Flexible sigmoidoscopy is a procedure used to see inside the sigmoid(the lower portion of the large intestine) colon and rectum. Flexible sigmoidoscopy can detect inflamed tissue, abnormal growths, and ulcers. The procedure is used to look for early signs of cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.
. The endoscope used for this test is about a half-inch wide and long enough to reach about two feet into the colon. A sigmoidoscopy can detect early cancers as well as polyps that could later become cancerous.
Sigmoidoscopy is an effective screening test for colon cancer if you have the procedure done every five years starting at age 50. Alternatively, you might choose to have a colonoscopy every 10 years to screen for colon cancer. In either case, it’s wise to have a fecal occult blood test in the years you don’t have a sigmoidoscopy or colonoscopy. A sigmoidoscopy is also useful for evaluating the cause of abdominal pain, blood in the stool, constipation, and diarrhea.
What are the sigmoid colon and rectum?
The sigmoid colon is the last one-third of the colon. The colon comprises three main parts: the ascending colon, the transverse colon, and the sigmoid colon—sometimes called the descending colon. The colon absorbs nutrients and water and forms stool.
CLICK & SEE The sigmoid colon is the last one-third of the colon.
The rectum is about 6 inches long and connects the sigmoid colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus control bowel movements.
Difference between flexible sigmoidoscopy and colonoscopy:
Flexible sigmoidoscopy enables the doctor to see only the sigmoid colon, whereas colonoscopy allows the doctor to see the entire colon. Colonoscopy is the preferred screening method for cancers of the colon and rectum; however, to prepare for and perform a flexible sigmoidoscopy usually requires less time.
How to Prepare for a Flexible Sigmoidoscopy:
To prepare for a flexible sigmoidoscopy, one or more enemas are performed about 2 hours before the procedure to remove all solids from the sigmoid colon. An enema is performed by flushing water, laxative, or sometimes a mild soap solution into the anus using a special wash bottle.
In some cases, the entire gastrointestinal tract must be emptied by following a clear liquid diet for 1 to 3 days before the procedure—similar to the preparation for colonoscopy. Patients should not drink beverages containing red or purple dye. Acceptable liquids include
*fat-free bouillon or broth
*strained fruit juice
*sports drinks, such as Gatorade
A laxative or an enema may also be required the night before a flexible sigmoidoscopy. A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water.
Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including
*vitamins that contain iron
What happens when the test is performed?
You wear a hospital gown for the procedure and lie on your side on a table. After applying some clear jelly to his or her gloved hand, the doctor feels the inside of your rectum with a finger, then gently inserts one end of the sigmoidoscope inside.
The doctor will fill your intestine with air, which often causes some pain similar to the cramping you might get when you have gas. As the camera on the scope transmits pictures to a video screen, your doctor watches for any suspicious lesions on your bowel lining. If one appears, he or she might use some small clippers on the end of the scope to take a tissue sample to check under the microscope. When the test is finished, the doctor vacuums the air out of your intestine and slowly removes the tube. The test usually takes 10-30 minutes.
How is a flexible sigmoidoscopy performed?
Examination of the Sigmoid Colon:
During a flexible sigmoidoscopy, patients lie on their left side on an examination table. The doctor inserts a long, flexible, lighted tube called a sigmoidoscope, or scope, into the anus and slowly guides it through the rectum and into the sigmoid colon. The scope inflates the colon with air to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the colon to a computer screen, allowing the doctor to carefully examine the tissues lining the sigmoid colon and rectum. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.
When the scope reaches the transverse colon, the scope is slowly withdrawn while the lining of the colon is carefully examined again.
The risks are minimal. The chance of perforation is less than for a colonoscopy. A few people have a small amount of bleeding after the procedure if a biopsy has been taken.
Must you do anything special after the test is over?
You should feel fine and be able to return to your regular activities immediately after the test. Call your doctor if you have more than light bleeding from the rectum or if you have continuing abdominal pain
Biopsy and Removal of Colon Polyps
The doctor can remove growths, called polyps, during flexible sigmoidoscopy using special tools passed through the scope. Polyps are common in adults and are usually harmless. However, most colon cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope.
During a flexible sigmoidoscopy, the doctor can also take samples from abnormal-looking tissues. Called a biopsy, this procedure allows the doctor to later look at the tissue with a microscope for signs of disease.
Tissue removal and the treatments to stop bleeding are usually painless. If polyps or other abnormal tissues are found, the doctor may suggest examining the rest of the colon with a colonoscopy.
A flexible sigmoidoscopy takes about 20 minutes. Cramping or bloating may occur during the first hour after the procedure. Bleeding and puncture of the large intestine are possible but uncommon complications. Discharge instructions should be carefully read and followed.
Patients who develop any of these rare side effects should contact their doctor immediately:-
*severe abdominal pain
*bloody bowel movements
Points to Remember
*Flexible sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum.
*One or more enemas are performed about 2 hours before the procedure to remove all solids from the sigmoid colon.
*In some cases, the entire gastrointestinal tract must be emptied—similar to the preparation for colonoscopy.
*A sigmoidoscope transmits a video image from inside the colon to a computer screen.
*A doctor can biopsy abnormal-looking tissues during a flexible sigmoidoscopy.
