Colon Polyps

Doctor performing colonoscopy.jpg

What are Colon Polyps?

Colon polyps are small, abnormal tissue growths that develop on the inner lining of the colon. While most start out harmless, they can slowly grow and potentially turn into cancer over time, usually within an 8-to-10-year period. Understanding these growths is crucial for preventing colon cancer.

Types of Colon Polyps: What’s Serious?

Several types of polyps develop in the colon. They’re categorized as either non-precancerous or precancerous polyps in the colon:

  • Hyperplastic polyps are generally non-cancerous, with some exceptions.
  • Precancerous polyps, on the other hand, are classified into two main types: adenomas and sessile serrated polyps.
    • Adenomas: Polyps that start as benign growths and slowly get larger over nearly a decade. They can eventually develop into cancer if left untreated.
    • Serrated polyps: Tend to be flat, subtle and are frequently found on the right side of the colon. They’re difficult to detect and progress to colon cancer at a much faster rate, potentially within a few years.
  • Polyposis syndrome: A genetic condition where individuals develop a significantly higher number of precancerous polyps than normal, which greatly elevates their risk for colon cancer. A prime example of colon polyp disease is familial adenomatous polyposis, where patients can develop hundreds, even thousands, of polyps throughout their colon, leading to a very high cancer risk.

It's crucial to understand that while doctors can’t predict which polyps will become cancerous, they all pose a risk and require regular screenings. What a colon polyp looks like, however, can give some insight into whether it’s benign or precancerous, but that’s ultimately decided by a pathology report.

Colon Polyp Size and Shape

Colon polyps are categorized by size and shape. Size-wise, they fall into three classifications:

  • Diminutive: 5 mm or less
  • Small: 6-9 mm
  • Large: 1 cm or greater

Regarding shape, there are three main types:

  • Flat polyps: Resemble a thin sheet or pancake
  • Pedunculated polyps: Develop a stalk and larger head, like a mushroom
  • Sessile polyps: Have a mound-like appearance

Flat polyps are the most common, followed by sessile, with pedunculated polyps being the least frequently occurring.

Size and location are key. For instance, very small polyps (less than 5 mm) in the rectum are often hyperplastic, though not always. While larger polyps are concerning, as they’ve had time to grow and undergo cellular changes that lead to cancer, the type of polyp matters significantly.

Location of Colon Polyps

You can get polyps anywhere in your colon, but some types are more common in specific areas. For example, serrated polyps tend to favor the right side, like the ascending and transverse colon. These can be tricky to spot since they’re flat, and they can turn into cancer quickly. You can find any type of polyp in the sigmoid colon, and small, harmless hyperplastic polyps are especially common in the rectum.

Colon Polyps Symptoms and Signs

If a patient has a large, mushroom-shaped polyp in the rectum or lower sigmoid where stool is solid, the stool can irritate the polyp, leading to rectal bleeding. However, there aren’t typically symptoms or signs of colon polyps.

What Causes Colon Polyps?

It’s tough to pinpoint the exact cause for colon polyps, but several things can increase your risk. Some you can change, some you can’t.

Things you can do to avoid colon polyps, include:

  • Exercising regularly
  • Limiting alcohol
  • Losing weight
  • Not smoking

Nutrition is also a key factor for preventing polyps and colon cancer. Foods that may cause polyps in the colon include excessive amounts of red or processed meat. Additionally, eating a diet that’s low in fiber puts you at higher risk. High fiber diets (at least 25-30 grams per day) are encouraged for preventing colon cancer.

Then, there are the things you can't change that increase your risk of developing colon polyps, like:

  • If you've had polyps or colon cancer before, you're more likely to get them again.
  • Getting older is also a risk factor, especially after 45 or 50.
  • Having inflammatory bowel disease, like ulcerative colitis or Crohn's Disease increases your risk.
  • Family history plays a big role. If a close relative had colon cancer before age 60, your risk is higher.
  • Certain genetic syndromes, like familial adenomatous polyposis, greatly increase risk.
  • Certain racial groups, such as people who are Black, African American or Native Alaskan have a higher risk.
  • Having type 2 diabetes elevates your risk, too.

However, regular colonoscopies are the most effective way to prevent colon cancer by identifying and removing polyps before they can develop into cancer.

Colon Polyp Removal and Detection

The colonoscopy age for screening begins at 45, as recommended in recent years due to an increase in colon cancer cases in younger individuals. Screenings are recommended until age 75. If your colonoscopy is normal, you typically won't need another one for 10 years.

A colonoscopy usually takes between 20 and 30 minutes, but occasionally it takes longer because of the patient's anatomy.

When a polyp is removed during a colonoscopy, it's called a polypectomy. Most of the time, a cold snare technique is used, which involves placing a wire loop around the polyp and cutting it off without heat. This minimizes bleeding risks, both during and after the procedure.

When larger, pedunculated polyps are located during a colonoscopy, especially around a centimeter or bigger, they’re removed using a different method than typical polyps. Big, mushroom-shaped polyps have bigger blood vessels in their stalks, so doctors use an electrocautery snare, a snare with heat. That can sometimes cause bleeding a week or two after the procedure.

Colonoscopy vs Cologuard

Cologuard and colonoscopy are two screening methods for colorectal cancer, each with distinct characteristics. Cologuard is a non-invasive stool DNA test that detects altered DNA and blood in stool samples, indicating the potential presence of cancer or precancerous polyps. You can perform the test at home. A positive result requires follow-up with a colonoscopy.

A colonoscopy, on the other hand, is a procedure where a flexible tube with a camera is inserted into the rectum and colon, allowing providers to see and remove polyps in real-time.

Talk to your doctor about which colorectal cancer screening method is right for you, considering your age, risk factors and symptoms. However, regular screening, starting at age 45 for average-risk adults, is crucial for early detection and prevention of colorectal cancer.