Tubular adenoma of the colon is a benign neoplasm on a pedicle or broad base, arising from the epithelium of the colon and rising above it. Tubular adenoma refers to adenomatous polyps, which, according to modern concepts, are precancerous diseases of the colon, which explains the close attention of coloproctologists to this problem.
- Tubular adenoma of the colon - what are its features?
- Tubular adenoma of the colon with dysplasia
- Reasons for development
- Diagnosis and treatment
- Prevention of the development of tubular adenomas
Tubular adenoma of the colon - what are its features?
Colon adenomas occur more often in men than in women, and mainly in older people. Tubular adenomas can have different sizes, but small ones are more common, up to 1 cm in diameter. When examining the colon, either one solitary adenoma or several can be detected. There is an opinion that it is numerous adenomas of the colon that are obligate precancer, that is, they have an almost one hundred percent risk of degeneration into a malignant tumor.
Tubular adenoma is the most common type of adenomatous polyps of the colon; according to the literature, they occur in 75-87% of cases. Can be detected in any part of the intestine. A feature of tubular adenoma is its histological structure, determined predominantly by tubular - as the name suggests - structures. At the microscopic level, tubular adenoma of the colon consists of glandular tubes that are longer than those in the normal mucosa.
Macroscopically, tubular adenomas have a stalk and a smooth lobulated surface, less often a wide base. They are similar in color to the surrounding mucous membrane, but have a denser consistency, move along with the mucous membrane, and rarely bleed or ulcerate.
In addition to tubular adenomas, there are two more types: tubulovillous adenoma and villous adenoma. Of the three listed, tubular adenomas have the least potential for malignancy (although it cannot be completely excluded), but over time, villous components may appear and predominate in their structure, that is, a tubular adenoma can turn into tubulovillous, and then into villous, which is at risk degeneration into a malignant tumor is already significant.
Classification
Histologists distinguish the following types of malignant neoplasms of the large intestine:
- Well-differentiated colon adenocarcinoma;
- Moderately differentiated colon adenocarcinoma g2;
- Poorly differentiated adenoma.
Glandular cancer can generally be represented by the following types of colon carcinomas: tubular, mucinous, signet ring cell, squamous cell. Tubular adenocarcinomas consist of tubular structures. Tumors of this type occur in more than 50% of patients with glandular cancer. They have blurred contours and small sizes.
Mucinous adenocarcinoma consists of mucous components and epithelial structures and has no defined boundaries. Metastasis occurs through the lymphogenous route. The high risk of recurrence is due to insensitivity to radiotherapy.
Signet ring cell adenocarcinomas are characterized by a highly aggressive clinical course. Most patients with tumors of this type, who seek medical help at the Yusupov Hospital for the first time, already have metastases in the lymph nodes and liver. Oncological disease is most often observed in young patients.
Squamous cell adenocarcinomas form in the area of the anal canal. The tumor consists of flat epithelial cells. The clinical course of squamous cell adenocarcinomas is characterized by a high level of malignancy. They often recur, growing into the tissue of the vagina, ureters, bladder, and prostate gland. The five-year survival rate for squamous cell adenocarcinomas does not exceed 30%.
Tubular adenoma of the colon with dysplasia
Each of the identified adenomas, regardless of type and structure, has signs of dysplasia. There are three degrees of dysplasia - mild, moderate and severe (or high). The degree of dysplasia is determined by histological examination of the removed adenoma based on a number of characteristics. Predominantly adenomas with a mild degree of dysplasia are diagnosed. The larger the size of the adenoma and the older the patient, the greater the risk of developing an adenoma with signs of severe dysplasia. The degree of dysplasia is one of the most important factors in the malignancy of an adenoma, along with its size, location, duration of the disease and replacement of the tubular structure with a villous one. An extreme degree of dysplasia is usually equated to cancer in situ. At the same time, epithelial dysplasia itself is not cancer, but since it is essentially a violation of the normal tissue structure of a part of an organ, in this case the colon, it can, with further progression and an increase in its severity, lead to the appearance of tumor cells.