*Polyps can be removed using special tools passed through the sigmoidoscope.
*If polyps or other abnormal tissues are found, the doctor may suggest examining the rest of the colon with a colonoscopy.
*A flexible sigmoidoscopy takes about 20 minutes.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases conducts and supports basic and clinical research into many digestive disorders.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.
For More Information
Fact sheets about other diagnostic tests are available from the National Digestive Diseases Information Clearinghouse at www.digestive.niddk.nih.gov, including
This writing might “stink” a little, but this information might serve as an important revelation to many particularly for elderly and persons with contineus stomac problem!
Human poops or stools, is the waste product of the human digestive system and varies significantly in appearance, depending on the state of the whole digestive system, influenced and found by diet and health.
Normally stools are semisolid, with a mucus coating. Small pieces of harder, less moist feces can sometimes be seen impacted on the distal (leading) end. This is a normal occurrence when a prior bowel movement is incomplete; and feces are returned from the rectum to the intestine, where water is absorbed.
Meconium (sometimes erroneously spelled merconium) is a newborn baby’s first feces. Human feces are a defining subject of humor.
Some persons have bloody stools on and off, usually accompanied by a sight tinch of discomfort. Many times, this doesn’t appear as a threat or danger to them as they often regard it as constipation though they may be passionate lover of fruits and vegetables. This might go on for some time until one day, bloody stools became really “bloody” and the pain became increasingly painful. Alarmed and paranoid, they call their dear ones who will recommend to see the doctor over at his or her clinic.
Now let us see What Does an Ideal Bowel Movement Look Like?
Alternative practitioners often ask clients about their stool as part of their assessment. Find out what normal stool should look like, and learn about the causes of green stool, pale stool, yellow stool, blood in stool, mucus in stool, pencil thin stool, infrequent stool, and more.
What Does an Ideal [amazon_textlink asin=’B001U1UKOO’ text=’Bowel Movement’ template=’ProductLink’ store=’finmeacur-20′ marketplace=’US’ link_id=’5c1f8c56-ee7e-11e6-87a4-8d88514c5f8b’]
An ideal bowel movement is medium brown, the color of plain cardboard. It leaves the body easily with no straining or discomfort. It should have the consistency of toothpaste, and be approximately 4 to 8 inches long. Stool should enter the water smoothly and slowly fall once it reaches the water. There should be little gas or odor.
Stool That Sinks Quickly
Rapidly sinking stool can indicate that a person isn’t eating enough fiber-rich foods, such as vegetables, fruits, and whole grains, or drinking enough water. This stool is often dark because they have been sitting in the intestines for a prolonged time. Click to learn 5 tips to boost your water intake.
Stool that is pale or grey may be caused by insufficient bile output due to conditions such as cholecystitis, gallstones, giardia parasitic infection, hepatitis, chronic pancreatitis, or cirrhosis. Bile salts from the liver give stool its brownish color. If there is decreased bile output, stool is much lighter in color.
Other causes of pale stool is the use of antacids that contain aluminum hydroxide. Stool may also temporarily become pale after a barium enema test.
Pale stool may also be shiny or greasy, float, and be foul smelling, due to undigested fat in the stool (see soft and smelly stool).
Other symptoms of spleen qi deficiency are: easy bruising, mental fogginess, bloating, gas, loose stools, fatigue, poor appetite, loose stools with little odor, symptoms that worsen with stress, undigested food in the stools, and difficulty ending the bowel movement. Spleen qi deficiency can be brought on by stress and overwork.
Eating certain foods in excess is thought to worsen spleen qi deficiency. Offending foods include fried or greasy foods, dairy, raw fruits and vegetables, and cold drinks, all believed to cause “cold” and “dampness” in the body. Dietary treatment of spleen qi deficiency involves eating warm, cooked foods. Ginger tea and cinnamon tea are also warming.
Pencil thin stool can also be caused by a bowel obstruction. Benign rectal polyps, prostate enlargement, colon or prostate cancer are some of the conditions that can cause obstruction.
Yellow stool can indicate that food is passing through the digestive tract relatively quickly. Yellow stool can be found in people with GERD (gastroesophageal reflux disease). Symptoms of GERD include heartburn, chest pain, sore throat, chronic cough, and wheezing. Symptoms are usually worse when lying down or bending. Foods that can worsen GERD symptoms include peppermint, fatty foods, alcohol, coffee, and chocolate.
Yellow stool can also result from insuffient bile output. Bile salts from the liver gives stool its brownish color. When bile output is diminished, it often first appears as yellow stool. If there is a greater reduction in bile output, stool lose almost all of its color, becoming pale or grey.
If the onset is sudden, yellow stool can also be a sign of a bacterial infection in the intestines.
Yellowing of stool can be caused by an infection known as Giardiasis, which derives its name from Giardia, an anaerobic flagellated protozoan parasite that can cause severe and communicable yellow diarrhea. Another cause of yellowing is a condition known as Gilbert’s Syndrome. This condition is characterized by jaundice and hyperbilirubinemia when too much bilirubin is present in the circulating blood.
Stool that is almost black with a thick consistency may be caused by bleeding in the upper digestive tract. The most common medical conditions that cause dark, tar-like stool includes duodenal or gastric ulcer, esophageal varices, Mallory Weiss tear (which can be linked with alcoholism), and gastritis.
