Finding a growth in the colon can naturally cause apprehension. While the term “cyst” is sometimes used broadly by the public, various types of growths can occur in the colon, each with different implications for health. Understanding these distinctions is important for clarifying when such growths might be dangerous and what steps are involved in their management.
Understanding Colon Growths: More Than Just “Cysts”
When people refer to “cysts” in the colon, they often use a generalized term for any abnormal growth. True cysts, which are fluid-filled sacs, are rare in the colon and are typically benign. Pseudocysts are collections of fluid or debris that lack a true lining and are usually related to inflammation, also benign.
The most common types of growths found in the colon are polyps, which are tissue growths on the inner lining of the colon. Polyps vary significantly in their characteristics. Hyperplastic polyps are common and generally have a very low risk of becoming cancerous, often found in the lower colon.
Other types, known as neoplastic polyps, carry a risk of developing into cancer. These include adenomatous polyps and sessile serrated lesions. Adenomatous polyps, or adenomas, are the most frequently encountered type, accounting for about 70% of all polyps found. While most adenomas are not cancerous when discovered, they have the potential to become malignant over time. Sessile serrated lesions (SSLs) are another serrated polyp type considered precancerous, often challenging to detect due to their flat or slightly raised appearance.
Another common finding during colon exams are diverticula, small, bulging pouches that form in the digestive system lining. These are not “cysts” or precancerous growths. They are out-pouchings of the colon wall, typically occurring in the lower colon. While generally harmless, they can sometimes lead to complications.
Assessing the Danger: When Colon Growths Become a Concern
The danger associated with colon growths stems from their potential to develop into cancer or cause other complications. Neoplastic polyps, such as adenomatous polyps and sessile serrated lesions, are of particular concern because they can progress to colorectal cancer. This transformation occurs through the adenoma-carcinoma sequence, where genetic changes accumulate, leading normal cells to become dysplastic (abnormal) and eventually cancerous.
Factors that increase the risk of a polyp turning cancerous include its size, number, and microscopic features. Polyps larger than 1 centimeter are associated with a greater cancer risk. Approximately 75% of colorectal cancers originate from adenomatous polyps. While most adenomas remain benign, about 5% are malignant.
Diverticula, although not precancerous, can lead to painful and serious conditions. If stool or bacteria become trapped within these pouches, it can cause inflammation and infection, known as diverticulitis. Complications include abscess formation, intestinal obstruction, fistulas, or even perforation, which can lead to peritonitis. Diverticular bleeding can also occur if a small blood vessel within a diverticulum ruptures.
True cysts and pseudocysts in the colon are benign and rarely cause significant problems. If they grow very large, they could cause symptoms due to obstruction or, in rare instances, rupture. Such occurrences are uncommon, and these growths do not pose a serious threat.
Identifying and Diagnosing Colon Growths
Many colon growths, especially in early stages, do not cause symptoms. This absence of symptoms underscores the importance of regular screening. When symptoms do occur, they can include changes in bowel habits like persistent diarrhea or constipation, rectal bleeding, abdominal pain or cramping, unexplained weight loss, or fatigue from anemia.
Colonoscopy is the primary method for detecting colon growths because it allows direct visualization of the entire colon. During the procedure, a flexible tube with a camera is inserted into the rectum and advanced through the large intestine. This not only identifies growths but also allows for their immediate removal or biopsy.
Other diagnostic methods include flexible sigmoidoscopy, which examines only the lower colon. Stool-based tests, such as Fecal Immunochemical Test (FIT) or stool DNA tests, screen for blood or altered DNA in the stool, indicating the need for further investigation. Imaging techniques like CT colonography, also known as virtual colonoscopy, use X-rays to create detailed images of the colon. While less invasive, suspicious findings require a follow-up colonoscopy for confirmation and removal.
Managing and Monitoring Colon Growths
Once colon growths are identified, management strategies depend on their type and characteristics. For polyps, removal during a colonoscopy, called a polypectomy, is the usual approach. This prevents precancerous polyps from developing into cancer. All removed polyps are sent for pathological examination to determine their type and assess for cancerous cells.
Diverticula do not require treatment if asymptomatic. Management involves dietary changes, such as increasing fiber intake, to promote regular bowel movements and reduce colon pressure. If diverticulitis occurs, treatment involves antibiotics and rest. In severe or complicated cases, such as those involving abscesses, perforations, or recurrent episodes, surgery may be necessary.
True cysts and pseudocysts in the colon require no specific intervention unless they become symptomatic due to their size or location. If they cause pain or obstruction, drainage or surgical removal might be considered. However, this is uncommon due to their benign nature.
Ongoing surveillance and follow-up are important after the detection and removal of colon growths, particularly for polyps. The frequency of follow-up colonoscopies is determined by factors such as the number, size, and type of polyps found, as well as an individual’s personal and family history of colon growths or cancer. Regular follow-up helps to monitor for new growths or the recurrence of polyps, ensuring early detection and intervention.