Reasons for development
The main reason for the development of tubular adenomas has not yet been established, but factors that can lead to their appearance have been identified.
Heredity plays an important role in the development of tubular adenoma of the colon.
Diffuse hereditary polyposis and familial adenomatous polyposis syndrome of the colon are diseases in which multiple colon adenomas develop, including tubular ones, which have the highest risk of degeneration into cancer. Therefore, patients with such syndromes require surgical treatment as early as possible, and their close relatives require careful screening monitoring.
Other reasons for the development of tubular adenomas include the following:
- A diet high in refined foods, animal fats and insufficient fiber intake,
- Dysbiosis of the colon, since in this condition local immunity is impaired and the restoration of the mucous membrane of the intestinal wall is impaired,
- Chronic diseases of the large intestine, primarily inflammatory,
- Diverticulosis,
- Frequent constipation and intestinal dyskinesia,
- Physical inactivity, excess body weight.
Complications
One of the most dangerous consequences is the process of malignancy, when benign cells begin to transform into malignant ones.
In addition, if the disease is not treated in time, the cellular structures continue to grow, which leads to blockage of the intestinal lumen. As a result, intestinal obstruction develops.
After surgery, complications may occur in the form of bleeding from the anus.
Perforation of the intestinal walls cannot be ruled out, which can occur against the background of a burn during electrocoagulation.
Diagnosis and treatment
Colon adenomas usually do not manifest any symptoms and are an incidental finding during screening or examination for other complaints.
In rare cases, a tubular adenoma of the colon may bleed, which becomes a reason to consult a doctor. In addition, patients may complain of abdominal pain, frequent constipation or diarrhea.
The gold standard for diagnosis is colonoscopy. In addition to it, irrigoscopy and sigmoidoscopy may be prescribed.
There is an opinion according to which endoscopic removal of only adenomas with a diameter of more than 5 mm is recommended, since smaller formations become malignant extremely rarely and dynamic observation is acceptable. However, a more common tactic is in which all adenomas are removed, regardless of the size of the tumor, since histological studies show that polyps even less than 5 mm in diameter in 60-70% of cases have tubular-type areas and, accordingly, have the potential to degenerate into malignant formations.
There is currently no effective conservative treatment for tubular adenomas, and patients are advised to undergo surgical treatment. The tactics of surgical treatment largely depend on the diagnostic method used to diagnose colon adenoma with dysplasia. If the patient undergoes a colonoscopy, then all detected polyps larger than 5 mm are removed. If polyps were identified during another type of intestinal examination (for example, irrigoscopy), then if a small tubular adenoma of less than 1 cm is detected, a biopsy must be performed, and after confirming the diagnosis, the patient is shown a colonoscopy to remove all visualized adenomas and their histological examination. If a colon adenoma larger than 1 cm in size has been identified, then there is no need for a biopsy - the patient must be immediately referred for a colonoscopy. Thus, colonoscopy for detected adenomas becomes both a diagnostic and therapeutic measure.
When adenomas are localized in the colon, removal is carried out endoscopically through a colonoscope. If the adenoma is located in the rectum, removal can be performed using an endoscope or by transanal endomicrosurgery. The peculiarity of this operation is that in this case the tubular adenoma is removed simultaneously with resection of the intestinal wall. This is explained by the fact that when an adenoma is localized in the rectum, in almost every third case, cancer cells are already detected at its base.
In the case of multiple polyps (so-called diffuse lesions), it is advisable to perform a colotomy or resection of the affected area of the intestine.
Unfortunately, tubular adenomas are prone to recurrence. The most common cause of relapse is incomplete removal of the base of the adenoma, if it is not located on a long stalk. In case of recurrent tubular adenoma, surgical removal of the affected area of the colon by laparotomy may be required, since postoperative changes may be an obstacle to complete endoscopic removal of the recurrent adenoma.