Certain foods, supplements, and medications can temporarily turn stool black. These include:
*Bismuth (e.g. Pepto bismol)
*Aspirin and NSAIDS (which can cause bleeding in the stomach)
*Dark foods such as black licorice and blueberries
Stool can be black due to the presence of red blood cells that have been in the intestines long enough to be broken down by digestive enzymes. This is known as melena (or melaena), and is typically due to bleeding in the upper digestive tract, such as from a bleeding peptic ulcer. The same color change (albeit harmless) can be observed after consuming foods that contain substantial proportion of animal bloods, such as Black pudding or Ti?t canh. The black color is caused by oxidation of the iron in the blood’s hemoglobin (haemoglobin). Black feces can also be caused by a number of medications, such as bismuth subsalicylate, and dietary iron supplements, or foods such as black liquorice, or blueberries. Hematochezia (also haemochezia or haematochezia) is similarly the passage of feces that are bright red due to the presence of undigested blood, either from lower in the digestive tract, or from a more active source in the upper digestive tract. Alcoholism can also provoke abnormalities in the path of blood throughout the body, including the passing of red-black stool.
Dark stool can also occur with constipation.
If you experience this type of stool, you should see your doctor as soon as possible.
Prussian blue, used in the treatment of radiation cesium and thallium poisoning, can turn the feces blue. Also, substantial consumption of products containing blue food dye (things such as blue koolaid or grape soda)
Bright Red Stool
When there is blood in stool, the color depends on where it is in the digestive tract. Blood from the upper part of the digestive tract, such as the stomach, will look dark by the time it reaches exits the body as a bowel movement. Blood that is bright or dark red, on the other hand, is more likely to come from the large intestine or rectum.
Eating beets can also temporarily turn stools and urine red.
Blood in stool doesn’t always appear bright red. Blood may be also present in stool but not visible, called “occult” blood. A test called the Fecal Occult Blood Test is used to detect hidden blood in stool.
A tarnished-silver or aluminum paint-like stool color characteristically results when biliary obstruction of any type (white stool) combines with gastrointestinal bleeding from any source (black stool). It can also suggest a carcinoma of the ampulla of Vater, which will result in gastrointestinal bleeding and biliary obstruction, resulting in silver stool.
This test detects blood in your stool, which can be a sign of bleeding anywhere from your nose and mouth to your rectum, such as from an ulcer, a polyp, or cancer. If you’re over 50, you should have this test annually during the years when you don’t have either a colonoscopy or sigmoidoscopy to screen for colon cancer. Keep in mind, however, that both colonoscopy and sigmoidoscopy are better at detecting cancer than a fecal occult blood test.
How the Test is Performed
If the test is performed in an office or hospital, stool may be collected by a doctor during an examination.
If the test is performed at home, a stool sample from three consecutive bowel movements is collected, smeared on a card, and mailed to a laboratory for processing. In order to ensure the accuracy of the guaiac test, follow the manufacturer’s instructions on how to collect the stool.
There are many ways to collect the samples. You can catch the stool on plastic wrap that is loosely placed over the toilet bowl and held in place by the toilet seat. Then put the sample in a clean container. One test kit supplies a special toilet tissue that you use to collect the sample, then put the sample in a clean container. Do not take stool samples from the toilet bowl water, because this can cause errors.
For infants and young children wearing diapers, you can line the diaper with plastic wrap. The plastic wrap is positioned so that it keeps the stool away from any urine. Mixing of urine and stool can spoil the sample.
Laboratory procedures may vary. In one type of test, a small sample of stool is placed on a paper card and a drop or two of testing solution is added. A color change indicates the presence of blood in the stool. How do you prepare for the test?
Do not eat red meat, any blood-containing food, cantaloupe, uncooked broccoli, turnip, radish, or horseradish for 3 days prior to the test.
You may need to stop taking medicines that can interfere with the test. These include vitamin C and aspirin. Check with your health care provider regarding medication changes that may be necessary. Never stop or decrease any medication without consulting your health care provider.
For several days before taking the samples, you must avoid medicines that can interfere with the results. These include NSAIDs and blood thinners which can cause minor stomach bleeding, thereby giving an abnormal test result. If you have hemorrhoids, wait until they stop bleeding before doing the test. Women shouldn’t collect stool samples near the time of menstruation. Finally, avoid using toilet bowl cleaners for several days before the test, because these chemicals can affect the results if they come in contact with your stool sample.
For several days before the test, you also need to avoid foods and vitamins that can affect the test result. Foods to avoid include red meat (the blood it contains can turn your test positive), radishes, turnips, cabbage, cauliflower, horseradish, uncooked broccoli, and cantaloupe (all of which contain a chemical that can turn the test positive), and citrus fruits and vitamin C supplements (which can turn the test falsely negative). What happens when the test is performed?
If one of the traditional tests is used, you collect three stool samples, ideally on three different days. Some kits include tissue paper that you can lay on the surface of the toilet bowl water to help keep the stool sample from sinking. As an alternative, you can pass your bowel movement into a disposable container. Once you’ve had a bowel movement, obtain a very small sample of the stool using the thin wooden sticks in your kit and smear it on a card from your kit. Then fold over the card to protect your sample.When you have all three samples, mail the cards to the clinic or lab in the plastic-lined envelope given to you.Make sure that your name is written on each card.
