Usually polyps are incidental things discovered when you’re having a colonoscopy for another reason,” says Dr Sinead Byrne, consultant gastroenterologist at the Mater Private Hospital.

“You’d have a colonoscopy if you’ve had abdominal pain or a change of bowel habit that has lasted more than two weeks or if you’ve had some rectal bleeding, for example.”

Polpys are little growths in the lining of the colon. They can vary in shape from a small raised area, a cluster of bumps or to looking like grapes on a stalk.

“There are four different types – two that bear a cancer risk and two that don’t,” Dr Beirne says, “so if we come across them we remove them in case of future problems.”

The inflammatory and hyperplastic type of polyps do not generally carry a cancer risk while the adenomatous and villus types do.

“The last two make up about 70% and 15% respectively of the polyps that go on to develop colon (or colorectal) cancer.”

DON’T KNOW YOU HAVE THEM

So what are the causes of polyps?

“There are a lot of potential causes but in the majority of cases there is a genetic predisposition towards them – a tendency you’re born with. Smoking increases the risk along with a diet high in animal fat and animal protein, so a very significant intake of red meat wouldn’t be ideal,” she says.

But would we know that we have a polyp?

“No, you don’t know you have them – that’s the problem,” she says. “Unless they are large and the tips of them become ulcerated, causing some blood in the stool, you wouldn’t know.”

If you see a doctor about symptoms like these, he or she will do what’s called a FIT test (fecal immunochemical test).

“This is a colon cancer screening test, the same as is done in the BowelScreen programme, and it will pick up small amounts of microscopic blood that might be coming from the polyps, so it could point to potential polyps if that FIT test was positive.

“If the polyp was extraordinarily large and obstructing the colon, that would cause symptoms too but in the majority of cases there are no symptoms,” she says.

If polyps are discovered they are always removed.

“That’s because it’s very difficult to tell by looking at them what type of polyp they are, so we take them out and send them to a pathologist for examination and to determine what type it is. The result of that test will determine what follow-up the person has afterwards.”

If a very large polyp is discovered and cancer is suspected, later surgery may be necessary.

“Polys are always removed during an endoscopy unless they are very big. If that’s the case, we would timetable surgery at a later date. Also, if we discover polyps and the patients is on anti-coagulants like aspirin or warfarin, we may postpone taking out the polyp until they’ve been off those drugs for a while. That’s to minimise the risk of bleeding,” she adds.

HOW POLYPS ARE REMOVED

While a variety of techniques are used to remove polyps, most are removed using what’s called ‘snare cautery’.

“It’s not really burning them off, it’s more a coagulation technique to coagulate the blood vessels so that you reduce the risk of bleeding.

“The polpys are elevated by injection first – the injection is given underneath them so that we don’t perforate – and then we put a snare, like a metal lasso, around them. We then either cut them off or photo-coagulate them off (a method that uses a laser beam to destroy or fuse small areas of tissue). The polyps are then sent to the laboratory for analysis.”

Patients will go home afterwards as normal, she says, and shouldn’t experience any ill effects from the colonoscopy.

As regards treatment, it’s very much a case-by-case scenario.

“Sometimes patients may need treatment before surgery, some need surgery directly. It depends on where the polyp is and other associated factors. There is no one solution fits all.”

ALL POLYPS AREN’T CANCER

It is difficult to say what percentage of polyps become cancerous, she says, because it depends on the type of polyp.

“What I can say is that not all polyps are cancer but most cancers arise from polyps.”

She recommends readers taking up the offer of the BowelScreen screening FIT test that those aged 60-69 are now being offered free in this country.

“It is a very good screening check. The FIT test is a simple test people can do at home and if it’s positive then you need to have a colonoscopy.”

WHAT IS A COLONOSCOPY?

A colonoscopy is a telescopic and visual examination of the interior lining of the bowel.

This is performed by passing a small flexible tube through the rectum into the large bowel.

During the examination, biopsies may be taken by passing a small forceps through the colonoscope to pinch out a small bit of the lining to send to the laboratory for analysis.

BOWEL PREPARATION IS ESSENTIAL

– FOLLOW INSTRUCTIONS

Having a colonoscopy is not a huge deal, Dr Byrne says, but she would like to stress that the bowel preparation before the test is very important.

“It is so important that you do this absolutely correctly, as per the instructions you get, because if the bowel is not cleaned out we will not be able to see all we need to see, eg small polyps in the colon. The examination is only as good as the bowel prep.”

The colonoscopy lasts about 30-40 minutes.

“The patient is lightly sedated – not knocked out cold – and can usually go home within four hours of the procedure. There are no residual symptoms afterwards. A colonoscopy is a very straightforward test.”

GET CHECKED IF FAMILY HISTORY

OF COLORECTAL CANCER

In relation to colon cancer risk, she advises requesting a colonoscopy if you have a history of colorectal cancer in your family, even if you have had no symptoms.

“Remember colon cancer can be prevented. Most polyps can develop into cancer but they are not cancerous at the polyp stage, so if they are removed then that removes the risk from that polyp.”

COULD RECUR

If you do have polyps, you will need a follow-up colonoscopy every three to five years, depending on the type and the number you have, to make sure they don’t recur as polyps have a tendency to do that.

“You can help modify your risk of them coming back by never smoking or stopping if you do, by having a healthy diet full of vegetables and fruit and eating less meat.

“Taking exercise four or five times a week and only drinking alcohol within the recommended limits will help too.”

For more information about the free bowel screen test for those between the ages of 60-69 visit www.bowelscreen.ie CL

>> Health news

DIABETES SCREENING

Lidl has teamed up with the charity Diabetes Ireland to offer free diabetes screening to its employees and customers.

The custom-built bus will be visiting the locations listed in September. The screening will involve a questionnaire, a finger prick test, BMI and waist measurements and analysis of this data.

Lidl is doing this to send out a clear message to its 5,000-person team that the company is invested in its employees’ health and wellbeing, they state, and to raise awareness of diabetes type two among their 1.5 million weekly shoppers.

Dr Anna Clarke of Diabetes Ireland says: “We are delighted to partner with Lidl Ireland in rolling out this important initiative, which we hope will help people across the country better understand the risk factors associated with type two diabetes, how to identify those risk factors in their own lifestyle and correct the modifiable ones and proactively manage their health.”

See www.diabetes.ie/are-you-at-risk for more information.

Screenings take place from 10am-4 pm. The initiative began on 17 July, visiting 92 locations in total.

Pictured left at the launch was Minister for Health Simon Harris TD with Dr Anna Clarke of Diabetes Ireland and Maeve McCleane, Lidl HR director.

ADULTS WITH DOWN’S SYNDROME MORE LIKELY TO GET DEMENTIA

A Trinity academic has called for urgent changes in diagnosis practices and care planning for those with Down’s Syndrome given that they are more likely to develop dementia and more likely to develop it at an earlier age than the general population.

These facts were shown in a 20-year study where 77 women with Down’s Syndrome over the age of 35 years were screened in 1996 and assessed for symptoms of dementia on an annual basis until death.

Assessments were completed in a specialist memory clinic.

97.6% of the women developed dementia over the 20 year period. The prevalence rates in the general population are 5-7% in people over 65 years.

In those with Down’s Syndrome the risk of developing dementia by the age of 65 is 88%.

Professor Mary McCarron who led the study says that radical changes need to be made in order to respond and address the needs of this often vulnerable group of people.