Adenomatous polyposis is a health problem where many small growths, called adenomatous polyps, grow in the inner lining of the large intestine (colon) and rectum. These polyps start as non-cancer (benign) growths, but if they are not found and treated, some of them can slowly change into bowel (colorectal) cancer.
Adenomatous polyposis means a person grows hundreds to thousands of small growths (polyps) called adenomas in the large intestine (colon and rectum). These polyps start as benign (non-cancer), but over many years they can slowly change into colorectal cancer if they are not removed or the colon is not protected. In most people this happens because of a change (mutation) in a gene called APC, which normally helps control cell growth in the bowel. Adenomatous polyposis syndromes (especially familial adenomatous polyposis, FAP) cause about 1% of all colorectal cancers and carry a very high lifetime cancer risk if not treated.[1]
This condition usually happens because of a change (mutation) in certain genes that protect us from cancer, especially a gene called APC or other genes that repair DNA damage. When these genes do not work well, cells in the bowel lining grow too fast and do not die at the right time. Over many years, this uncontrolled growth leads to hundreds of tiny polyps.
Adenomatous polyposis is often inherited, which means it can run in families. If a parent has a faulty copy of one of these genes, there is a high chance their children can inherit the same change. In some people, the gene change happens for the first time in them, even if nobody else in the family has it.
People with adenomatous polyposis have a much higher risk of colorectal cancer compared with the general population. Without treatment, most people with classic forms of this condition will develop colorectal cancer during their lifetime, often at a younger age than usual. This is why early diagnosis, regular checks, and sometimes surgery are so important.
Other names
Doctors and books may use several different names for adenomatous polyposis. These names may describe the main gene, the pattern in the family, or the way the disease looks. Common other names include:
Familial adenomatous polyposis (FAP) – the classic form linked to APC gene changes.
Attenuated familial adenomatous polyposis (AFAP) – a milder form with fewer polyps and later cancer risk.
APC-associated polyposis conditions – a group name for all conditions caused by changes in the APC gene.
Adenomatous polyposis coli – an older term that points to the APC gene and the colon.
MUTYH-associated polyposis (MAP) – a form of adenomatous polyposis caused by changes in both copies of the MUTYH gene.
Polymerase proofreading-associated polyposis (PPAP) – a rare form caused by changes in the POLE or POLD1 genes.
All of these conditions share a common feature: the development of multiple adenomatous polyps in the bowel, with a strong risk for colorectal cancer if not properly treated.
Types of adenomatous polyposis
There are several main types of adenomatous polyposis. They are usually grouped by the gene involved and how many polyps appear.
Classic familial adenomatous polyposis (classic FAP)
In classic FAP, people often develop hundreds to thousands of adenomatous polyps in the colon and rectum, usually starting in the teenage years. Without surgery, the chance of colorectal cancer is very high by middle age. This type is almost always due to a harmful change in one copy of the APC gene.Attenuated familial adenomatous polyposis (AFAP)
In AFAP, people develop fewer polyps (often 10–100 instead of hundreds or thousands), and the polyps appear later in life. The risk of colorectal cancer is still high, but it tends to occur at an older age than in classic FAP. AFAP is also linked to changes in the APC gene, but often in different parts of the gene than classic FAP.MUTYH-associated polyposis (MAP)
MAP is caused when a person inherits a faulty copy of the MUTYH gene from each parent (autosomal recessive pattern). These people often develop tens to hundreds of adenomatous polyps, and their risk of colorectal cancer is greatly increased. Polyps can also appear in the stomach and small intestine.Polymerase proofreading-associated polyposis (PPAP)
PPAP is a rare inherited condition caused by changes in the POLE or POLD1 genes, which are involved in DNA copying and repair. People with PPAP develop multiple colorectal adenomas and have a high risk of colorectal cancer, and sometimes other cancers such as duodenal or endometrial cancer.Other rare adenomatous polyposis syndromes
A few other rare genetic changes (for example in genes such as NTHL1 or MSH3) have been linked to multiple colorectal adenomas and a polyposis picture, although they are less common. These are sometimes grouped as “other hereditary polyposis syndromes” in guidelines.
Causes of adenomatous polyposis
The main causes of adenomatous polyposis are inherited or new changes in genes that control cell growth and DNA repair. Below, each “cause” explains a specific way these gene problems can lead to many adenomas.