In the lab, the cards are treated with a chemical that produces a blue color when blood is present in the sample. This test works fine no matter how long it took your samples to reach the lab.
If you have the flush pad test, you drop the pad into the toilet bowl after you’ve had a bowel movement, for three consecutive days. The pads change color when blood is present in the toilet bowl. You can flush the toilet to dispose of the pads, but-if blood is detected-should contact your doctor.
How the Test Will Feel
There is no discomfort when the test is done at home, because this test only involves normal bowel functions. If stool is collected during an exam, there may be some discomfort in the anal canal and rectum.
Stool guaiac testing is sometimes used to screen for colon cancer, but it is not a reliable test for this purpose, and other screening methods should be used.
Additional non-GI related causes of positive guaiac test may include:
*Coughing up blood
Abnormal tests require follow-up with your doctor. How long is it before the result of the test is known?
With the flush pad method, results are available immediately.With the more traditional methods, testing is performed in only a few minutes once the lab receives your sample. Some clinics or labs do this testing in batches and wait to process the test until samples have been received from several people. You should hear from your doctor’s office within a week after the lab has received your specimen. If your test is positive, it means you have blood in your stool, and your doctor will recommend some additional testing to find out the cause.
Indians haven’t reached the stage of Methuselah (who, the Bible says, lived for 969 years), but our life expectancy has increased from 32 years in 1940 to 65 years in 2000. Seven per cent of the 1.1 billion Indian population is today over the age of 60. We now have better access to health care but can we look forward to fun, health, dignity, economic independence and a peaceful death? ..CLICK & SEE
Today children work far away from home, the joint family system is breaking down, and women (traditional care-givers) have joined the work force. The old have to fend for themselves.
They cannot afford to be ill as sickness is expensive. Preventive medicine and maintenance of health is, therefore, a priority
Good vision and hearing prevent accidents, but unfortunately they are the first senses that fail. After the age of 60, 30 per cent of the people are unable to hear a conversation. Leaning slightly forward and turning to the right side does help initially, but eventually hearing aids may be needed. Eyes too should be checked regularly and defects corrected promptly.
The skin loses its elasticity with age, becoming dry and wrinkled. Itching and scratching cause mechanical injury and secondary bacterial infection. Apply a small quantity of a mixture of 500ml of coconut oil, 500ml of sesame oil and 100ml of olive oil half an hour before bath. Add a teaspoon of coconut oil to the bath water. Use a moisturising soap. Apply body lotion or baby oil after bath.
Despite good care, regular brushing and flossing, the teeth may become discoloured, brittle, and may decay and recede. Visit the dentist at least once a year.
Sleep becomes less relaxing with early waking up and relative insomnia. Extrinsic factors like a snoring spouse or frequent essential trips to the toilet may compound the problem. Intrinsic factors like reduction in the restful delta rhythm, depression, pain, anxiety and stress can be tackled with exercise, meditation, yoga and prayer instead of getting addicted to sleeping pills.
With age the heart and blood vessels become less efficient even in the absence of obvious diseases. The heart tends to get enlarged and the pumping action decreases. The blood vessels become less pliable and elastic. This can result in the swelling of feet, high blood pressure and heart failure. Restricting salt consumption to 5gm (one teaspoon in 24 hours) and avoiding salty fried food, pickles and chutneys will help alleviate this problem.
The digestive tract also slows down. When this is compounded with a decrease in fibre content of the food and insufficient fluid intake, constipation becomes a problem. The oesophageal sphincter becomes inefficient, allowing acid to regurgitate from the stomach, causing burning and chest pain. Digestive problems are aggravated by smoking, drinking, untimely meals or lying down immediately after food.
Bones weaken with age, arthritis sets in, flexibility is lost and muscle strength reduces. These can lead to pain, falls and fractures. Supplements of calcium (1.2gms/day), walking for 40 minutes a day, and strengthening and flexibility exercises will help.
If you have a chronic disease like diabetes or high blood pressure, regular health checkups are a must.
Men need an annual digital exam of the prostate and a PSA (prostate specific antigen) test to rule out cancer of the prostrate.
Women need a pelvic examination and a PAP smear starting at 35-40 years, repeated every three years.
A breast self examination should be done every month. A screening mammogram at 40 years, and then every two years after that, is needed to detect breast cancer early enough.
Annual haemoglobin, blood sugar, lipid profile, urea, creatinine and thyroid function tests are also needed.
A baseline chest X-ray will help detect tuberculosis, emphysema and cancer.
A baseline ECG should be done around the age of 50 years and then repeated every 2-3 years.
Flexible sigmoidoscopy/colonoscopy at 50 and every 4 years thence is advisable.
Bone densitometry evaluates the risk of osteoporosis. It should be done every 1-2 years after menopause.
Immunisation does not stop in childhood. After the age of 65 years, pneumococcal vaccine will help prevent pneumonia, and “flu” vaccine influenza. Both are debilitating and can be fatal in the elderly.
