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What happens when they find polyps in my colonoscopy

By | John Preston

Colorectal cancer is one of the most preventable forms of cancer, if promptly screened for. Detection of precancerous growths on the wall of the colon, called polyps, which the doctor can remove.

“They’re not cancer, and most of them haven’t started to turn into cancer,” says Dr. John Saltzman, an associate professor at Harvard Medical School and director of endoscopy at Brigham and Women’s Hospital in Boston. “If it occurs in the precancerous stage, it won’t have a chance to grow into cancer.”

But you’ll need to come back every so often for follow-up tests to check for any more abnormal growths in the future. Most polyps do not cause symptoms. The larger ones cause blood in the stool, but even these are usually asymptomatic. Therefore, the best way to detect them is to test people who will not have symptoms.

Several other examination techniques are available: testing stool samples for blood, performing a sigmoidoscopy to view the lower third of the colon, or using a radiological test such as a barium enema or CT colonography. If one of these tests finds polyps or raises suspicions about polyps, your doctor will usually recommend a colonoscopy to remove them.

What are polyps?

They are abnormal growths of tissue within the inner wall of the colon (mucosa). A colonoscope (flexible device used to inspect the colon) can detect, and fully remove. The timing of follow-up depends on the type, number, and size of polyps the doctor finds.

  • Hyperplastic: These polyps are not precancerous and do not carry any risk. Doctors usually remove them anyway, just to be safe.
  • Adenomas: two thirds of colon polyps are of this type. It can take seven to 10 years or more for an adenoma to progress to cancer, if it ever does. In general, only 5% of adenomas progress to cancer, but their individual risk is difficult to predict. Doctors remove any adenomas they find.
  • Serrated sessile: This type of adenoma is the riskiest because it tends to progress to cancer more quickly or aggressively. These are also removed.

Factors by which they can be found

Polyps are very common in adults, whose chances of developing polyps increase with age. Although they are not common in people in their 20s, it is estimated that the average person in their 60s, with no special risk factors for polyps, has a 25 percent chance of developing a polyp.

We don’t know what causes polyps. Some experts believe that a high-fat, low-fiber diet may predispose to polyp formation. Additionally, there may be a genetic risk of developing polyps.

The biggest risk factor for developing these abnormal growths is being over the age of 50. A family history of colon polyps or colon cancer increases the risk of developing polyps. Additionally, patients with a personal history of polyps or colon cancer are at risk of developing new polyps. There are even some rare polyp or cancer syndromes that run in families that increase the risk of polyps developing at younger ages.

When to return for follow-up?

After the polyps are removed, you will need to return for a follow-up colonoscopy. There is a 25% to 30% chance that a repeat colonoscopy will find additional polyps. The time with which you should return for follow-up depends largely on the size, type, and number of polyps found on the first colonoscopy.

  • If the colonoscopy finds one or two small polyps (5 mm in diameter or less), it is considered relatively low risk. Most people won’t need to return for a follow-up colonoscopy for at least five years, and possibly longer.
  • If the polyps are larger (10 mm or larger), more numerous, or appear abnormal under a microscope, they may need to come back in three years or sooner.
  • If the test finds no polyps, “your cancer risk is essentially the population average and you can wait 10 years for the next test,” says Dr. Saltzman.

Polyp removal (or polypectomy) during colonoscopy is a routine outpatient procedure. Possible, though rare, complications include bleeding from the polypectomy site and perforation (a hole or tear) of the colon.

Bleeding from the polypectomy site can be immediate or take several days, persistent bleeding can almost always be stopped with treatment during colonoscopy. On rare occasions, perforations occur that may require surgery to repair.

Get the best exam you can

Whenever you have a colonoscopy, you should have the highest quality exam possible so the doctor can find all the polyps. During the colon cleanse “prep” before your colonoscopy, follow the instructions to the letter. Eating a low-fiber diet for four to five days prior to the study may improve the quality of the preparation. In colonoscopy for early detection of colon cancer, the doctor must find and remove as many abnormal growths as possible.

Reducing your risk

After polyp removal, certain steps can reduce your risk of colon cancer:

  • Eat Less Meat: Eat a healthy, balanced diet with a minimum of red meat, especially processed or cured meats. Studies suggest that people with diets rich in meat may have higher rates of colon cancer.
  • Smoking: The direct relationship of smoking with colon cancer is well established, so you should consider quitting.

Remember that the contents of this page are consulted by specialists and are constantly updated, but, regardless of the date, they should not be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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