All You Ever Wanted To Know About Polyps

What Are Polyps?

Polyps are growths in the bowel.

They can have a stalk, like a cauliflower, or be flat like moss. Polyps can cause bleeding or mucus in the stools, and on rare occasions it can cause bowel obstruction.  There are 2 types of polyps: malignant as well as benign polyps.

However, evidence suggests that polyps kept for a long time in the body can turn cancerous.

Hundreds of Polyps In The Bowel?
Polyp as seen on colonoscopy
Polyp as seen on colonoscopy

Yes, some patients have a rare condition called Familial Adenomatous Polyposis (FAP).

Patients with this condition have hundreds of polyps in the bowel.

These patients have a risk of cancer approaching 100%, mostly before the age of 40 years. If you suffer from FAP, the best course of action is to remove the entire large bowel leaving the small bowel, preferably before it becomes cancerous.

Do I Have Polyps and If So, How Do I Get Rid of Them?

If you do not have any symptoms, we can screen you to see if you might have polyps using a test called Faecal Occult Blood test to see if there is any blood mixed in the stool.

If it is positive, you should have a colonoscopy. A colonoscopy is the best way to find out if you have polyps or not.

If we find polyps during the colonoscopy examination, we can remove them with a special snare.

If you are on “blood thinning medicines” (Aspirin, Clopidogrel, Ticlodipine, Xarelto or Warfarin) you need to stop taking these medicines at least 5 days before removal of a polyp to avoid bleeding from the stalk afterwards.

Colon Cancer: Symptoms & Treatment

What Is Colorectal Cancer?

Colorectal cancer is cancer of the large bowel. In Malaysia, it is one of the top 3 most common cancers for men and women.

Like all cancers, it is dangerous because it can spread to involve other organs in other parts of the body. Once the cancer has spread, it may not be possible to remove it completely with surgery.

 

Colorectal cancer causing obstruction
Colorectal cancer causing obstruction
Symptoms of Colorectal Cancer

Colorectal (large bowel) cancer may be silent and display no symptoms. However, most patients would have had some symptoms at one time or other.

Here are some symptoms to check for:

  • Passing blood in the stools
  • Recent change in bowel habit – constipation or diarrhea
  • Difficulty passing motions
  • Passing slime or mucus in the stools
  • Unexplained abdominal pain
  • Abdominal mass

If you have any of these symptoms, or if you have a strong family history of bowel cancer you should have your bowel checked with a colonoscopy.

What If I Don’t Have Pain?

If you don’t experience pain that does not mean you are OK.

Although cancers can cause pain, very often we see cancers without any pain at all. In fact, painless rectal bleeding is often a sign of colorectal cancer.

Am I At Risk For Colorectal Cancer?
  • Age – more common in middle aged & elderly
  • Gender – more common in males
  • Diet – more common if diet is rich in red meats or in low fibre diets
  • Genetic – family history of colorectal cancer
  • Polyps – Polyps are now regarded as having the potential to become cancerous (see my explanation on polyps)
  • Inflammatory bowel disease – ulcerative colitis & Crohn’s disease (uncommon in Malaysia)
How Should I Change My Diet?

I get this question all the time. My advice is, take less red meat and consume more fruits and vegetables.

However, diets are weak risk factors for colorectal cancer. In other words, changing your diet may not necessarily prevent you from getting colorectal cancer.

Can I Take Preventive Medicine?

You can.

Some studies suggests that Aspirin and Celecoxib can reduce the risk of getting colorectal cancer but this is only recommended for those who are at high risk.

Colorectal Cancer Treatment

Colorectal cancer treatment depends on several things including what stage the cancer has reached as well as whether other organs are involved.

Surgery is one of the main ways of treating colorectal cancer and if it can be removed safely, it should be removed. Surgery is often combined with radiotherapy and chemotherapy.

This is not a one-size-fits all treatment plan. The treatment plan can be complicated and varies from patient to patient, especially if other organs are involved. On the whole, as doctors, we do tailor the treatment according to your needs as a patient.

If you suspect something amiss or have been diagnosed with colorectal cancer and need someone to advise or discuss your options either for medication, management plan or surgery, I may be able to help.

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A Thank You is Simply Inadequate

Yes, I did not forget to thank Mr. Khoo Saye Thiam who effectively removed the cancerous colon bothering me. Yes, I repeated that each time I bumped into him subsequent to my operation. Mr. Khoo is a surgeon who listens and understands his patients well. He has done all he could to put away the first huge problematical part of my medical journey to provide me with the necessary foundation and confidence to engage with my other medical challenges.

Dr. P. S. Yeoh
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All You Ever Wanted To Know About Piles

What Are Piles?

Piles or haemorrhoids are swellings around the anus caused by enlarged or engorged veins.
Piles 01

Piles Symptoms

Piles may present as a lump at the anus or the lump may come out only when passing motion. Piles may also cause bleeding, typically dripping into the toilet bowl after opening the bowels. If the piles prolapse out and the blood inside clots, the piles become very painful. Patients may have difficulty sitting down. Not all of the above symptoms are caused by piles. I have personally seen many cases where the cause of the lump or bleeding is something else. Common examples include:

  • anal fissures
  • anal polyps
  • mucosal prolapse
  • perianal fistula
  • cancer
What Causes Piles?