To age healthily, control your weight, blood pressure and diabetes, eat four to six portions of fruit or vegetables daily, do not smoke, avoid salt, drink alcohol in moderation, walk daily, maintain muscle strength and flexibility with exercise and sleep for six or seven hours a night.
Definition Colon polyps are fleshy growths that occur on the inside (the lining) of the large intestine, also known as the colon. Polyps in the colon are extremely common, and their incidence increases as individuals get older. As many as 30 percent of middle-aged and older adults have one or more colon polyps — a small clump of cells that forms on the colon lining. Although the great majority of colon polyps are harmless, some may become cancerous over time. Anyone can develop colon polyps, but you’re at higher risk if you are 50 or older, are overweight or a smoker, eat a high-fat, low-fiber diet, or have a personal or family history of colon polyps or colon cancer.
Sometimes colon polyps can cause signs and symptoms such as rectal bleeding, a change in bowel habits and abdominal pain. But most small colon polyps don’t cause problems, which is why experts generally recommend regular screening. Colon polyps that are found in the early stages usually can be removed safely and completely.
Types of polyps become cancerous:
The polyps that become cancerous are called adenomatous polyps or adenomas. Adenomas account for approximately 75% of all colon polyps. There are several subtypes of adenoma that differ primarily in the way the cells of the polyp are assembled when they are examined under the microscope. Thus, there are tubular, villous, or tubulo-villous adenomas. Villous adenomas are the most likely to become cancerous, and tubular adenomas are the least likely.
Other Factors that may determine a polyp’s chance of becoming cancerous
Another factor that contributes to a polyp’s likelihood of becoming cancerous is its size. The larger a polyp grows, the more likely it is to become cancerous. Once a polyp reaches two centimeters or approximately one inch in size, the risk of cancer is in excess of 20 percent. Therefore, it is advisable to remove polyps of any size, preferably when they are of a small size, to prevent their growth and progression to cancer.
Although adenomas are by far the most common type of colon polyps, there are several other types of polyps. Among the other types of polyps that have no malignant potential are the hyperplastic, inflammatory, and hamartomatous polyps
Colon polyps range from smaller than a pea to golf ball sized. Small polyps, especially, aren’t likely to cause problems, and you may not know you have one until your doctor finds it during an examination of your bowel. Sometimes, however, you may have signs and symptoms such as:
Rectal bleeding. You might notice bright red blood on toilet paper after you’ve had a bowel movement. Although this may be a sign of colon polyps or colon cancer, rectal bleeding can indicate other conditions, such as hemorrhoids or minor tears (fissures) in your anus. Hemorrhoids don’t usually bleed consistently over a period of weeks, however, so if your bleeding is prolonged, be sure to tell your doctor.
Blood in your stool. Blood can show up as red streaks in your stool or make bowel movements appear black. Still, a change in color doesn’t always indicate a problem — iron supplements and some anti-diarrhea medications can make stools black, whereas beets and red licorice can turn stools red.
Constipation or diarrhea. Although a change in bowel habits that lasts longer than a week may indicate the presence of a large colon polyp, it can also result from a number of other conditions.
Pain or obstruction. Sometimes a large colon polyp may partially obstruct your bowel, leading to crampy abdominal pain, nausea, vomiting and severe constipation.
Your digestive tract stretches from your mouth to your anus. As food travels along this 30-foot passageway, nutrients are broken down and absorbed by your body to build cells and produce energy.
The last part of your digestive tract is a long muscular tube called the large intestine. The colon is the upper 4 to 6 feet of the large intestine; the rectum makes up the lower 8 to 10 inches. The colon’s main function is to absorb water, salt and other minerals from colon contents. Your rectum stores waste until it’s eliminated from your body.
Why polyps form
The majority of polyps aren’t cancerous (malignant), yet like most cancers, they result from abnormal cell growth. Healthy cells grow and divide in an orderly way — a process that’s controlled by two broad groups of genes. Mutations in any of these genes can cause cells to continue dividing even when new cells aren’t needed. In the colon and rectum, this unregulated growth can cause polyps to form, and over a long period of time, some of these polyps may become malignant.
Polyps can develop anywhere in your large intestine. They can be small or large and flat (sessile) or mushroom shaped and attached to a stalk (pedunculated). Small and mushroom-shaped polyps are much less likely to become malignant than flat or large ones are. In general, the larger a polyp, the greater the likelihood of cancer.
There are three main types of colon polyps:
Adenomatous. Once adenomatous polyps grow beyond the size of a pencil eraser — about 5 millimeters (mm), or 1/4 inch — there’s a small but increasing chance that they’ll become cancerous. This is especially true when their diameter exceeds 10 mm. For that reason, doctors normally take a tissue sample (biopsy) from polyps during a sigmoidoscopy and either biopsy or remove large polyps during a colonoscopy. Hyperplastic. These polyps occur most often in your left (descending) colon and rectum. Usually less than 5 mm in size, they’re rarely malignant. Inflammatory. These polyps may follow a bout of ulcerative colitis or Crohn’s disease of the colon. Although the polyps themselves are not a significant threat, having ulcerative colitis or Crohn’s disease of the colon increases your overall risk of colon cancer.
