Pediatric Gastroenterology

Polyps

What are polyps?

Polyps are abnormal tissue growths that grow out of a mucous membrane. Sometimes the polyps are attached to the mucous membrane by a narrow and elongated "stalk", in which case the polyp is classified as a pedunculated growth. If there is no stalk, then the polyp is known as a sessile polyp. Polyps are found anywhere on the body where mucous membranes are located, including the stomach, colon, nose, vocal cords, cervix, intestines, and bladder. This article, however, will focus on gastrointestinal polyps in children.

Types of Gastrointestinal Polyps

Gastrointestinal polyps are just one type of the condition, and there are many sub-types of gastrointestinal polyps within this category. These polyps vary from having a high risk of malignancy to having nearly no risk of malignancy at all. Unfortunately, many types of gastrointestinal polyps are cancerous, although many of the most dangerous types of polyps are commonly found in those over 60. The chances of children getting these polyps are almost zero.

There is, however, a condition known as juvenile polyps that children commonly get. This condition does not usually result in cancer, but it can if dysplasia develops. Proper treatment will prevent this from happening most of the time, but many children in developing countries die from this sort of cancer.

What is Dysplasia?

Dysplasia is an ambiguous term that describes pre-cancerous changes in cells and tissues. The occurrence of dysplasia does not necessarily mean that the patient will get cancer, but it increases the chances significantly. Dysplasia is usually detected through regular screenings. These screenings should be done at set intervals if the doctor has already detected polyps on an earlier visit. Screenings must be conducted at regular intervals even after polyps have been removed, to ensure that no new polyps displaying signs of dysplasia are present.

What are Colorectal Polyps?

While colon polyps are more common in older adults, children can get them too. They do not usually cause symptoms. However, they can cause symptoms in rare cases, even if they are not cancerous. Some of these symptoms include rectal bleeding, chronic pain, diarrhea, and even constipation. Whether cancerous or not, these polyps should be removed as soon as possible to prevent them from becoming cancerous. Many benign colon polyps eventually become malignant.

Colon polyps are usually found through screening. These screenings are carried out various ways; including blood tests, colonoscopies, and sigmoidoscopies, lower gastrointestinal series, virtual colonoscopies, and digital rectal examinations (also known as DREs). Digital rectal examinations are the most common type of screenings and are commonly performed on patients of all ages. This is contrary to the common misconception that only adults over the age of 40 are screened in this manner.

How are Polyps Removed?

A minor case of polyps is usually treated at the time of screening. As long as there are, only a few and they are not very large, they can be removed quite easily on the spot. They can be removed with biopsy forceps or with snare cautery. Snare cautery is the most common way these days. It is a simple procedure, with a heated metal snare drawn around the polyp and tightened until the polyp is severed from the mucous membrane.

All polyps should be removed immediately, even though those smaller than 2.5 centimeters are rarely cancerous. Another screening is usually done in several years to ensure there is no recurrence of the polyps. Recurrences are very common, so screenings are very important and should not be skipped, despite their unpleasantness.

The Risks of Polyps

The risk of becoming cancerous increases when the polyps are larger than one centimeter and have a large percentage of the villous component. The shape of the polyp also provides an indication of the risk of it becoming malignant. Pedunculated polyps are less likely to become cancerous. Sessile polyps, however, are different. They are significantly more likely to become malignant. This is because sessile polyps lie closer to surrounding tissue, and it is easier for them to metastasize. They are also much more likely to recur than pedunculated polyps and thus are considered significantly more dangerous.

The Genetics of Polyps

As with many medical conditions, polyps are more common in those that have a family history of them. While those that do not have a family history of polyps can still get them, they are significantly less likely to have the condition. The exact numbers are a matter of some debate amongst medical professionals, but most agree that the rate of increase is roughly 50%.