How likely is gastric polyps to become cancerous?

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How likely is gastric polyps to become cancerous?

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How likely is gastric polyps to become cancerous? How to treat? Prevention is very important!

Gastric polyp refers to one or more bulging “small balls” in the gastric mucosa that are visible to the naked eye. 

Gastric polyp refers to the local gastric mucosa with one or more visible, raised “small balls”, which are mucosal hyperplasia protruding from the gastric cavity and are generally benign; the name polyp does not indicate its etiology and histology Structure, but polyps can become cancerous.

Gastric polyps are generally located in the antrum of the stomach, which is the same as the prevalent site of gastritis and gastric ulcer.

A few can also be found in the upper part of the stomach, cardia and fundus.

The pedicled polyps of the pylorus and the polyps that grow near the cardia should be emphasized, which are prone to vomiting and dysphagia, respectively.

What kinds of stomach polyps are there?

Pathologically, gastric polyps are mainly divided into hyperplastic polyps and adenomatous polyps.

1. Hyperplastic polyps

Most of them are hyperplastic polyps, which are less cancerous, and are polyp-like substances formed by inflammatory mucosal hyperplasia, not real tumors, and are also called inflammatory polyps.

The characteristics are: polyps are small, generally less than 1.5cm in diameter, round, etc., with or without pedicle, smooth surface, and may be accompanied by erosion. A small number of intestinal metaplasia, dysplasia, adenomatous transformation, there is a risk of cancer, but the cancer rate generally does not exceed 1% to 2%.

2. Adenomatous polyps

Adenomatous polyps are benign gastric tumors derived from the epithelium of the gastric mucosa, accounting for about 15% of gastric polyps. The characteristics are: generally large in size, spherical or hemispherical, most have no pedicle, smooth surface, a few are flat, striped or lobed.

Histologically, it is mainly formed by surface epithelium, pit epithelium and glandular hyperplasia. Epithelial differentiation is immature, and mitotic figures are more common, which can be divided into tubular, villous and mixed adenomas, often accompanied by obvious intestinal metaplasia and dysplasia.

This type of polyp has a high canceration rate, which can reach >30%, especially for those with tumor diameter greater than 2cm, villous adenoma, and third degree dysplasia.

What causes gastric polyps?

• 1. Genetic susceptibility, some people are prone to stomach polyps.
• 2. The causes that can cause gastritis and gastric ulcer can also cause gastric polyps, but the probability of occurrence is much less.

For example, Helicobacter pylori infection, gastroduodenal reflux, drugs such as aspirin, and other chronic physical and chemical irritants.

What are the clinical manifestations of gastric polyps?

Gastric polyps have no specific clinical manifestations, and can have dyspeptic symptoms such as bloating, belching, epigastric discomfort, and anorexia. Polyps are eroded and necrotic, may have hematemesis, melena, etc.

The pedicled polyp located in the pylorus can break into the pyloric duct or duodenum, and the pyloric obstruction appears, showing prominent stomach distension and vomiting.

Polyps grow near the cardia, because of mechanical obstruction when eating, it is manifested as stagnant swallowing and difficulty swallowing.

How high is the cancer rate of gastric polyps?

1. Hyperplastic polyps (inflammatory polyps) cancer rate <2%;
2. The carcinogenesis rate of adenomatous polyps is >30%, so the focus of preventing gastric polyps from carcinogenesis is adenomatous polyps, which should be surgically removed once they are diagnosed.
3. Pathological examination is required for polyps found.

How to treat gastric polyps?

(1) Treatment of hyperplastic polyps

Polyps with a diameter of less than 2cm, pedicles, and no ulcers are mostly inflammatory polyps (hyperplastic polyps). Hyperplastic polyps are non-tumor polyps and rarely develop malignant lesions.

They are treated symptomatically by internal medicine, such as HP (Helicobacter pylori) Positive, killing HP treatment can make some polyps disappear, and the effect is better (HP-negative inflammatory gastric polyps do not even need to be treated); even if the inflammatory polyps still exist, as long as they do not grow, do not be too nervous.

However, in order to prevent gastric polyps from becoming cancerous, gastroscopy should be done once a year.

For dysplasia, adenoma-like changes, and fast-growing inflammatory polyps, gastroscopic resection can be selected.

(2) Treatment of adenomatous polyps

Choose gastroscopic resection or even surgery.

(3) Endoscopic treatment

Endoscopic resection is the first choice for the treatment of gastric polyps.

Indications are:

1. Stemless or broad-based polyps larger than 2cm.
2. Those who have progressively enlarged polyps have ulcers.
3. The disease is diagnosed as adenomatous polyps with dysplasia, suspicious cancer and cancer.

(4) Anti-Hp treatment

In recent years, studies have shown that Helicobacter pylori (Hp) infection is closely related to the occurrence of hyperplastic polyps.

After successful eradication of Hp infection in patients with Hp-positive hyperplastic polyps, about 40% of the polyps have completely resolved.

Therefore, Hp testing should be performed for patients with hyperplastic polyps during diagnosis and treatment.

If positive, Hp eradication should be performed, and then corresponding treatments should be made according to the regression of the polyps.

How likely is gastric polyps to become cancerous?

(source:cinanet, reference only)

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