Anyone can get polyps, but certain people are more likely than others. You may have a greater chance of getting polyps if you
*Are over age 50
*Have had polyps before
*Have a family member with polyps
*Have a family history of colon cancer
*Most colon polyps do not cause symptoms. If you have symptoms, they may include blood on your underwear or on toilet paper after a bowel movement, blood in your stool, or constipation or diarrhea lasting more than a week.
A number of factors may contribute to the formation of colon polyps and colon cancer. They include:
*Age. The great majority of people with colon cancer are 50 or older. Your risk generally starts increasing around age 40.
*Your sex. More men than women develop colon polyps and colon cancer.
Inflammatory intestinal conditions. Long-standing inflammatory diseases of the colon such as ulcerative colitis and Crohn’s disease can increase your risk.
In an autosomal dominant disorder, the mutated gene is dominant, which means you only need one mutated gene to have the disorder. A person with an autosomal dominant disorder — in this case, the father — has a 50 percent chance of having an affected child with one mutated gene (dominant gene) and a 50 percent chance of having an unaffected child with two normal genes (recessive genes). These chances are the same in each pregnancy. .
*Family history. You’re more likely to develop colon polyps or cancer if you have a parent, sibling or child with them. If many family members have them, your risk is even greater. In some cases this connection isn’t hereditary or genetic. For example, cancers within the same family may result from shared exposure to an environmental carcinogen or from similar diet or lifestyle factors.
*Diet. Eating a high-fiber diet — one plentiful in fruits, vegetables and whole grains — can reduce your risk of colon polyps and colon cancer. Fiber seems protective against colon cancer because it provides bulk that moves your stool more quickly through your bowel. This means that cancer-causing substances (carcinogens) in the foods you eat aren’t in contact with your bowel wall as long as they might be if you ate a low-fiber diet. Fruits and vegetables are also rich in antioxidants — substances that protect cells from damage caused by unstable molecules (free radicals) that may lead to cancer.
*Smoking and alcohol. Smoking significantly increases your risk of colon polyps and colon cancer. Smokers are 30 percent to 40 percent more likely to die of colon cancer than are nonsmokers. Drinking alcohol in excess also makes it more likely that you’ll develop colon polyps. If you smoke and drink, your risk increases even more.
*A sedentary lifestyle. If you’re inactive, you’re more likely to develop colon cancer. This may be because when you’re inactive, waste stays in your colon longer.
*Obesity. Being significantly overweight — 30 pounds or more — has been linked to an increased risk of several types of cancer, including colon cancer.
*Race. If you are black, you are at higher risk of developing colon cancer than if you are white.
Inherited gene mutations
Another risk factor for colon polyps is genetic mutations. A small percentage of colon cancers result from gene mutations. These cancers are autosomal dominant, meaning you need to inherit only one defective gene from either of your parents. If one parent has the mutated gene, you have a 50 percent chance of inheriting the mutation. Although inheriting a defective gene greatly increases your risk, not everyone with a mutated gene develops cancer.
One genetic defect that plays a key role in colon cancer occurs in the adenomatous polyposis coli (APC) gene. When the APC gene is normal, it helps control cell growth. But if it’s defective, cell growth accelerates, leading to the formation of multiple adenomatous polyps in your intestinal lining. Conditions related to APC gene defects include:
*Familial adenomatous polyposis (FAP). This is a rare, hereditary disorder that results from an APC gene defect. FAP causes you to develop hundreds, even thousands, of polyps in the lining of your colon beginning in your teenage years. If these go untreated, your risk of developing colon cancer is nearly 100 percent. The encouraging news about FAP is that in some cases, genetic testing can help determine whether you’re at risk of the disease.
*Gardner’s syndrome. This syndrome is a variant of FAP. This condition causes polyps to develop throughout your colon and small intestine. You may also develop noncancerous tumors in other parts of your body, including your skin (sebaceous cysts and lipomas), bone (osteomas) and abdomen (desmoids).
*Hereditary nonpolyposis colorectal cancer (HNPCC). This is the most common form of inherited colon cancer. It, too, results from a defect in the APC gene, but unlike people with FAP or Gardner’s syndrome, people with hereditary nonpolyposis colorectal cancer tend to develop relatively few colon polyps. They do, however, often have tumors in other organs. Hereditary nonpolyposis colorectal cancer includes Lynch I and Lynch II syndromes. People with Lynch I syndrome usually develop a small number of polyps that quickly become malignant. Those with Lynch II syndrome tend to develop tumors in the breast, stomach, small intestine, urinary tract and ovaries as well as in the colon.
Tests and diagnosis:
Nearly all colon cancers develop from polyps, but the polyps grow slowly, usually over a period of years. Screening tests play a key role in detecting polyps before they become cancerous. These tests can also help find colorectal cancer in its early stages, when you have a good chance of recovery. When early-stage cancers are found and removed during routine screening, the five-year survival rate may be as high as 90 percent.
Several screening methods exist — each with its own benefits and risks. Be sure to discuss these with your doctor:
*Digital rectal exam. In this office exam, your doctor uses a gloved finger to check the first few inches of your rectum for polyps. Although safe and relatively painless, the exam is limited to your lower rectum and can’t detect problems with your upper rectum and colon. In addition, it’s difficult for your doctor to feel small polyps. This test should not be used alone as a screening method.