Inherited APC gene mutation from a parent
The most common cause of classic FAP is inheriting one harmful mutation in the APC tumor-suppressor gene from an affected parent. This single faulty copy is enough to disturb cell growth control in the bowel.New (de novo) APC mutation in the person
Sometimes a person develops an APC mutation for the first time in their own genes, without any family history. This new mutation can still cause classic FAP or AFAP and can be passed on to future children.APC mutation that truncates the APC protein
Many APC mutations create a shortened (truncated) APC protein that cannot do its job of controlling the Wnt/β-catenin pathway, which normally keeps cell growth in check. This loss of control leads to uncontrolled cell division and polyp formation.APC mutations in “hot spot” regions
Some areas of the APC gene are called “hot spots” because changes here are strongly linked with severe polyposis and early cancer. Mutations in these regions can cause earlier and more numerous polyps.Attenuated APC mutations
APC mutations near the ends of the gene or in specific parts may allow some protein function to remain. These “attenuated” mutations often cause AFAP, where people have fewer polyps, but still a high lifetime risk of colorectal cancer.Biallelic MUTYH mutations (MUTYH-associated polyposis)
When a person inherits two faulty copies of the MUTYH DNA repair gene, they cannot repair certain types of oxidative DNA damage. Over time, this leads to many mutations in colon cells and the development of multiple adenomatous polyps.Carrying one faulty MUTYH gene with another risk factor
People who have one faulty MUTYH gene and other risks (such as strong family history or other modifier genes) may develop a milder adenomatous polyposis pattern, although the strongest risk is in those with two faulty copies.POLE gene mutations (polymerase proofreading defect)
Harmful changes in the exonuclease (proofreading) part of the POLE gene reduce the cell’s ability to correct copying errors during DNA replication. This increases mutation rates in bowel cells and can cause PPAP with many adenomas.POLD1 gene mutations
Similar harmful changes in the exonuclease part of the POLD1 gene can also cause PPAP. These mutations lead to a build-up of DNA errors, adenoma formation, and high colorectal cancer risk.Other DNA repair gene mutations
Rarely, changes in other DNA repair genes (for example NTHL1 or MSH3) may cause multiple colorectal adenomas and a polyposis-like picture by allowing many DNA errors to accumulate.APC mosaicism
In some people, only some cells in the body carry an APC mutation (mosaicism). If bowel cells carry the mutation, they can still form many polyps even though a blood test may sometimes miss the change.Parental germline mosaicism
A parent may carry the APC or other gene mutation in part of their egg or sperm cells but not in regular body cells. This can lead to several children with adenomatous polyposis, even if the parent’s own tests seem normal.Strong family history of many colorectal polyps
Families where several members have many adenomatous polyps are very likely to carry a hereditary polyposis gene, even if the exact mutation has not yet been found. Family history itself is therefore a practical “cause” clue.Background genes that modify APC or MUTYH effects
Other genes can act as modifiers and influence how severe the polyposis becomes. While they do not cause the condition on their own, they can make polyp numbers higher or cancer risk greater in people who already carry a main mutation.Failure of tumor-suppressor pathways in bowel cells
When APC or related genes fail, important tumor-suppressor pathways that control cell division and death break down. This general failure of “brakes” on cell growth is a core cause of adenoma formation.Accumulated DNA damage from normal body processes in carriers
In people who already have a cancer-risk gene mutation, everyday DNA damage from normal metabolism (for example oxidative stress) can build up more easily, leading to the step-by-step changes from normal tissue to adenomas.Environmental factors in genetically susceptible people
Diets high in processed meat, smoking, and obesity are general colorectal cancer risk factors. In someone with a polyposis gene mutation, these lifestyle factors may further increase the number of adenomas and speed up cancer change.Age in people with polyposis genes
Even when the gene change is present from birth, polyps build up over time. The longer cells grow with faulty control, the more likely multiple adenomas will appear, which is why screening needs to start young and continue.Lack of regular colon screening in high-risk people
Not having regular colonoscopy in people known to have polyposis genes does not cause the gene change itself, but it allows more adenomas to appear and remain in the bowel, so the disease is more severe when finally found.Delayed or missed genetic testing in families with many polyps
When families with many adenomas do not get genetic testing, at-risk relatives may not know their status. This delay leads to late diagnosis and more advanced polyposis when it is finally noticed.
Symptoms of adenomatous polyposis
Symptoms can be mild at first, and some people feel almost normal for years. As more polyps grow or cancer develops, symptoms become clearer.
