Colorectal polyps are classified as to neoplastic polyps and nonneoplastic polyps. Nonneoplastic polyps include hamartomas, benign lymphoid polyps, inflammatory polyps, and hyperplastic polyps. Neoplastic polyps are adenomas and account for one-third of all polyps. Adenomas increase with age and occur anywhere in the colon with a slight predominance in the left colon.
The risk factors for adenomas polyps and colorectal cancer include: age>40 years, previous history of polyp, inflammatory bowel disease, a first-degree relative with colon cancer or adenoma.
The polyposis syndromes include: Familial Adenomatous Polyposis, Gardners Syndrome, and Turcots Syndrome, Peutz-Jeghers Syndrome, Familial Juvenile Polyposis. . An energetic student may want to discuss these.
The common signs and symptoms of colorectal cancer include: rectal bleeding (usually red), obstruction, diarrhea, tenesmus, change in caliber of stool, perineal pain, anemia and other signs of anemia, anorexia, weight loss, ascites hepatomegaly
Patient #1 who is healthy with a guaiac positive stool is unlikely to have cancer. He may have hemorrhoids, polyps, AVMs. IBD is a possibility but he has no other symptoms. Diverticulosis does not usually bleed occultly. UGI source also unlikely without symptoms. He needs a colonoscopy.
The CBC in Patient #1 should be normal with normal red cell indices. Patient #2 is likely to have a microcytic, hypochromic anemia.
Unlike Patient #1, Patient #2is likely to have colorectal cancer. There is a family history of cancer, weight loss, new onset constipation, and worsening symptoms with fiber supplements. A left sided lesion is likely. She needs colonoscopy for diagnosis and probable surgical intervention.