*Fecal occult (hidden) blood test. This noninvasive test checks a sample of your stool for blood. It can be performed in your doctor’s office, but you’re usually given a kit that explains how to take the test at home. Be sure to follow the instructions carefully, because your diet and other factors can affect the results. You then return the test to a lab or your doctor’s office to be checked. The problem is that most polyps don’t bleed, nor do all cancers. This can result in a negative test result, even though you may have a polyp or cancer. On the other hand, if blood shows up in your stool, it may be the result of hemorrhoids or an intestinal condition other than cancer. For these reasons, many doctors recommend other screening methods instead of, or in addition to, fecal occult blood tests.
*Flexible sigmoidoscopy. In this test, your doctor uses a slender, lighted tube to examine your rectum and sigmoid — approximately the last 2 feet of your colon. Nearly half of all colon cancers are found in this area. Yet a sigmoidoscopy only looks at the last third of your colon, and doesn’t detect polyps elsewhere in the large intestine. It’s often combined with a barium enema to better visualize the entire colon, or your doctor may recommend performing a colonoscopy instead. A sigmoidoscopy can be somewhat uncomfortable, and though there’s a slight risk of perforating the colon, the risks are less than they are for colonoscopy.
*Barium enema. This diagnostic test allows your doctor to evaluate your entire large intestine with an X-ray. Barium, a contrast dye, is placed into your bowel in an enema form. The barium fills and coats the lining of the bowel, creating a clear silhouette of your rectum, colon and sometimes a small portion of your small intestine. Air may also be added to provide better contrast on the X-ray. The test typically takes about 20 minutes and can be somewhat uncomfortable because the barium and air distend your bowel. There’s also a slight risk of perforating the colon wall. Because barium enema has a higher miss rate for colon polyps, it’s not nearly as reliable as other screening tests. It also doesn’t allow your doctor to take a biopsy during the procedure to determine whether a polyp is cancerous.
*Colonoscopy. This procedure is the most sensitive test for colorectal polyps and colorectal cancer. It’s better at detecting polyps than is a barium enema X-ray alone. Colonoscopy is similar to flexible sigmoidoscopy, but the instrument used — a colonoscope, which is a long, slender tube attached to a video camera and monitor — allows your doctor to view your entire colon and rectum. If any polyps are found during the exam, your doctor may remove them immediately or take tissue samples (biopsies) for analysis. A colonoscopy takes about a half-hour. You’re likely to receive a mild sedative to make you more comfortable. The risks of diagnostic colonoscopy include hemorrhage and perforation of the colon wall. Complications are more likely to occur when polyps are removed.
*Genetic testing. If you have a family history of colorectal cancer, you may be a candidate for genetic testing. This blood test may help determine if you’re at increased risk of colon or rectal cancer, but it’s not without drawbacks. The results can be ambiguous, and the presence of a defective gene doesn’t necessarily mean you’ll develop cancer. Knowing you have a genetic predisposition can alert you to the need for regular screening.
*Pill camera. Colonoscopy is effective at detecting polyps in the colon, but the colonoscope can’t reach the small intestine. Until recently, a barium X-ray was the only way to screen the small intestine, but the test is often inaccurate. Now doctors have found that a tiny camera fitted inside a capsule that you swallow can identify polyps in the small intestine with a high degree of accuracy. But because small intestine polyps are rare, the test isn’t routinely performed.
*New technologies. New technologies such as virtual colonoscopy (CT colonography) may make colon screening safer, more comfortable and less invasive. In virtual colonoscopy, you have a two-minute computerized tomography scan, a highly sensitive X-ray of your colon. Then, using computer imaging, your doctor rotates this X-ray in order to view every part of your colon and rectum without actually going inside your body. Before the scan, your large intestine is cleared of any stool, but researchers are looking into whether the scan can be done successfully without the usual bowel preparation. Although virtual colonoscopy potentially is a tremendous step forward, it may not be as accurate as regular colonoscopy, it is highly dependent on the skill of the doctor reading the test, and it doesn’t allow your doctor to remove polyps or take tissue samples during the procedure.
Another new test checks a stool sample for DNA from abnormal cells. In preliminary studies, the test proved highly accurate, but results in the first large trial of the test were disappointing. In that trial, the DNA test found more colon and rectal cancers than did the fecal occult blood test, but fewer than did colonoscopy.
Treatments and drugs:
Although some types of colon polyps are far more likely to become malignant than are others, a pathologist usually must examine a polyp under a microscope to determine whether it’s potentially cancerous. For that reason, your doctor is likely to remove all polyps discovered during a bowel examination.
The great majority of polyps can be removed during colonoscopy or sigmoidoscopy by snaring them with a wire loop that simultaneously cuts the stalk of the polyp and cauterizes it to prevent bleeding. Some small polyps may be cauterized or burned with an electrical current. Risks of polyp removal (polypectomy) include bleeding and perforation of the colon.
Polyps that are too large to snare or that can’t be reached safely are usually surgically removed — often using laparoscopic techniques. This means your surgeon performs the operation through several small incisions in your abdominal wall, using instruments with attached cameras that display your colon on a video monitor. Laparoscopic surgery may result in a faster and less painful recovery than does traditional surgery using a single large incision. Once the section of your colon that contains the polyp is removed, the polyp can’t recur, but you have a moderate chance of developing new polyps in other areas of your colon in the future. For that reason, follow-up care is extremely important.
