Colorectal polyp or colonic polyp are growth or mass that appear on the inner surface of the colon. Most of them are benign or harmless. Usually these does not cause any symptom. Two main types of polyps, One is non-neoplastic which is most common in which chances of conversion to cancer is negligible and other is neoplastic polyp which have a chance to convert to cancer Non-neoplastic polyps are of three types: Hyperplastic polyps most common, inflammatory polyps and hamartomatous polyps Neoplastic are of two types: Adenomas and serrated polyps.
Most colorectal polyp do not cause any symptom, but some people with large polyps may have such as change in bowel habits, Rectal bleeding, Pain, Iron deficiency anemia due to blood loss, mucus discharge
Age: It is the most commmon risk factor. Chances of developing colonic polyp are more in older age
Inflammatory bowel disease such as ulcerative colitis and crohns disease
Family history and Genetic disorders such as Familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome
Other rare cause: tobacco and alcohol use, obesity, type 2 diabetes
Colonoscopy is the most common test for detection of colorectal polyp. It is an OPD base procedure in which gastroenterologist examine mucosa or the inner lining of the colon and rectum using a long, thin flexible tube with a camera and a light on the end. If polyp size is large they take a biopsy, otherwise small polyps can be removed at the same time
CT colonography also called as virtual colonoscopy can also be used to examine the colon indirectly but no biopsy or polypectomy can be done
Polypectomy is advised for colorectal polyps as no test can predict which polyp will turn into cancer. most polyps can be removed during colonoscopy, rarely patients may require surgery for removal of large polyps
After polypectomy prognosis depends on the histopathology report. Polpectomy is sufficient for non-neoplastic and non-invasive cancer. Bowelresection may be required in invasive cancer. Follow up colonoscopy is required as patient may again develop polyps. Daily Aspirin or NSAIDs may reduce the risk of new polyps forming
A colonoscopy is lower gastrointestinal tract endoscopy in which inside that is mucosa of the large intestine (Colon & Rectum) is examined. It is used to evaluate GI symptoms such as rectal bleeding, chronic diarrhoea and altered bowel habits. During the procedure a flexible tube called as colonoscope which has a tiny video camera at the tip is inserted into the rectum and the doctor view the inside of the entire colon
Indications for Colonoscopy
Colon Cancer Screening: For average risk patients for colon cancer, colonoscopy is done starting from age of 50 year and after 10 year thereafter for early detection of colon cancer For Evaluation of intestinal symptomsand signs such as rectal bleeding, chronic diarrhoea, chronic constipation
Preparation for Colonoscopy
It is important to clean out or empty the colon as any residue may obscure the view of rectum and colon. Patient is asked to have clear liquid diet one day prior to procedure. Laxative in the form of solution in the evening a day before procedure to empty the large bowel
Perforation: Most serious complication which may be life threatening and in 80% of cases require immediate surgery for perforation repair. Bleeding: Generally occur during therapeutic procedures such as polypectomy. It may be treated during the procedure itself by cauterization. Patient may require surgery if not controlled endoscopically
Day After Colonoscopy
Patient may feel bloating and abdomen fullness during first few hours after the procedure. Better not to drive himself after the procedure.It is expected a full recovery by the next day, if not so doctor should be consulted
Cost varies from one institute to other and also vary whether diagnostic or therapeutic procedure is done. It vary from RS 5000 to Rs 15,000
The incidence of gastrointestinal cancer is increasing. Reason being change in lifestyle, dietary habits, increased alcohol intake and smoking.The prognosis of gastrointestinal cancer patients is good if it is detected early and treated at early stage.Anorexia and weight loss are common symptom in cancer patients, along these symptoms with some GI symptoms if present should not be ignored and doctor should be consulted. There are various screening programmes for early detection of colo-rectal and liver cancer. These programmes are done for high risk patients. Screening Colonoscopyis done for patients with inflammatory bowel disease, family history of colo-rectal cancer diagnosed at early age. Regular ultrasound is done in chronic liver disease patients. Neo-adjuvant therapy for locally advance cancer of esophagus, rectum and pancreas has shown good result. Pre-operative biliary drainage is done in patients with high bilirubin who require liver resection
Upper Gastrointestinal Cancer
It include cancer of the esophagus, stomach, duodenum and small intestine.Dysphagia, Vomitting,melena are common symptom. Upper GI Endoscopy is helpful for diagnosis. CECT chest and abdomen for staging.
Lower Gastrointestinal Cancer
Cancer of the colon and rectum are lower gastrointestinal cancer. Most common symaptoms are altered bowel habits, blood in stool. Diagnosis is made by Colonoscopy. CECT abdomen for staging.MRI is done for cancer rectum There is role of Neoadjuvant therapy in locally advance rectal cancer.Surgery is the treatment of choice if cancer is resectable
Hepato-Biliary GI Cancer
It include cancer of the liver, gallbladder, bile ductand pancreas. Patient have symptom of right sided pain abdomen with jaundice. CECT abdomen along with MRCP is helpful to delineate biliary anatomy
Dr Amit Jain MS MCh (GI Surgery) is Best GI Surgeon in Delhi Noida Ghaziabad Indrapuram. Call us at 7351088686 for your queries. Visit our facebook page Dr Amit Laparoscopic Gastrointestinal Cancer & Bariatric Surgeon to know about GI cancers.