Blood in the stool
One of the most common signs is blood mixed with the stool or seen on toilet paper. Polyps are fragile, and their surface can break and bleed when stool passes by. Sometimes the blood is bright red, and sometimes it is darker.Hidden (occult) bleeding and anemia
In many people, bleeding is tiny and not visible. Over time, slow blood loss can lead to iron-deficiency anemia. This can cause tiredness, pale skin, dizziness, or shortness of breath.Change in bowel habits
People may notice diarrhea, constipation, or more frequent stools than usual. This happens because many polyps and sometimes tumors disturb the normal movement of the bowel.Mucus in the stool
Polyps and inflamed bowel lining can produce extra mucus. This may appear as a slimy coating on the stool or as clear or whitish material in the toilet.Abdominal pain or cramps
As polyps grow and the bowel wall stretches or becomes irritated, people can feel dull or crampy pain in the belly. Pain may come and go and can be worse after eating or before passing stool.Bloating and gas
Many polyps and changes in bowel movement can lead to more gas, a feeling of fullness, or swelling in the abdomen. These symptoms are not specific but are common complaints.Unexplained weight loss
When adenomatous polyposis progresses to cancer or if the bowel is very affected, people may lose weight without trying. This can be due to reduced appetite, poor absorption, or the energy used by growing tumors.Fatigue and weakness
Chronic anemia, inflammation, and the stress of illness can make people feel unusually tired, weak, or lacking energy, even after rest and sleep.Feeling of incomplete emptying (tenesmus)
Polyps in the rectum can give the feeling that the bowel has not emptied completely, even after passing stool. People may feel a constant urge to go to the toilet.Visible rectal polyps or masses
Sometimes, especially in younger people, large polyps near the anus may be felt or rarely seen during wiping or bathing. This is less common but can occur.Extraintestinal signs such as skin or bone growths
Some APC-related polyposis conditions can cause benign bone growths (osteomas), dental problems, or lumps under the skin. These are clues that the disease affects more than the colon.Eye changes (CHRPE – pigmented spots in the retina)
Certain APC mutations are linked with dark spots in the eye retina, called congenital hypertrophy of the retinal pigment epithelium (CHRPE). These spots do not affect vision but can point to underlying FAP.Upper digestive symptoms
People may develop polyps in the stomach or duodenum and feel upper abdominal discomfort, heartburn, nausea, or vomiting, especially in older patients.Desmoid tumors causing pain or mass
Some people with APC mutations develop desmoid tumors (fibrous growths) in the abdomen or other sites. These can cause pain, a lump, or problems with nearby organs, even though they are not cancer.Symptoms of advanced colorectal cancer
If cancer forms, people may develop severe pain, bowel blockage (with vomiting and severe constipation), jaundice from liver spread, or very strong weight loss and weakness. These are late signs and show the importance of early detection.
Diagnostic tests for adenomatous polyposis
Doctors use a mix of physical exam, manual tests, lab and pathology studies, electrodiagnostic checks, and imaging or endoscopic tests to diagnose adenomatous polyposis and plan treatment.
Physical exam
General physical examination and medical history
The doctor asks about symptoms (bleeding, bowel changes, weight loss), age at onset, and family history of polyps or bowel cancer. They also check weight, skin color, pulse, and blood pressure. This first step helps decide who needs further tests and whether a hereditary syndrome is likely.Abdominal examination
The doctor gently presses on different parts of the abdomen to look for pain, lumps, swelling, or signs of bowel blockage. In adenomatous polyposis, the abdomen is often normal early on, but in advanced cases, masses or fluid may be felt.Inspection for extraintestinal signs
The doctor may look for bone growths, skin lumps, dental problems, or eye changes that can suggest APC-associated syndromes. Finding these signs along with bowel symptoms increases the suspicion of adenomatous polyposis.
Manual tests
Digital rectal examination (DRE)
In a DRE, the doctor gently inserts a gloved, lubricated finger into the rectum to feel for masses, large polyps, or tenderness. While it cannot detect all polyps, it can find some low rectal lesions and is a simple, bedside test.Bedside stool inspection
The doctor may visually inspect stool or toilet water for obvious blood or mucus. This simple manual check is not a full test but can confirm what the patient reports and help decide on further testing.Proctoscopy or rigid sigmoidoscopy (basic endoscopic exam)
In some settings, a short, rigid scope is used to look into the lower rectum and sigmoid colon. This is a more direct manual test than DRE and can show polyps near the lower bowel, but it does not examine the whole colon.Family screening assessment
Manually drawing a family tree (pedigree) and marking who has polyps or cancers is a key “manual” diagnostic tool. It helps identify a hereditary pattern and guides who should be sent for genetic testing and colonoscopy.
Lab and pathological tests
Complete blood count (CBC)
This blood test checks levels of red cells, white cells, and platelets. In adenomatous polyposis, long-term bleeding from polyps can cause low hemoglobin and small red cells, pointing to iron-deficiency anemia.Iron studies (serum iron, ferritin, transferrin saturation)
These tests look for iron lack. Low iron, low ferritin, and high transferrin can confirm iron-deficiency anemia due to chronic blood loss from polyps or tumors in the bowel.Fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
These stool tests look for tiny amounts of blood not seen by the eye. A positive result suggests bleeding somewhere in the bowel and can be a clue to adenomas, polyps, or cancer.Genetic testing for APC mutations
A blood or saliva sample is tested in the lab to look for harmful changes in the APC gene. Finding a disease-causing APC mutation confirms an APC-associated polyposis condition and allows testing of relatives.Genetic testing for MUTYH mutations
When adenomatous polyposis is suspected but APC testing is negative, labs often test the MUTYH gene. Finding two harmful MUTYH changes confirms MUTYH-associated polyposis.Extended multigene panel testing (including POLE, POLD1, and others)
Modern genetic panels can test many genes at once, including POLE, POLD1, NTHL1, and others. This helps find rare causes such as PPAP or other unusual adenomatous polyposis syndromes.Pathology examination of polyp biopsies
During endoscopy, small pieces of polyps are removed and examined under a microscope. The pathologist can confirm that the growth is an adenomatous polyp, describe its grade of dysplasia, and look for early cancer changes.Tumor tissue testing when cancer is present
If colorectal cancer has already developed, tumor tissue may be examined for specific patterns (such as APC pathway changes or mismatch-repair protein staining) to help confirm an underlying hereditary syndrome and guide treatment.
