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Tumor polyps

  Tumor polyps are true tumors of colonic mucosal epithelial cells. Solitary ones are generally referred to as adenomas, and they can be divided into three types according to their histological characteristics and biological behavior: tubular, villous, and mixed. Multiple ones are commonly familial adenomatous polyposis, and others include non-familial adenomatous polyposis and Gardner's syndrome, Turcot's syndrome, etc., which are associated with extraintestinal tumors. They have different malignancy rates and are considered precancerous lesions, therefore, the diagnosis of adenomas has important clinical significance.

Table of Contents

1. What are the causes of the onset of tumor polyps
2. What complications can be caused by tumor polyps
3. What are the typical symptoms of tumor polyps
4. How should tumor polyps be prevented
5. What laboratory tests need to be done for tumor polyps
6. Diet recommendations and taboos for patients with tumor polyps
7. The routine methods of Western medicine for the treatment of tumor polyps

1. What are the causes of the onset of tumor polyps

  The histogenesis of adenomas is not yet fully clear. Initially, Lane indicated that the deep crypt cells gradually develop into atypical hyperplasia with migration towards the surface. The consistency of the histochemical reaction between the adenoma epithelium and the deep crypt epithelium strongly supports the possibility that adenomas originate from the deep crypts. Another hypothesis about the origin of adenomas was described by Urbanski et al. in 1986, who found that in this type of lesion, the crypts contain fewer goblet cells and are lined by eosinophilic cells. Eosinophilic epithelium is often located near the adenoma epithelium, and there is a phenomenon of transition between the two. However, some other authors have found that eosinophilic crypts can also be seen in lesions lacking adenomatous glands. Some authors have also noted the role of intestinal mucosal lymphoid follicles, which are often adjacent to the adenoma epithelium and have been found to be related to the occurrence of adenomas in humans and experimental animals.

 

2. What complications can be caused by tumor polyps

  Tumor polyps are reversible. Autopsy findings show that in elderly individuals, there are cysts in the internal organs, and pathological examination reveals the presence of cancer cells. Therefore, they often show cellular carcinoma. However, these elderly individuals had no tumor symptoms before their death and could live with the tumor for a long time. This phenomenon has caused much thought among medical experts. Many cancer patients have not taken any medication in despair, and some common medications cannot cure cancer. It has been found that they survived with strong willpower, faith, and perseverance. Later, after being encouraged to go to the hospital for a check-up, the examination results showed no tumor, and the tumor had completely disappeared. Moreover, many of our adenoma and polyp patients have also seen their adenomas and polyps completely disappear after taking traditional Chinese medicine. In some of the tumor patients we have treated, we have combined the 'reversal therapy', 'transfer therapy', and 'starving therapy' (not directly killing cancer cells), and found that the patients' conditions stabilized after treatment, and the tumors in their bodies were encapsulated.

3. What are the typical symptoms of tumor polyps?

  Adenomas are protrusions of colonic mucosal epithelial tissue into the intestinal lumen, appearing slightly red, which can be distinguished from grayish-white hyperplastic polyps. However, even experienced endoscopists cannot diagnose them with certainty beyond 70%. Misdiagnosis is very common for adenomas less than 0.5cm in diameter or hyperplastic polyps larger than 0.5cm.

  Most adenomas are tubular adenomas, with the exact incidence rate varying in different statistical reports. This is because some statistics are based on clinical data, while others are based on experience, and it also relates to the patient's age, gender, the thoroughness and accuracy of the examination, the uniformity of diagnostic criteria, and the uniformity of naming. Tubular adenomas are commonly found in the rectum and sigmoid colon, with pedunculated adenomas more common, accounting for 85%. Their size ranges from a few millimeters to 10cm, with adenomas 1 to 2cm in diameter being most common. Adenomas found in asymptomatic population screening are often smaller than those in clinical patients, with adenomas less than 5mm in diameter being called microadenomas. They are mainly tubular adenomas but can also show moderate to severe atypical hyperplasia, and occasionally invasive cancer, which deserves attention.

  The morphology of adenomas is often spherical or semispherical, with a smooth surface and may have superficial fissures, marked congestion, and redness. Some have pinpoint hemorrhagic spots, forming a虎斑-like structure. In cases of secondary infection, the surface is covered with mucopurulent secretions. 5% to 10% of tubular adenomas may appear as white spots on the adjacent mucosa around the pedicle, or even on the opposite intestinal mucosa at the top of the adenoma. These white spots are round, about a few millimeters in size, and distributed in clusters. Their nature is not entirely clear, and histologically, they are mainly inflammatory changes.

  Villous adenomas are relatively rare, commonly occurring in adults over 50 years old, and most frequently found in the left colon, with the rectum accounting for about 82%, the sigmoid colon for about 13%, and the right colon extremely rare. Most are sessile or subpedunculated, with pedunculated adenomas accounting for only 17%. The morphology is irregular, with sessile ones presenting as flower bed-like or cauliflower-like, subpedunculated ones as fluffy balls, and pedunculated ones resembling a cluster of grapes. The surface is not smooth, with numerous fine villous protrusions, often covered with a large amount of mucus. They are relatively脆, often accompanied by erosion and bleeding, with a diameter generally greater than 2cm, larger than tubular adenomas, and gradually increasing with age.

  Mixed adenomas are a histological term, most of which are large tubular adenomas with villous growth of the aden上皮 cells, forming a mixed type. Therefore, they are similar to tubular adenomas, with pedicles and sub-pedicles being common. They may have an irregular surface, deep fissures, and are lobulated, accompanied by many villous protuberances.

