A polyp mentioned in a colonoscopy report is not a cancer diagnosis. A polyp is a growth of tissue projecting from the inner lining of the colon or rectum. Some types can develop into cancer over time, so they are removed and examined under a microscope. Size is not the only consideration. The tissue type and changes in the cells also determine the risk.
Most polyps can be removed during colonoscopy, an examination of the inside of the bowel using a flexible instrument with a camera. When choosing how to remove a large polyp, the doctor assesses its location, shape, any previous attempts at removal and the likelihood of cancer extending into deeper layers; abdominal surgery is not always necessary.
Why does the type of polyp matter?
Two polyps that look similar may have different pathology results. Whether a polyp has a thin stalk, a broad base attached to the bowel wall or spreads across the surface affects how it is removed, but its appearance alone does not determine the risk.
An adenoma is a type of polyp that can develop precancerous changes. This is not a cancer diagnosis. The report may use the terms tubular, villous or tubulovillous adenoma; these describe the structure of the tissue under a microscope. A villous structure and a larger size may increase the likelihood of finding more serious changes in the tissue.
Serrated polyps, named for their saw-toothed structure, form a separate group. Sessile serrated lesions and traditional serrated adenomas can give rise to cancer, whereas small hyperplastic polyps are usually low risk, particularly in the rectum and nearby bowel. Not all serrated polyps can be considered equally harmless.
Inflammatory polyps can develop against a background of long-standing bowel inflammation. Finding them does not mean the same thing as finding an adenoma. However, in ulcerative colitis or Crohn's disease affecting the colon, follow-up is based not only on the polyp but also on how long the underlying disease has been present and the changes in the bowel.
The word dysplasia in a pathology report means that cells have developed an abnormal structure. High-grade dysplasia is a more serious precancerous change, but on its own it does not mean cancer has spread into the deeper layers of the bowel. How deeply cancer cells have reached is assessed separately when deciding on further treatment.
Do polyps need to be removed even without symptoms?
Most polyps cause no symptoms. Having no pain and normal stools does not tell you whether polyps are absent. Some polyps are found because of bleeding, iron deficiency or a change in bowel habits, but these symptoms can also have other causes.
The decision to remove a polyp is not based on how severe the symptoms are. By removing potentially precancerous tissue, the doctor both clarifies the diagnosis and aims to eliminate the possibility of that growth changing in the future. Waiting for an existing polyp to disappear with diet or medication is not a substitute for recommended removal.
Multiple polyps, detection at a young age and similar cases in the family may prompt investigation for an inherited condition. To determine whether standard follow-up intervals are sufficient, the doctor considers the number of polyps found at previous colonoscopies, their pathology results and the family medical history together.
How is the choice made between endoscopic removal and surgery?
Endoscopic removal uses instruments passed through the camera-equipped device, without an abdominal incision. A small polyp is often removed with a special snare. For a larger growth, fluid may need to be injected beneath it to lift it away from the underlying tissue, or special instruments may be needed to cut through the superficial layers of the bowel wall. The choice depends on the polyp's features and the experience of the specialist performing the procedure.
Sometimes a polyp is removed in pieces. This is not always a problem, but it can make the tissue margins harder to assess and may require an earlier check of the removal site. When cancer is suspected, the decision about removing the tissue in one piece is particularly important.
A large polyp left in place at the first examination does not necessarily need surgery. For a polyp that appears benign but is technically difficult to remove, an opinion from a doctor experienced in endoscopic removal may be helpful. Suspected cancer extending into deeper layers, inability to remove the polyp safely and completely, or additional risks identified in the pathology results may lead to consideration of surgery to remove part of the bowel.
For selected rectal lesions, TAMIS: Transanal Minimally Invasive Surgery, a minimally invasive procedure using special instruments through the anus, may be an option. This technique is not suitable for every polyp. Lymph nodes around the bowel, small tissue structures belonging to the immune system, are not removed during this procedure, so more extensive surgery may be needed if there is a risk that cancer has spread to them.
Removal of a recurrent rectal polyp through the anus can be seen in the video TAMIS for a recurrent rectal polyp. This is surgical footage intended for adults. It shows a specific procedure; the choice of technique for you depends on your examination and pathology results.
When is the next colonoscopy?
The timing of follow-up cannot be determined by the number of polyps alone. Size, type, complete removal and how well the bowel was cleaned for the initial colonoscopy are considered together. A separate follow-up plan is used for a polyp containing cancer and for inherited conditions.
For example, some international recommendations suggest a repeat colonoscopy in 7 to 10 years after complete removal of one or two low-risk tubular adenomas smaller than 10 millimetres during a high-quality examination. For an adenoma measuring at least 10 millimetres or one with high-grade dysplasia, the interval is often shortened to 3 years. These are general examples; personal and family history may change the plan.
If a polyp measuring 20 millimetres or more has been removed in pieces, the first check may be needed about 6 months later to look for residual tissue. An early examination like this does not mean that a new cancer has been found. Its purpose is to reassess the removal site.
Increasing bleeding, severe abdominal pain, fever or fainting after the procedure require urgent medical attention without waiting for a scheduled follow-up. Once the pathology results are ready, it is useful to keep a copy and a record of the date of your next colonoscopy. If you see another doctor, saying only that a polyp was removed is not enough to continue the follow-up plan appropriately.