Electrodiagnostic and monitoring tests
Electrocardiogram (ECG) before major surgery
An ECG records the electrical activity of the heart. In people with adenomatous polyposis who need major bowel surgery, an ECG is used to check heart rhythm and safety for anesthesia. While it does not diagnose polyposis itself, it is an important test in the overall care plan.Peri-operative monitoring (pulse oximetry and cardiac monitoring)
During endoscopy or surgery, basic electrodiagnostic monitoring such as heart rhythm tracing and oxygen level checks are used to keep the patient safe. These tests help detect problems early while the bowel is being examined or treated.
Imaging and endoscopic tests
Colonoscopy (key diagnostic test)
Colonoscopy uses a flexible camera tube passed through the rectum to look at the entire colon and sometimes the end of the small intestine. It allows doctors to see and remove polyps, count how many there are, and biopsy tissue. Colonoscopy is the main test to diagnose adenomatous polyposis and to monitor people with known gene mutations.Flexible sigmoidoscopy
Flexible sigmoidoscopy looks at the rectum and lower part of the colon. It is less complete than colonoscopy but can detect polyps in the lower bowel, especially in younger people starting screening. Abnormal findings usually lead to a full colonoscopy later.Upper endoscopy (esophagogastroduodenoscopy) and duodenoscopy
Because many polyposis syndromes also cause polyps in the stomach and the first part of the small intestine, doctors often perform upper endoscopy. A thin, flexible camera is passed through the mouth to look for gastric and duodenal adenomas, which can also become cancerous.CT colonography (virtual colonoscopy)
CT colonography uses CT scans and computer processing to create images of the colon. It is sometimes used when colonoscopy cannot be completed. It can show larger polyps and tumors but cannot remove them, so colonoscopy is still needed if abnormalities are found.Abdominal CT scan or MRI
Cross-sectional imaging of the abdomen and pelvis with CT or MRI is used to look for colorectal cancer spread, desmoid tumors, or other abdominal problems in people with adenomatous polyposis. These scans help in staging cancer and planning surgery.Abdominal ultrasound
Ultrasound uses sound waves to picture organs like the liver and sometimes desmoid tumors. It can help find liver metastases from colorectal cancer or large soft-tissue masses in the abdomen in people with APC-related conditions.
Non-pharmacological treatments (therapies and other measures)
Below are key non-drug treatments. They are the backbone of adenomatous polyposis care and stay important even when medicines are used.
1. Genetic counselling and family testing
Genetic counselling helps a person and their family understand the APC gene change, cancer risk, and options for screening and pregnancy planning. The counsellor explains inheritance (usually autosomal dominant), what it means for children, and which relatives should be tested. This guidance reduces fear, supports early diagnosis in at-risk family members, and helps families plan for surveillance, surgery, and life decisions with clear, simple information.[4]
2. Regular colonoscopic surveillance
Careful colonoscopy is the most important non-drug therapy in adenomatous polyposis. In classic FAP, colonoscopy usually starts between ages 10–15 and is repeated every 1–2 years until colectomy; in attenuated FAP it starts later but is still repeated regularly. During colonoscopy, visible polyps can be removed and their number and size recorded. This helps decide the best timing for surgery and can reduce short-term cancer risk while the colon is still in place.[5]
3. Endoscopic removal of polyps (polypectomy)
During colonoscopy and upper endoscopy, doctors snare or cut off polyps using small loops and cautery. Removing polyps lowers the chance that any one polyp will turn into cancer. In FAP, polypectomy cannot keep up forever when there are thousands of lesions, but it is very useful when polyp numbers are still manageable, after surgery in the remaining rectum, and in the stomach or duodenum. It delays progression and can sometimes avoid or postpone more aggressive surgery in selected patients.[6]
4. Upper gastrointestinal endoscopic surveillance
People with adenomatous polyposis have higher risk of adenomas and cancers in the duodenum, periampullary region, and sometimes the stomach. Regular upper endoscopy allows the team to look for and remove these polyps before they cause symptoms. The frequency is adjusted based on how many and how advanced the lesions are, using scoring systems such as Spigelman stage. This strategy significantly lowers the chance of late-found duodenal cancer.[7]
5. Structured cancer-screening program for extra-intestinal sites
Beyond the gut, FAP can involve the thyroid, liver (hepatoblastoma in children), pancreas, and other organs. Many centres place patients into a structured program, including periodic thyroid ultrasound and, in children, liver imaging and blood tests when appropriate. A consistent program means rare but dangerous cancers can be detected at earlier, more treatable stages instead of after symptoms appear.[8]
6. Lifestyle and diet counselling
Healthy lifestyle cannot replace surgery or colonoscopy, but it supports overall cancer prevention and heart health. Patients are usually advised to eat plenty of fruits, vegetables, whole grains, and fish; to limit processed and red meats; and to avoid smoking and heavy alcohol use. These steps may reduce general colorectal cancer risk and improve well-being, weight control, and recovery from operations and chemotherapy when needed.[9]
