Benign rectal tumor

Disease Description (Causes and Symptoms)

• Definition: Abnormal tissue (polyps, submucosal tumors, etc.) that grows from the epithelium or submucosa inside the rectum and protrudes into the rectal lumen.
• Main lesion types (summary):
  • Adenomatous polyp: A precursor lesion of cancer.
  • Hyperplastic polyp: Generally small (≤5 mm) and asymptomatic.
  • Juvenile polyp: Mainly occurs in children and adolescents. Passage of blood and mucus and prolapse are common.
  • Polyps associated with hereditary diseases, such as Peutz–Jeghers polyps and familial adenomatous polyposis (FAP).
  • Mucosal/submucosal tumors: Lipoma, carcinoid/neuroendocrine tumor, leiomyoma, lymphangioma, etc.
• Causes (presumed): Genetic predisposition, diet (high-fat, low-fiber), constitution, etc. The exact cause is unknown.
• Pathophysiology in brief: Some adenomas may progress over time from dysplasia to invasive cancer (the risk increases depending on size and histologic type).
• Main symptoms: Mostly asymptomatic (incidentally detected during screening). If large or if the surface is damaged, symptoms may include bloody stool, mucus in the stool, rectal bleeding, and prolapse during defecation (mainly with juvenile polyps).

Treatment Methods

• Principle: Remove lesions when malignancy is possible or symptoms are present. The method is determined according to the lesion’s size, histologic findings, and location.
• Endoscopic treatment (primarily used)
  • Hot biopsy (electrocautery): Mainly for small polyps 5 mm or less.
  • Polypectomy (snare): Commonly used for lesions 2 cm or less.
  • Endoscopic mucosal resection (EMR): The lesion is resected after injecting normal saline into the submucosal layer, and lesions approximately 3 cm in size can be treated.
  • Piecemeal resection: A large lesion is removed in sections.
• Surgical treatment
  • If endoscopic removal is not possible, or in cases of histologic malignancy, deep invasion, or a large lesion, surgical resection comparable to the principles of rectal cancer surgery is required. Laparoscopic or open surgery may be performed depending on the case.
• Management principles by lesion (summary)
  • Small hyperplastic polyps: Observation may be possible if there are no symptoms.
  • Lipoma: If asymptomatic and definitively diagnosed, removal is not always necessary (biopsy if uncertain).
  • Carcinoid (neuroendocrine tumor): The extent of resection is determined according to size and invasiveness (caution is needed because metastasis is possible).
  • Juvenile polyp: Removal is generally recommended because bleeding and prolapse are common.
  • In hereditary conditions such as FAP, early and extensive surgical treatment and family screening are necessary.
• Imaging tests: Biopsy when a lesion is observed; if necessary, CT/MRI to evaluate invasion and metastasis.
• Lifestyle management and preventive recommendations: Increase fiber intake, reduce excessive animal fat, and undergo regular colorectal examinations (determined according to age and risk factors).
• Risk of complications: Bleeding and perforation may occur after endoscopic resection; recurrence is possible (and increases with multiple lesions, high-grade dysplasia, and multiple adenomas).

Checklist Before an Outpatient Visit (Items to Bring and Example Questions)

• Items/documents to bring
  • A list of recently taken medications (including anticoagulants/antithrombotic agents) and allergy history.
  • Copies of previous colonoscopy, biopsy, and imaging (CT/MRI) results.
  • A record of when symptoms began and how they have changed (bloody stool, mucus, changes in bowel habits, etc.).
  • Family history (colorectal cancer, multiple polyps, FAP, etc.).
• Things to confirm before the outpatient visit
  • Follow the attending physician’s instructions regarding whether to stop anticoagulants (important if a procedure is planned).
  • Receive instructions in advance on appropriate bowel preparation before colonoscopy (such as taking laxatives) and follow them.
• Example questions (items for the patient to prepare independently)
  • "When should I stop the medications I am currently taking (such as aspirin or warfarin)?"
  • "May I bring the results of my previous tests (endoscopy images and biopsy report)?"
  • "How have the amount and frequency of my recent bloody stool and mucus changed?"

Examples of General Questions to Ask the Doctor

• "What do the biopsy results for this polyp (or tumor) mean (such as adenoma, high-grade dysplasia, or findings of malignancy)?"
• "What resection method is recommended, and what are the risks of the procedure (bleeding and perforation) and its success rate?"
• "What is the risk of recurrence after resection, and how often should follow-up endoscopy be performed?"
• "Are there any lifestyle factors (diet or exercise) or medications I should avoid?"

Examples of Disease-Specific Questions

• "Considering the size of my polyp (e.g., 1.5 cm) and its histologic findings, what treatment is recommended (endoscopic resection versus surgery)? How likely is it to progress to cancer?"
• "There is a history of multiple polyps or colorectal cancer in my family. If familial adenomatous polyposis (FAP) is suspected, what genetic testing and family screening are needed, and when should they begin?"