  Since the gross morphology of adenomas does not have characteristic changes, there is still some error in endoscopic diagnosis and adenoma typing at present. Thompason et al. stained the polyps removed by endoscopy with 1% trypan blue and used a dissecting microscope to precisely describe the gross morphological characteristics of adenomas. They found that the lobular structures of tubular adenomas and villous adenomas are significantly different. The degree of atypical hyperplasia and the presence of invasive cancer can be predicted based on the degree of atypicality of the mucosal surface grooves and the presence of fissures or ulcers.

  The main symptoms of familial multiple adenomatosis are bloody and mucous stools, increased frequency of defecation, loose stools, as well as varying degrees of abdominal discomfort and symptoms such as weight loss and anemia. Cancerous changes often lead to intestinal obstruction, and there may also be asymptomatic individuals. The prominent feature of familial adenomatosis is the multiple adenomas in the large intestine, with the number exceeding 100 as the standard. According to Bussoy's statistics, the number ranges from 104 to over 5000, with an average of about 1000. The adenomas are distributed most frequently in the left half of the colon, especially in the sigmoid colon and rectum. According to the degree of distribution of adenomas, the adenomatosis is divided into dense and non-dense types. The former refers to dense growth of adenomas with almost normal mucosa in between, while the latter refers to adenomas with normal mucosa between them. Generally, adenomas with a total number exceeding 1000 are more likely to be dense, and those with fewer than 1000 are non-dense. Under X-ray, they appear as nearly uniform circular filling defects throughout the large intestine, with a diameter of 0.3 to 0.5 cm, smooth contours, and in areas with dense polyps, air-barium double contrast imaging resembles corn-like arrangement, but traditional barium enema is easily overwhelmed by barium and may lead to missed diagnosis.

4. How to prevent neoplastic polyps

  There is no effective preventive method for this disease. Early detection and early treatment are the key to prevention and treatment. It is recommended to have a full-body examination once a year to achieve primary prevention. If the presence of neoplastic polyps has been detected, active treatment should be sought, and surgery may be necessary for removal, followed by pathological examination for secondary prevention. At the same time, maintaining a good mental state, active physical exercise, regular sleep and rest, and a healthy diet can enhance resistance and prevent the disease.

 

5. What laboratory tests are needed for neoplastic polyps

  1. X-ray:Barium enema can sensitively detect colonic polyps through the filling defect of barium, but it often cannot correctly classify and determine the nature of the lesions. Endoscopic examination not only allows direct visualization of the fine lesions of the colonic mucosa but also can determine the nature of the lesions through tissue biopsy and cytological brush examination, making it the most important means for the detection and diagnosis of colonic polyps.

  2. Endoscopic examination:All discovered polyps must undergo histological examination to understand their nature, type, and whether there is malignancy, etc. Small polyps with pedicles can be removed by biopsy forceps or snare forceps, followed by examination, while large or broad-based polyps often can only be subjected to biopsy by forceps.

  3. Biopsy:Since the amount of villous components and the degree of atypical hyperplasia in different parts of the same adenoma are often different, the lesion at the biopsy site cannot fully represent the whole picture. The absence of cancer transformation at the biopsy site cannot definitely confirm that there is no cancer transformation elsewhere in the adenoma. Therefore, the degree of atypical hyperplasia and the absence of cancer transformation in adenomas often require the entire tumor to be removed and carefully sectioned for examination to be confirmed. The pathological results of needle biopsy can be referred to, but are not the final conclusion. The discrepancy between the preoperative needle biopsy results and the postoperative pathological diagnosis is quite common in villous adenomas, as reported in 1140 cases of villous adenomas collected by Tayloy, where preoperative needle biopsy was benign, but the postoperative confirmed cancer transformation reached 23% to 80%. Clinical physicians must understand the limitations of needle biopsy in diagnosis.

6. Dietary taboos for patients with tumor polyps

  1. Eat more foods with anti-tumor effects:Goat's blood, horseshoe crab, crab, sheep brain, sea cucumber, oyster, turtle, tortoise, sand worm, deer blood, large-leaf vegetables, wheat, amaranth, rapeseed, jujube, wild grape.

  2. Eat foods that can prevent the side effects of radiotherapy and chemotherapy:Honey, walnut, kiwi, silver ear, mushroom, rapeseed, pollen.

  3. Avoid spicy and刺激性 foods:Such as scallion, garlic, ginger, Sichuan pepper, chili, cassia bark, etc. Avoid fatty and greasy foods.

7. Conventional methods of Western medicine for treating tumor polyps

  1. Treatment principles for adenomas:Once found, it should be removed endoscopically and a full tumor biopsy should be performed. For those who have the following conditions, surgical treatment should be performed: lymphatic infiltration; histological demonstration of poor differentiation of cancer tissue; invasion of cancer in the resection margin or adjacent to the adenoma. In adenoma specimens, about 2% to 5% are found to have invasive adenocarcinoma, and the total number of patients with lymphatic metastasis does not exceed 5%, indicating that the majority of polyps undergo malignant transformation, especially those with pedicles, endoscopic resection is appropriate. Lymphatic metastasis is very rare in pedunculated polyps where cancer transformation is limited to the head of the polyp.

  2. Treatment principles for familial multiple adenomatous polyposis:Once diagnosed, the entire colon that may undergo cancer transformation should be removed to prevent the occurrence of colorectal cancer. For patients who have already developed cancer, appropriate radical surgery should be chosen.

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