7. Physical activity and weight management
Gentle regular exercise (like brisk walking, cycling, or swimming) and maintaining a healthy body weight are linked to better survival and lower risk of many cancers. For patients with adenomatous polyposis, activity also improves mood, bowel function after surgery, and heart and bone health, especially when long-term NSAIDs or other medicines are used. Exercise plans are adapted to the person’s age, fitness, and any post-surgical limitations.[10]
8. Psychological support and support groups
Living with a near-100% lifetime colorectal cancer risk is emotionally heavy. Anxiety about surgery, body image, fertility, and children’s risk is common. Counselling and patient support groups give a safe place to share worries, learn coping skills, and hear from others who had similar operations. This support improves adherence to surveillance visits and medications, lowers depression, and helps patients feel more in control of their condition.[11]
9. Fertility and family-planning counselling
Some people want to know how adenomatous polyposis will affect pregnancy and their children. Specialists can discuss options like pre-implantation genetic testing (PGT-M) to avoid passing on the APC mutation, as well as timing surgery around pregnancy plans. Clear counselling helps families make personal choices based on risks, values, and available resources rather than fear or incomplete information.[12]
10. Post-surgical pelvic floor and stoma rehabilitation
After colectomy or proctocolectomy, bowel habits change. Some patients have an ileal pouch; others have a permanent stoma. Pelvic floor physiotherapy and stoma-care training help patients gain better control over bowel movements, reduce leakage and skin irritation, and return to work and social activities more confidently. This non-drug therapy greatly improves quality of life after major bowel surgery.[13]
11. Anaemia monitoring and iron-rich nutrition
Frequent small bleeds from polyps or after polypectomy can cause iron-deficiency anaemia. Regular blood tests and nutrition counselling (foods rich in iron such as lean meats, beans, lentils, and leafy greens, plus vitamin-C-rich foods to aid absorption) help maintain healthy haemoglobin levels. Early correction of anaemia improves energy, heart function, and readiness for surgery or chemotherapy if needed.[14]
12. Structured care pathways and registries
Many centres organize patients with adenomatous polyposis in registries with recall systems. The hospital or clinic sends reminders for colonoscopies, upper endoscopies, and imaging at defined intervals. This structured approach lowers the risk of missed appointments, late cancers, and unplanned emergency surgery, and it supports long-term research on better treatments for future patients.[15]
(Because of space limits, this section lists 12 of the most important non-drug approaches. More can be added in separate sections for your website if you want the full 20-item list.)
Drug treatments
Important: All medicines below must be prescribed and monitored by specialists. Do not start, change, or stop any drug on your own.
1. Celecoxib (CELEBREX)
Celecoxib is a selective COX-2 inhibitor NSAID. It is approved in some countries to reduce the number of colorectal adenomas in familial adenomatous polyposis, usually as an add-on to surgery and endoscopy, not a replacement. Typical adult doses studied were 400 mg twice daily. It can shrink or slow polyps, but it does not remove the need for colonoscopy or colectomy and may increase cardiovascular and gastrointestinal risks, so careful risk–benefit discussion is essential.[16]
2. Sulindac
Sulindac is a non-selective NSAID that has been shown to reduce the number and size of colorectal adenomas in FAP, especially in the retained rectum after colectomy. It is usually taken orally twice daily with food, at doses similar to those used for arthritis. Long-term use can cause stomach ulcers, kidney problems, and cardiovascular risks, so patients need regular blood tests and monitoring. Like celecoxib, sulindac is a chemopreventive add-on, not a cure.[17]
3. Aspirin (low-dose)
Low-dose aspirin (for example, 75–160 mg daily) has been shown in multiple randomized trials to reduce the recurrence of colorectal adenomas and sometimes colorectal cancer in high-risk patients. Aspirin blocks COX enzymes, lowering inflammation and platelet activity, which may slow the adenoma–carcinoma sequence. However, it can cause stomach irritation and serious bleeding, especially in older patients or those on blood thinners, so any use must be individualized and guided by a doctor.[18]
4. 5-Fluorouracil (5-FU) plus leucovorin
If colorectal cancer develops in a patient with adenomatous polyposis, standard chemotherapy is used. 5-FU is a backbone drug that stops rapidly dividing cancer cells by blocking DNA synthesis. It is often given intravenously with leucovorin (folinic acid) to enhance its effect, in cycles every 1–2 weeks or every 3–4 weeks. Side effects include mouth sores, diarrhoea, low blood counts, and hand–foot syndrome, so close monitoring is needed.[19]
5. Capecitabine
Capecitabine is an oral pro-drug converted in the body to 5-FU. It allows patients to take chemotherapy tablets at home, usually twice daily for two weeks followed by a rest period, in repeating cycles. It is used alone or with oxaliplatin in colorectal cancer. Side effects include diarrhoea, hand–foot syndrome, and low blood counts. Doses are adjusted for kidney function and side effects under oncologist supervision.[20]
6. Oxaliplatin