Prevention of the development of tubular adenomas
In many cases, colon adenoma is a sign of a hereditary disease, so patients with a family history of colon diseases, including cancer, form a risk group that should be under close medical supervision and regularly undergo screening tests for the early detection of adenomas.
Since chronic diseases of the large intestine, such as colitis, can contribute to the development of tubular adenomas, treatment or compensation of these diseases will also prevent the formation of adenomas.
Since nutritional factors such as high fat content, especially refined fat, and low dietary fiber content in the daily diet are directly related to the appearance of intestinal adenomas, diet correction will help not only prevent the appearance of tubular adenomas, but also have a positive effect on the growth dynamics of existing ones adenoma.
A connection has also been identified between smoking and the development of tubular adenomas, and the number of adenomas is directly proportional to the duration of smoking, so giving up this bad habit will have a positive effect not only on the lungs, but also on the colon.
Finally, since the development of colon adenomas is promoted by a sedentary lifestyle and excess body weight, exercise and weight management may also be a reasonable recommendation for the prevention of the development of tubular adenomas.
In the case of already identified tubular adenomas, dynamic monitoring of patients using endoscopic methods is indicated. The frequency of examinations is determined individually, based on the specific clinical situation, but the following regimen is considered optimal:
- after removal of large adenomas on legs and narrowed bases: in the first year - every 6 months, subsequently - once a year;
- after removal of large wide-based adenomas and tubular adenomas with dysplasia (regardless of their macroscopic properties): in the first year - once every 3 months, in the second year - once every 6 months, thereafter - once a year.
Tubular adenoma of the colon is a benign neoplasm that can be the source of a malignant neoplasm - colon cancer. Therefore, in no case should one be dismissive of this pathology. Euroonko has all the capabilities to conduct comprehensive diagnostics, professional removal of adenomas and follow-up with highly qualified specialists.
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Rehabilitation
Recovery takes place under constant medical supervision. If endoscopic intervention was performed to cut off a benign polyp, the first control gastroscopy is done two weeks later. For cavity removal of adenomatous neoplasms - when the incision has completely healed. The basis of patient rehabilitation is diet. In the first month, the patient is allowed only liquid porridges and pureed soups. Then he is transferred to dietary table No. 1 for people with gastrointestinal diseases.
The basis of the diet of a patient with adenomatous benign neoplasms is:
- vegetable broth soups;
- meat, low-fat fish;
- dried white bread;
- soft-boiled eggs (steam omelet);
- porridge with milk or water;
- sweet berries, fruits;
- fermented milk products with a low fat content.
Dishes need to be boiled, baked, steamed. Boil vegetables and pasta well and grind in a blender.
The following sweet desserts are allowed:
- cookie;
- jam;
- berry, fruit mousses, purees;
- cottage cheese;
- dry biscuit;
- paste;
- baked pies;
- honey;
- marshmallows
You need to eat sweets little by little, 2-3 times a week. It is permissible to diversify the menu with light sour cream sauces, adding a small amount of dill and parsley.
Prohibited for patients with gastric adenoma:
- fatty meat, fish, lard;
- baking from yeast dough;
- legumes;
- marinades;
- cabbage;
- canned food;
- mayonnaise;
- fast food;
- pickles;
- semi-finished products;
- radish, radish;
- citrus;
- confectionery;
- hot, spicy sauces.
Tea and coffee are allowed to be drunk occasionally, weak, with the addition of milk. Carbonated and alcoholic drinks should be replaced with natural sweet juices (not packaged), fruit drinks, and rosehip decoction.
During the first time after surgery to cut off benign adenomatous polyps of the stomach, patients are prohibited from taking a hot bath, lifting weights, or playing sports. Any discomfort or pain in the area of the affected organ should be reported to your doctor immediately. Drug therapy is used only as recommended by a doctor. Self-administration of any medications can provoke recurrence of adenomatous neoplasms. If necessary, the patient will be prescribed a course of physiotherapeutic procedures.