Piles are most commonly caused by constipation. When your stools are hard, you have to strain hard during bowel movement. This increases the pressure inside your abdomen and also in the veins. Over time, your veins become swollen and engorged. Sometimes, when the veins get very large, they may prolapse or slip out through the anus. Chronic laxative abuse can also cause excessive straining. Pregnancy causes piles too. As your baby presses on your pelvic veins, this partially obstructs the flow of blood back to your heart and results in rising pressure in your pelvic veins, including the veins around the anus. Piles can also be caused by liver disease like cirrhosis, tumours in the pelvis and abnormal vessels around the anus.

Types of Piles

There are two types of piles: external and internal piles. External piles appear as a bluish lump at the anus. If a clot forms inside, it can become sensitive & painful. Internal piles are usually not visible. They often cause bleeding especially when opening bowels. If they get very large, they can prolapse or slip out as a lump at the anus. When this happens, the piles can become very painful. Often there is a combination of internal and external piles.

Treatment for Piles

If you have been told you have piles, do not delay in seeing a doctor. If you come to me for a check-up, I will conduct a detailed examination to make sure it is really piles and not something else. You’d also be advised in terms of treatment. You can then decide exactly how far you want to go and which treatment to opt for.

4 Common Ways To Treat Piles

If your piles are small and do not cause much trouble, they can be left alone. Small piles which bleed can be helped with medication. This includes medication to deal with constipation if you suffer from constipation. In terms of larger piles, they can be “banded” which means placing a small tight rubber band at the base of the pile. This stops blood flow into the pile so that the pile can shrink down. Later, the rubber band will fall off on its own. Another way to treat piles is by injection. This method has become less and less popular because it causes bleeding and discomfort. If you have very large or multiple piles, I suggest you remove them using surgery.

Using Surgery To Treat Piles

Many people are now opting for stapled haemorrhoidectomy (PPH haemorrhoidectomy) as a treatment method. In this treatment, we use a circular stapler to excise and staple the piles. As the operation is carried out on the inside, you won’t see any visible scars. There is considerably less pain using this method and healing is also faster compared to conventional surgery. However, not everyone can be treated this way. If your piles are not suitable for this method, you can still have them removed using conventional surgery, that is, removing the piles and then suturing the wound. You then have to wash twice daily with salt baths until the wounds heal, which takes about 3 to 4 weeks. Alternatives to stapling include ultrasound guided suture ligation of the piles as well as laser haemorrhoidectomy. Each method has its strengths and weaknesses.

Cancer In The Colon

Madam T was a 78 year old Chinese lady who was referred to me with blood in her stools. She also had diabetes, high blood pressure and had previously suffered a stroke.

When I met her, I advised her to undergo a colonoscopy.  During this procedure I found she had small polyps in her rectum and left colon which I removed with the colonoscope.

However, this was not the last of her problems.

Cancer In The Colon

The colonoscopy also showed a cancer of the left colon as well as a huge polyp in the right colon which looked very suspicious. The right colon polyp was too large to remove safely with the colonoscope and could only be removed surgically.

colon cancer and polyp removal
Madam T’s Colon Cancer and Polyp

I decided to do a CT scan of the chest, abdomen and pelvis just to be sure the cancer had not spread elsewhere.

As polyps can become cancerous over time, I could not leave the polyp alone especially as she had already developed a cancer in the left colon.

To remove the cancer in the left colon as well as the polyp on the opposite side, undergoing open surgery would have meant a long incision from the upper to lower abdomen.

I recommended laparoscopic surgery as this would mean a much smaller scar, less pain and faster healing. Nevertheless, the operation still had some risks due to her age, diabetes, high blood pressure and previous stroke.

She was also on blood thinning medication (antiplatelet drugs) which would increase the risk of bleeding during surgery.

But the biggest obstacle was yet to come.

She Refused Surgery

Madam T was completely against surgery. She was understandably worried and frightened.

She firmly refused surgery although I told her that this could be an early cancer. Her best hope was to remove the cancer through surgery. Untreated, it would most certainly progress, possibly to obstruction or spread elsewhere beyond the reach of any medical help.

Sensing her fear, I decided to keep my silence as I completed her tests including a thorough cardiac assessment.

Finally, I drew her family aside and explained the situation clearly to them. Yes, there were risks including leaks, bleeding and another stroke.

No, I could not promise to deliver an operation without complications but I did promise I would leave no stone unturned and would try my very best to make it as safe as humanly possible. It helped that the daughter had seen me as a patient on an earlier occasion and I had already won her trust.

Madam T finally agreed to proceed after much cajoling from her family, signing the consent form dejectedly.

The laparoscopic surgery was a success. We managed to remove both the cancer and polyp using just a 6 cm long incision. During the operation, we noticed there was no visible spread of the cancer which was a relief!

Soon after, Madam T had a good recovery post-operation without any complications. She was relieved that her surgery went well and was glad she was persuaded to undergo it, despite her earlier misgivings.

She is presently on chemotherapy and there are presently no signs of recurrent cancer.