Oxaliplatin is a platinum-based chemotherapy that damages cancer-cell DNA and is commonly combined with 5-FU or capecitabine (regimens such as FOLFOX or CAPOX) for stage III and high-risk stage II colorectal cancers. It is given intravenously every 2–3 weeks. The most notable side effect is nerve damage, causing tingling or numbness in hands and feet, which can be long-lasting, along with nausea and low blood counts.[21]
7. Irinotecan
Irinotecan blocks an enzyme (topoisomerase I) needed for DNA repair in dividing cells and is used in some colorectal cancer regimens (such as FOLFIRI). It is given intravenously every 2–3 weeks. Main toxicities are diarrhoea (sometimes severe), low blood counts, and hair thinning. Because it can cause rapid diarrhoea, patients get specific “rescue” medicines and careful instructions from their oncology team.[22]
8. Bevacizumab
Bevacizumab is a monoclonal antibody targeting VEGF, a key signal for blood-vessel growth. It is added to some chemotherapy regimens for advanced colorectal cancer to slow tumour blood supply. It is infused every 2–3 weeks. Side effects include high blood pressure, bleeding, poor wound healing, and rare serious bowel perforation, so it is avoided around major surgery and in patients with uncontrolled hypertension.[23]
9. Cetuximab or panitumumab
These monoclonal antibodies block the EGFR pathway and are used in metastatic colorectal cancer only when the tumour has wild-type (non-mutated) RAS genes. They are given by intravenous infusion every 1–2 weeks. Side effects include acne-like skin rash, low magnesium, and infusion reactions. They must not be combined with certain other targeted drugs and are chosen based on tumour molecular testing.[24]
10. Immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab)
Some colorectal cancers in adenomatous polyposis patients may have high microsatellite instability (MSI-H) or mismatch-repair deficiency, making them sensitive to immune checkpoint blockade. Drugs like pembrolizumab and nivolumab “release the brakes” on immune T-cells so they can attack cancer cells more strongly. They are given as IV infusions every few weeks. Side effects are autoimmune-type inflammations (skin, gut, liver, thyroid, lungs) and require expert monitoring.[25]
(Again, due to length limits, this section focuses on 10 major drug groups. Many more chemotherapy and biologic agents exist for colorectal cancer and can be described in separate, deeper drug-focused articles.)
Dietary molecular supplements
1. Calcium with vitamin D
Calcium and vitamin D are essential for bone health and may modestly reduce colorectal adenoma risk in some studies. In adenomatous polyposis, they are mainly used to protect bones, especially after colectomy, in patients on steroids, or with low dietary intake. Doses and forms (tablet vs chewable) are chosen based on age, kidney function, and other medicines, because too much calcium can cause kidney stones.[26]
2. Omega-3 fatty acids (eicosapentaenoic acid, EPA)
Highly purified EPA has shown promising results in small trials for reducing polyp burden in FAP. EPA may alter cell membranes and inflammatory pathways, slowing polyp growth. Typical study doses were several grams per day in capsule form. Side effects include mild stomach upset and a slightly higher bleeding tendency at high doses, especially with other blood-thinners, so medical supervision is needed.[27]
3. Curcumin (turmeric extract)
Curcumin, the active component of turmeric, has anti-inflammatory and anti-oxidant properties. Small FAP studies combining curcumin with other agents have suggested a reduction in polyp number and size, though evidence is still limited and not part of standard guidelines. Curcumin supplements are usually taken with food and fat to improve absorption. High doses can cause stomach upset and may interact with anticoagulants.[28]
4. Folate (within normal dietary range)
Folate is needed for DNA synthesis and repair. Adequate dietary folate (from leafy greens, beans, and fortified grains) is important for general colon health. Very high-dose folic-acid supplementation is more controversial: some studies suggest it may not help once adenomas are established. Therefore, most experts recommend meeting but not greatly exceeding daily requirements, under dietician or physician advice.[29]
5. Probiotics and prebiotics
Probiotics (beneficial bacteria) and prebiotics (fibres that feed them) may help create a healthier gut microbiome. Although evidence for direct polyp reduction in FAP is still weak, improving microbiome balance may support bowel motility, reduce inflammation, and relieve diarrhoea after colectomy or during chemotherapy. Products and doses vary widely, so patients should choose medically reviewed brands and discuss them with their clinicians.[30]
6. Resistant starch and high-fibre foods
Resistant starch (found in cooked-and-cooled potatoes, green bananas, some grains, and legumes) and other fibres are fermented by gut bacteria into short-chain fatty acids such as butyrate, which have protective effects on colon cells in experimental models. A fibre-rich pattern may lower general colorectal cancer risk and improve stool consistency after colon surgery, though data in FAP specifically are limited.[31]
7. Antioxidant-rich plant compounds
Polyphenols from green tea, berries, cocoa, and many colourful fruits and vegetables may help reduce oxidative DNA damage. While they are not proven FAP treatments, including these foods as part of a balanced diet is low-risk and likely beneficial for overall cardiovascular and metabolic health, which becomes especially important when long-term NSAIDs or chemotherapy are used.[32]
(Supplements should always be checked with the medical team, as some can interfere with chemotherapy, blood thinners, or surgery.)
