease itself isn't usually serious. It tends to grow very slowly over months or years, and there are several very effective treatments for it.

The concern is that Bowen's disease can eventually develop into a different type of skin cancer called squamous cell skin cancer if it's left undiagnosed or neglected.

It's estimated this happens in up to 1 in 20 to 1 in 30 people with untreated Bowen's disease.

Squamous cell skin cancer is often treatable, but it can spread deeper into the body and is sometimes very serious.

Symptoms of Bowen's disease
Bowen's disease usually appears as a patch on the skin that has clear edges and doesn't heal. Some people have more than one patch.

Picture of Bowen's disease
The patch may be:

red or pink
scaly or crusty
flat or raised
up to a few centimetres across
itchy – but isn't always
The patch can appear anywhere on the skin, but is especially common on exposed areas like the lower legs, neck and head. Sometimes they can affect the groin area and, in men, the penis.

If the patch bleeds, starts to turn into an open sore (ulcer) or develops a lump, it could be a sign it has turned into squamous cell skin cancer.

When to get medical advice
See your GP if you have a persistent red, scaly patch of skin and don't know the cause.

It's important to get a proper diagnosis, as Bowen's disease can look like other conditions, such as psoriasis or eczema.

If necessary, your GP will refer you to a skin specialist (dermatologist) to determine what the problem is.

If they're not sure about the cause, they may need to remove a small sample of skin so it can be looked at more closely (a biopsy).

Causes of Bowen's disease
Bowen's disease usually affects older people in their 60s and 70s.

The exact cause is unclear, but it has been closely linked with:

long-term exposure to the sun or use of sunbeds – especially in people with fair skin
having a weak immune system – for example, it's more common in people taking medication to suppress their immune system after an organ transplant, or those with AIDS
previously having radiotherapy treatment
the human papillomavirus (HPV) – a common virus that often affects the genital area and can cause genital warts
Bowen's disease doesn't run in families and you can't pass it on to others.

Treatments for Bowen's disease
There are a number of treatment options for Bowen's disease. Talk to your dermatologist about which treatment is most suitable for you.

The main treatments are:

cryotherapy – liquid nitrogen is sprayed on to the affected skin to freeze it. The procedure may be painful and the skin may remain a bit uncomfortable for a few days. The affected skin will scab over and fall off within a few weeks.
imiquimod cream or chemotherapy cream (such as 5-fluorouracil) – this is applied to the affected skin regularly for a few weeks. It may cause your skin to become red and inflamed before it gets better.
curettage and cautery – the affected area of skin is scraped away under local anaesthetic, where the skin is numbed, and heat or electricity is used to stop any bleeding, leaving the area to scab over and heal after a few weeks.
photodynamic therapy (PDT) – a light-sensitive cream is applied to the affected skin, and a laser is directed on to the skin a few hours later to destroy the abnormal cells. The treatment session lasts about 20-45 minutes. You may need more than one session.
surgery – the abnormal skin is cut out under local anaesthetic and stitches may be needed afterwards.
In a few cases, your dermatologist may just advise monitoring your skin closely – for example, if it's very slow-growing and they feel the side effects of treatment will outweigh the benefits.

Looking after your skin after treatment
After treatment, you may need follow-up appointments with your dermatologist or GP to see if you need any further treatment.

If you had surgery, you may need to have any stitches removed at your GP surgery a week or two later.

After treatment:

see your GP if an existing patch starts to bleed, change in appearance or develops a lump – don't wait for your follow-up appointment
see your GP if you notice any worrying new patches on your skin
make sure you protect your skin from the sun – wear protective clothing and use a sunscreen with a high sun protection factor (SPF) of at least 30

Diagnosing bowel polyps
Bowel polyps are usually found when your bowel is being looked at for another reason or during screening for bowel cancer.

If polyps are found, a colonoscopy or CT colonography is needed to view the whole of the large bowel and remove them at the same time.

Monitoring bowel polyps
Some people with a certain type of polyp may be at risk of it coming back in the future (recurring).

This is uncommon, but means you'll need examining (by colonoscopy) at regular intervals of around three to five years. This is to catch any further polyps that may develop and potentially turn into bowel cancer.

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