In cases of rare, inherited syndromes, such as FAP, your surgeon may perform an operation to remove your entire colon and rectum (total proctocolectomy). Then, in a procedure known as ileal pouch-anal anastomosis, a pouch is constructed from the end of your small intestine (ileum) that attaches directly to your anus. This allows you to expel waste normally, although you may have several watery bowel movements a day.
You can greatly reduce your risk of colon polyps and colorectal cancer by having regular screenings and by making certain changes in your diet and lifestyle. The following suggestions may help lower your risk of colon polyps and colon cancer:
*Pay attention to calcium. Calcium can significantly protect against colon polyps and cancers, even if you’ve had them before. For example, studies have shown a 19 percent to 34 percent reduction in recurrence of polyps in those who take daily calcium supplements. Good food sources of calcium include skim or low-fat milk and other dairy products, broccoli, kale and canned salmon with the bones. Vitamin D, which aids in the absorption of calcium, also appears to help reduce the risk of colorectal cancer. You get vitamin D from foods such as vitamin-D fortified milk products, liver, egg yolks and fish. Sunlight also converts a chemical in your skin into a usable form of the vitamin. If you don’t drink milk or you avoid the sun, you may want to consider taking both a vitamin D and a calcium supplement.
*Include plenty of fruits, vegetables and whole grains in your diet. These foods are high in fiber, which can cut your risk of developing colon polyps. Fruits and vegetables also contain antioxidants, which may help prevent cancer. The American Cancer Society recommends eating five or more servings of fruits and vegetables every day. Look for deep green and dark yellow or orange fruits and vegetables such as Swiss chard, bok choy, spinach, cantaloupe, mango, acorn or butternut squash, and sweet potatoes, as well as vegetables from the cabbage family, including broccoli, brussels sprouts and cauliflower. Lycopene, a nutrient found in tomatoes and other red fruits and vegetables, such as strawberries and red bell peppers, may be a particularly powerful anti-cancer chemical.
*Limit fat. People who eat high-fat diets have a higher rate of colorectal cancer than do people who consume less dietary fat. Be especially careful to limit saturated fats from animal sources such as red meat. Other foods that contain saturated fat include whole milk, cheese, ice cream, and coconut and palm oils. Restrict your total fat intake to less than 35 percent of your daily calories, with no more than 8 percent to 10 percent coming from saturated fats.
*Limit alcohol consumption. Consuming moderate to heavy amounts of alcohol — more than one drink a day for women and two for men — may increase your risk of colon polyps and cancer. A drink is considered to be a 4- to 5-ounce glass of wine, a 12-ounce can of beer, or a 1.5-ounce shot of 80-proof liquor. Curbing alcohol consumption can reduce your risk, even if colon cancer runs in your family.
*Stop smoking. Smoking can increase your risk of colon cancer and a wide range of other diseases. Talk to your doctor about ways to quit that might work for you.
*Stay physically active and maintain a healthy body weight. Controlling your weight alone can reduce your risk of colorectal cancer. And staying physically active may significantly cut your colon cancer risk. Exercise stimulates movement through your bowel and reduces the time your colon is exposed to harmful substances that may cause cancer. The American Cancer Society recommends at least 30 minutes of physical activity five or more days a week. Forty-five minutes of moderate or vigorous activity can lower your risk of breast and colon cancer even more. If you’re overweight, lose weight until you are at a healthy level and maintain it.
*Talk to your doctor about aspirin. Studies on the role of aspirin in colorectal polyp and cancer prevention are mixed. Some show a 13 percent to 28 percent reduction in relative risk of these conditions with aspirin use. Others show no risk reduction. Aspirin appears to decrease the risk of these conditions primarily when taken at a high dose, such as 325 milligrams or more a day, and for more than 10 years. But aspirin use can increase your risk of gastrointestinal bleeding, and in high enough doses, stroke. So check with your doctor before starting any aspirin regimen.
*Talk to your doctor about hormone therapy (HT). If you’re a woman past menopause, hormone therapy may reduce your risk of colorectal cancer. Women who use HT have a somewhat lower risk of colorectal cancer than do women who don’t use HT. But not all effects of HT are positive. Taking HT as a combination therapy — estrogen plus progestin — can increase your risk of breast cancer, dementia, heart disease, stroke and blood clots. Discuss your options with your doctor. Together you can decide what’s best for you.
*If you’re at high risk, consider your options. If you’re at risk of FAP because of a family history of the disease, consider having genetic counseling. And if you’ve been diagnosed with FAP, start having regular colonoscopy tests in your early teens and discuss your options with your doctor. To prevent cancer from developing, most experts recommend having surgery to remove your entire colon when you’re in your 20s. The risk for people with hereditary nonpolyposis colorectal cancer isn’t quite as great as it is for those with FAP. Doctors recommend that people at risk of HNPCC begin having regular colonoscopies around age 20, but less often recommend removing the colon.
In the past, researchers believed that folate could help prevent colon polyps, but subsequent research indicates that it has no protective effect and should not be taken for that purpose.
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.