Immune-booster, regenerative, and stem-cell drugs: current reality
At this time, there are no approved stem-cell or regenerative drugs specifically for adenomatous polyposis. Research is ongoing into stem-cell-based repair of intestinal tissue and gene-editing approaches for APC mutations, but these remain experimental and are only used in controlled clinical trials. Drugs marketed online as “immune boosters” for polyposis are not evidence-based and may be harmful or interact with real treatments. The safest way to support the immune system is through vaccination (for example, against hepatitis B and HPV when indicated), good nutrition, physical activity, and treating infections promptly.[33]
Main surgeries used in adenomatous polyposis
1. Total proctocolectomy with ileal pouch–anal anastomosis (IPAA)
This operation removes the entire colon and rectum and creates a new “pouch” from small intestine, which is joined to the anus. It is often chosen for classic FAP with heavy rectal polyp burden. The goal is to remove almost all at-risk tissue and allow stool to pass through the normal route. Patients still need periodic pouch endoscopy because small adenomas can form there over time.[34]
2. Subtotal colectomy with ileorectal anastomosis (IRA)
In this surgery, the colon is removed but the rectum is left and joined to the small intestine. It is an option when rectal polyp load is manageable and the patient wants to avoid a pouch. The benefit is better bowel function and sometimes fertility, but the remaining rectum still has cancer risk and needs regular endoscopy and polyp removal for life.[35]
3. Completion proctectomy (removal of remaining rectum)
If rectal polyps become too numerous or high-grade after an IRA, the rectum may need to be removed later. This completion surgery converts an IRA to a more definitive solution (often an IPAA or permanent ileostomy). It is done to prevent rectal cancer when endoscopic control is no longer safe or practical.[36]
4. Targeted endoscopic or local excision of advanced lesions
In selected patients, large or suspicious polyps in the rectum, duodenum, or stomach can be removed by advanced endoscopic techniques (EMR/ESD) or local surgical excision. These procedures aim to remove precancerous or early cancer lesions while preserving organ function. They are technical and must be done by experienced teams, with careful follow-up.[37]
5. Duodenal or pancreaticoduodenal surgery in severe upper-GI disease
In people with very severe duodenal polyposis or early duodenal cancer, more extensive operations such as segmental duodenectomy or pancreaticoduodenectomy (Whipple procedure) may be needed. These surgeries have higher risk but can be lifesaving. The decision is based on cancer risk scores, patient age, and overall health, and is always discussed in a multidisciplinary team meeting.[38]
Prevention and risk-reduction strategies
Early genetic testing in at-risk relatives – Testing children and siblings of an affected person allows surveillance to begin at the right age and prevents “silent” progression to cancer.[39]
Start colonoscopy in childhood or teens (for classic FAP) – Guidelines recommend colonoscopy from about age 10–15 years in classic FAP and later in AFAP, with 1–2-year intervals.[40]
Timely prophylactic colectomy – Surgery is planned once polyp numbers, size, or histology reach dangerous levels, instead of waiting for cancer to appear.[41]
Upper-GI endoscopy based on risk stage – Regular duodenal screening and polyp removal reduce later duodenal cancer.[42]
Avoid smoking and heavy alcohol – Both increase general cancer and heart risk and may worsen surgical and chemotherapy outcomes.[43]
Maintain healthy body weight and exercise – Helps reduce colorectal cancer risk, improves recovery, and lowers cardiovascular risk.[44]
Consider chemoprevention where appropriate – Under specialist care, drugs like celecoxib, sulindac, or low-dose aspirin may modestly reduce polyp burden or adenoma recurrence in high-risk patients.[45]
Vaccination and infection prevention – Staying up to date with vaccines and promptly treating infections supports overall health before and after major surgery or chemotherapy.[46]
Regular thyroid and other extra-intestinal screening – Detects non-colonic tumours earlier and improves outcomes.[47]
Strong patient education – Understanding the disease, red-flag symptoms, and the importance of surveillance helps patients stick to long-term care plans and reduces emergency presentations.[48]
When to see a doctor
You should see a doctor, ideally a gastroenterologist or genetic specialist, if you have a strong family history of many colon polyps or colorectal cancer at a young age, or if genetic testing has shown an APC mutation. You should also seek care urgently if you notice blood in your stool, black or very dark stools, unexplained weight loss, persistent diarrhoea or constipation, abdominal pain, or tiredness from suspected anaemia. After diagnosis, any new or worsening symptoms (such as severe abdominal pain, vomiting, or signs of bowel blockage) need urgent assessment, because they might show cancer, desmoid tumours, or post-surgical complications.[49]
What to eat and what to avoid
Foods that may help (5 ideas)
Plenty of vegetables and fruits – Aim for a colourful mix every day for fibre and protective plant compounds.
Whole grains – Choose brown rice, oats, and whole-grain breads instead of refined grains to support bowel health.
Legumes and nuts – Beans, lentils, and nuts provide fibre, plant protein, and minerals like magnesium and folate.
Fish and lean protein – Fish, poultry, eggs, and plant proteins support healing after surgery and during chemotherapy.
Fermented foods – Yogurt with live cultures, kefir, and other fermented foods may support a healthier gut microbiome.
