Signs of Precancerous Colon Conditions

What Are Precancerous Polyps?

Precancerous polyps, also called adenomas or adenomatous polyps, are small clumps of cells that form on the inside of the colon. These clumps create abnormal bumps or growths on the colon lining. Polyps are fairly common, especially in older individuals, and are typically harmless. In rare cases, however, they may turn into colon cancer. For this reason, many healthcare providers recommend that polyps be removed, especially if other colon cancer risk factors are present.

Precancerous or adenomatous polyps are typically detected during routine screenings. If polyps are found, they will be removed with a biopsy. Further testing is used to determine their growth pattern, which can be used to predict their likelihood of becoming cancer.

• Tubular: Most small polyps follow a tubular growth pattern, with cells forming in orderly, tube-like rows. This type is less likely to become cancerous.
• Villous: Larger polyps may follow a villous growth pattern with a shaggy cauliflower appearance and finger-like protrusions. This type is more likely to become cancerous.
• Tubulovillous: This growth pattern combines features of both tubular and villous polyps and has an intermediate risk of becoming cancer.

Polyps will also be evaluated for dysplasia, or their resemblance to cancer cells. Polyps with low-grade dysplasia appear mostly normal, with only some similarities to cancer cells. Polyps with high-grade dysplasia are more abnormal and look more like cancer. Dysplasia in polyps is not necessarily a concern. As with growth patterns, however, it can be a predictor of whether they will become cancer.

In most cases, adenomatous polyps are small enough to be fully removed with a colonoscopy biopsy. The healthcare provider may request a follow-up colonoscopy to ensure that all the polyp tissue has been removed. Rarely, very large polyps may require surgery for complete removal.

Signs of Precancerous Polyps

Most adenomatous polyps do not cause any noticeable symptoms. People can go for years without noticing they have polyps unless they receive a colonoscopy. In some cases, however, an individual may notice some changes. Common signs and symptoms include:

• Bowel habit changes: The person may experience chronic constipation or diarrhea that cannot be explained by other factors.
• Stool changes: There may be changes in the appearance of stools, especially excess mucus or an unusually elongated or pebble-like shape.
• Rectal bleeding: Blood may appear in stool or when the individual wipes. This is the most common sign of precancerous polyps.
• Anemia: Significant rectal bleeding may cause iron-deficient anemia with side effects that include persistent weakness or fatigue.

It is important to note that the great majority of women and men who experience one or more of the symptoms will not have colon cancer. Nonetheless, it is important to consult a physician about these symptoms, particularly if they are pronounced, arose suddenly, or have persisted for an extended period. Prompt evaluation will enable a doctor to address your concerns and to provide a treatment plan for whatever condition may be responsible for the symptoms.

What Are Hereditary Colorectal Syndromes?

Anybody can be affected by precancerous polyps. A few hereditary conditions, however, can cause large numbers of polyps to form. These are known as hereditary colorectal syndromes. Though rare, they can increase a person’s likelihood of developing colorectal cancer.

Familial Adenomatous Polyposis

Familial adenomatous polyposis, also called FAP or Gardner syndrome, is an inherited condition that causes hundreds of adenomatous polyps to form. Early stages of FAP cause no identifiable symptoms. In later stages, people may experience changes in their bowel habits, small or bloodied stools, abdominal cramps, gas, bloating, and vomiting. Abnormalities may appear in other areas of the body as well, including cysts, bumps or lumps on bones, or spots on the inside lining of the eyes.

Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome (PJS) is a condition that causes polyps to form inside the gastrointestinal tract while dark spots appear on the face, hands, feet, and other body parts. The spots arise during childhood and are caused by hyperpigmentation, or an excess of pigment. They are often mistaken for natural freckles. While spots generally fade over time, the polyps remain into adulthood. The polyps themselves are benign. PJS itself, however, substantially increases an individual’s cancer risk.

Lynch Syndrome

Lynch syndrome, also called hereditary non-polyposis colorectal cancer (HNPCC), is a common hereditary condition that puts individuals at higher risk of other cancers in the gastrointestinal or reproductive systems. Lynch syndrome causes no symptoms by itself. If a person’s family has a high incidence of cancer, however, they should consider genetic testing to determine whether a mutation like Lynch syndrome is responsible.

Juvenile Polyposis Syndrome

Juvenile polyposis syndrome (JPS) is an inherited disorder that causes multiple polyps to form in the gastrointestinal tract, often before age 20. People may experience symptoms of adenomatous polyps. They may also have abnormalities elsewhere in the body, including the heart, brain, fingers, toes, genitals, and roof of the mouth. JPS greatly increases the likelihood of developing a variety of gastrointestinal cancer types, not just colon cancer.

The Importance of Colon Cancer Screening

Precancerous polyps, and colon cancer itself, may cause no symptoms at the start. This is why routine screenings are important. These tests are an opportunity to detect colon conditions in their earliest stages. The American Cancer Society recommends that people at average risk for colon cancer should start routine screenings at age 45. Screening types and recommended frequencies include:

• Stool-based tests: These tests check the stool for blood, mucus, immune cells, and other signs of colon or rectal cancer. They should be performed every three years.
• Visual exams: These tests look inside the colon and rectum for abnormalities. Visual exams (using medical imaging) should be performed every five years, while colonoscopies (using a scope) should be performed every 10 years.
• Blood-based tests: These tests check blood for DNA changes that may indicate the presence of cancer or pre-cancerous polyps. There are currently no guidelines for blood-based colon cancer screening.

Individuals at high risk of colon cancer, such as those with a hereditary colorectal syndrome, may need more frequent screening. Their healthcare provider can help them determine what screening schedule is most appropriate.

Learn More about Colon Cancer Screenings

When it comes to colon cancer treatment, early detection is key. Precancerous polyps and hereditary syndromes can be diagnosed through medical screening, allowing people to act fast to seek treatment and reduce their risk of cancer.

Many individuals who are diagnosed with colon and other cancer types turn to RCCA, a group of more than 100 medical oncologists and hematologists who treat patients who have solid tumors, blood-based cancers and benign blood disorders. RCCA patients can receive cutting-edge treatments close to home, making cancer care convenient for patients and their families. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, cutting-edge diagnostics as well as access to approximately 300 clinical trials in community-based centers close to home.