Ulcerative colitis is inflammatory condition of large bowel which starts from the rectum amd involves in a retrograde fashion the proximal large bowel. Rarely it involves the small bowel. The most common symptom is diarrhoea. Biopsy taken during colonoscopy done by gastroenterologist confirms the diagnosis. The cause of ulcerative colitis is unknown. It has been postulated that it may be caused by interaction between patient genetic susceptibility and the environment. The course of the disease is characterized by period of exacerbation of symptoms and remission. The remission of symptoms may be spontaneous or may be due to medicine. Because of transmural nature of disease it may lead to complications like abscess formation, fistula to orther organs and bowel stenosis. Long term ulcerative colitis is risk factor for bowel cancer
Indications for Surgery in Ulcerative Colitis
Fulminant disease activity not responsive to maximal medical therapy
Complications of Medical therapy for ulcerative colitis
Frequent remission despite maximal medical therapy
Growth retardation in children
Surgery for Ulcerative Colitis
Total abdominal colectomy with Hartman procedure or mucus fistula and end ileostomy is done. Once patient condition improve rectum is removed and restoration is done using ileal pouch
It can be done in one stage or two stage. Surgery done is total procto-colectomy in which whole of large bowel and rectum are removed. After that a pouch is created from distal part of ileum and this pouch is anastomosed to anal canal. The whole procedure is called as total procto-colectomy with ileo-anal pouch anastomoses.This can be done as a single time surgery. In high risk patients who are on steroids a diverting loop ileostomy is also created. In these patients ileostomy is closed after 4 weeks
The recommended colon cancer treatment or intestinal cancer is surgery. Colon cancer is one of the gastrointestinal cancer in which surgery carries a very good prognosis. Patient should be fit for surgery and cancer should be resectable. Recent studies suggest that no bowel preparation is required before surgery.Patient should be on clear liquid diet one day prior to surgery
Colon Cancer Treatment: Curative
The standard surgical treatment of colon cancer is radical colectomy. Colon is divided into four parts, ascending or right colon, transverse colon, descending or left colon and sigmoid colon. Depending on location of cancer respective colectomy is done. After colonic resection depending on patient nutrition status and tumor burden either anastomosis is done or stoma is created. Minimal 12 lymph nodes is the criteria for adequate lymadenectomy for colon cancer has been recommended. If the number of lymph nodes resected is less than 12 then the patient need adjuvant chemotherapy irrespective of staging on histopathology report
Laparoscopic Colon Cancer Surgery
Colon cancers are being operated more frequently laparoscopically by Laparoscopic colo-rectal surgeon. The length of incision in laparoscopic surgery is very minimum as compared to open surgery. Minimal incision cause less pain in the post-op period, allow early mobilization of patient and early recovery
Colon Cancer Treatment: Palliative
Palliative surgery is done for multiple site metastatic disease.The two most common symptoms for which palliation is required is large bowel obstruction and bleeding. Right or ascending colon have a tendency to bleed. Left or descending colon because diameter is less compared to right colon causes obstruction. For patients who present with large bowel obstruction depending on tumor burden and patient nutrition status either bypass is done or stoma is created. For bleeding tumors resection is done and attendants are counselled for high risk surgery
Colon Cancer Treatment: Role of Chemo-Radiotherapy
Colon cancer are less sensitive to chemo-radiotherapy thats why its role is minimal in the management of colon cancer
Today is era of Laparoscopic Surgery.Laparoscopic Colorectal Surgery has evolved gradually and nowadays even Colorectal Cancer surgery are also being done Laparoscopically.
Laparoscopic ColoRectal Surgery for Benign ColoRectal Disease
There are various benign colorectal diseases which are being done Laparoscopically. Common disease include Appendectomy, Right Hemicolectomyfor ileo-cecal tuberculosis, Sigmoidectomy for sigmoid diverticular disease, Total abdominal colectomy for Ulcerative Colitis. In Ulcerative colitispatients even pouch procedure is done laparoscopically
Laparoscopic ColoRectal Surgery for ColoRectal Cancer
Malignancy can involve any part of colon and rectum. Depending on the site of cancer various colectomy are done. These are called as radical colectomy as lymphadenectomy is also done. For rectal cancer anterior resectionis done. Depending on the location of tumor in the rectum either low anterior resection or ultra-low resection is done. Initially there was concern of long term survival rate in colorectal cancer patients being operated Laparoscopically. But now we have enough data which says that there is no difference in recurrence rate and survival rate patients being operated open or laparoscopic approach.It is the reason that colorectal malignancy patients are being operated more commonly laparoscopically by colorectal surgeon who are trained in laparoscopic surgery
Emergency Laparoscopic ColoRectal Surgery
It Include surgery for large bowel perforation, traumatic large bowel injury and large bowel obstruction.
Advantages of Laparoscopy ColoRectal surgery is early recovery.Patient can be discharged early from the hospital.No prolonged rest is required.
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Dr Amit Jain is Best ColoRectal Surgeon in Noida. Trained in GI Surgery at GB Pant Hospital Delhi. Special training in advance laparoscopic GI Cancer Surgery. Got Fellowship in Advance Laparoscopic ColoRectal Surgery. He is working at Max Hospital Patparganj Delhi and Vaishali Ghaziabad as Senior Consultant Dept of GI Surgery