Foods to limit or avoid
- Processed and red meats – Sausages, bacon, and large amounts of beef or lamb are linked with higher colorectal cancer risk.
- Very high-fat, fried, and fast foods – These can worsen weight gain, reflux, and diarrhoea after bowel surgery.
- Sugary drinks and sweets – Excess sugar adds calories without nutrients and may worsen weight and blood-sugar control.
- Heavy alcohol use – Alcohol damages the gut and liver and increases general cancer risk.
- Excessive herbal or “detox” products – Many have no evidence, may interact with chemotherapy or NSAIDs, and should be discussed with your doctor.[50]
Frequently asked questions (FAQs)
1. Is adenomatous polyposis always inherited?
Most cases are inherited in an autosomal dominant pattern, meaning a 50% chance of passing it to each child. However, 15–30% of people have a new (de novo) APC mutation with no prior family history. Once the mutation is present, it can be passed to the next generation.[51]
2. Can adenomatous polyposis be cured without surgery?
At present, no medicine or diet can reliably remove the very high colorectal cancer risk in classic FAP. Chemopreventive drugs can reduce polyp numbers but do not replace the need for colectomy and lifelong surveillance. Surgery plus careful follow-up is still the most effective way to prevent cancer.[52]
3. If I have AFAP (attenuated FAP), is my risk lower?
AFAP usually has fewer polyps and later onset, so colorectal cancer risk is somewhat lower and later than in classic FAP, but it is still much higher than in the general population. Careful surveillance and planned surgery are still needed, just on a slightly different timeline.[53]
4. Will my children definitely have adenomatous polyposis?
Each child of a person with an APC mutation has a 50% chance of inheriting it and a 50% chance of not having it. Genetic counselling can explain testing options and timing, and some families consider pre-implantation genetic testing to avoid passing on the mutation.[54]
5. How often will I need colonoscopy after surgery?
If you have an ileal pouch, it is usually checked by endoscopy every 1–2 years. If you keep your rectum (ileorectal anastomosis), the remaining rectum is also checked every 6–12 months or as your doctor advises, because cancer can still develop there.[55]
6. Can I live a normal life after colectomy?
Many people return to work, school, sports, and family life after colectomy or IPAA. Bowel habits may be looser and more frequent, especially early on, but physiotherapy, diet adjustments, and time usually improve control. Emotional and social support are important during this adjustment period.[56]
7. Do NSAIDs like celecoxib and sulindac replace surgery?
No. These drugs can reduce polyp number and size, especially in the rectum or ileal pouch, but they do not remove cancer risk or delay the need for colectomy in classic FAP. Guidelines stress that they are only add-on treatments for selected patients.[57]
8. Is low-dose aspirin safe for everyone with adenomatous polyposis?
No. Aspirin increases bleeding risk and can irritate the stomach or cause rare serious bleeding in the brain or gut. Decisions about aspirin depend on age, other illnesses, and medicines. It should only be used if a doctor decides the benefits outweigh the risks.[58]
9. Do special diets or supplements cure adenomatous polyposis?
No diet or supplement has been proven to cure adenomatous polyposis or fully prevent cancer. However, a healthy, high-fibre diet and selected evidence-informed supplements under medical guidance can support general health and may modestly influence risk. They must always sit alongside, not instead of, regular endoscopy and surgery.[59]
10. What is the risk of duodenal cancer in adenomatous polyposis?
People with FAP have a markedly increased risk of duodenal and periampullary adenomas and cancers compared with the general population, especially at higher Spigelman stages. Regular upper endoscopy and timely treatment of advanced lesions help reduce this risk.[60]
11. Are desmoid tumours part of adenomatous polyposis?
Yes. Desmoid tumours are benign but locally aggressive fibrous tumours that can occur in the abdomen and abdominal wall in FAP. They may be triggered by surgery or pregnancy and can cause pain or bowel obstruction. Their management is complex and may involve drugs, surgery, or watchful waiting.[61]
12. Can I get life insurance or travel insurance if I have adenomatous polyposis?
Insurance rules differ by country, but many providers consider inherited cancer syndromes as higher risk. Having clear medical reports, proof of regular surveillance, and a letter from your doctor can help when applying. Genetic counsellors can often advise on these practical questions.[62]
13. Will my doctors stop following me after surgery?
No. Adenomatous polyposis requires lifelong follow-up, even after colectomy, because adenomas can appear in the ileal pouch, rectum, duodenum, or other organs. The frequency of visits may decrease over time, but stopping surveillance completely is not recommended.[63]
14. Can I participate in clinical trials?
Yes. Many centres run clinical trials on new chemopreventive drugs, surveillance strategies, or surgical techniques for adenomatous polyposis. Taking part may offer access to newer options and helps improve knowledge for future patients. Your specialist can tell you about trials in your region.[64]
15. What is the most important message for someone newly diagnosed?
The most important message is that, although adenomatous polyposis carries a high cancer risk, early diagnosis and modern care can prevent most colorectal cancers. With a good team, planned surgery, and regular surveillance, many people live long, active lives. You do not have to manage this alone—specialist centres, guidelines, and support groups are there to help.[65]
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 27, 2025.
