Episode 192 - Introduction to Colon Polyps with Dr Ali Eqbal

Colon polyps develop on the inner lining of the large intestine or rectum and are medically significant, as a small percentage may subsequently develop into colon cancer. They affect roughly 15% to 40% of all adults and become increasingly frequent with age. Whilst we are now observing an increasing prevalence of polyps and colon cancer in young adults, they are still relatively uncommon before the age of 40 years. Colorectal polyps are found in about 25% of adults aged 45 years. By age 50 years, approximately 40% to 50% of people will develop at least one polyp, slightly more in men than women. Polyps generally fall into two main categories: non-neoplastic, including hyperplastic polyps, inflammatory polyps and hamartomas; and potentially neoplastic polyps, which include adenomas and sessile serrated polyps. While harmless initially, adenomas and sessile serrated polyps are considered precancerous and may develop into invasive cancer over time. Fortunately, only a small minority, approximately 5% to 10% of conventional adenomas and an estimated 2% to 6% of isolated non-dysplastic sessile serrated polyps (SSPs), will ever progress to malignancy. Conventional adenomas progress to cancer via a traditional adenoma-to-carcinoma pathway, a relatively slow process that may take 10 to 15 years. By contrast, sessile serrated polyps (SSPs) develop through an alternative biological pathway. They are flat, often hidden under a mucus cap, tend to be more right-sided in location, and are historically difficult to spot during a colonoscopy. For an isolated non-dysplastic SSP, the 10-year cumulative risk of becoming cancerous is relatively low, at around 2% to 6%. When dysplasia is present, however, the malignant potential is much higher. The bottom line is that colorectal surveillance by colonoscopy is essential. Colon cancer surveillance and screening have been shown to reduce colorectal cancer (CRC) incidence by approximately 50% to 90%. This dramatic reduction is achieved primarily because colonoscopy allows direct detection and removal of precancerous polyps before cancer development. To discuss this important topic in more detail, particularly focussing on large colonic polyp management, we are joined by Dr Ali Eqbal. Ali has expertise in advanced colonic interventional endoscopy and inflammatory bowel disease. He completed a two-year advanced endoscopy fellowship at King's College Hospital, London, where he developed expertise in the diagnosis and management of complex colonic polyps using techniques including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). He also undertook a clinical research fellowship in complex IBD at the Austin Hospital in Melbourne. He is widely respected and recognised for his advanced technical skills and commitment to minimally invasive treatment options. He has published and presented both nationally and internationally. Please welcome Ali to the podcast. References Dr Ali Eqbal, www.gihealth.com.au GESA  National Center for Biotechnology Information (NCBI). Colonic Polyps. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430761/ PubMed Central