Adenomas and Other Polyps in the Colon
After your colonoscopy – what are all those scary terms in the pathology report?
So you’ve had your colonoscopy – good for you!
If your physician said there was nothing wrong with your colon, that’s obviously good news.
If your physician found a polyp or two, that still may be good news, but now you’re probably dealing with some unfamiliar terms while trying to figure out what it all means.
So first let’s talk about the 3 common “indications” (or reasons) for performing colonoscopy:
- Screening colonoscopy – exams for patients who have no symptoms and no personal history of significant polyps, generally performed at 10-year intervals beginning at age 50, unless there’s a reason to suspect that a patient has increased risk for colorectal cancer
- Surveillance colonoscopy – exams in patients who have previously had adenomas or other lesions removed from their colons, usually performed 3-5 years later, or sometimes sooner if the previous lesion was a cancer
- Diagnostic colonoscopy – exams in patients who have worrisome symptoms that could be due to a bowel problem, or who have an abnormal result on any kind of screening test
You’ve probably heard the term “polyp” in the past, and you may also have heard of a very common type of polyp called “adenomas.” As everyone knows, all apples are fruit, but not all fruit are apples. Well, all adenomas are polyps, but not all polyps are adenomas. In fact, many types of polyps can be found in the colon. Some are of absolutely no concern and some have very serious implications, but the most common are intermediate in significance, and we’ll try to help you sort it out.
When polyps are removed during colonoscopy, their size and location within the colon is recorded, and because it is generally not possible to determine the tissue type by appearance, they are sent to a lab for histological evaluation. A few days (or sometimes a couple of weeks) later, the pathologist sends a histology report to your doctor with the results of the microscopic exam of the tissue and the diagnosis.
So let’s look at some of the possible diagnoses sent back by the pathologist.
First we’ll deal with the ones that should be of no concern at all. Hyperplastic polyps, lymphoid polyps and inflammatory polyps are regarded to have essentially no potential for becoming malignant, and their presence in your colon does not increase your risk of colorectal cancer. Therefore, if you have only these types of polyps, the guidelines recommend that you should return for your next screening colonoscopy in 10 years – just like anyone else with average risk.
Adenomas are the most common type of polyp with the potential to transform into cancer, so they’re often referred to as “pre-cancerous polyps.” There’s actually considerable variation in the likelihood that an adenoma will progress to something more serious, and recommendations for follow-up depend on the number and size of adenomas found and whether they are “advanced adenomas” – ones that appear to be on the way to becoming cancerous.
Most adenomas are small and have a tissue type that is described by the pathologist as “tubular.” These small tubular adenomas have the potential for malignant transformation, but most do not become cancers, and if they do, the process takes many years. Because they present little risk, the guidelines suggest that if you have no more than 1-2 small tubular adenomas – defined as less than 1 cm in diameter – it is safe to wait 5-10 years before returning for another colonoscopy.
The recommendation changes to surveillance colonoscopy in 3 years if any of the following conditions exist:
- 3 or more small tubular adenomas
- A small tubular adenoma in which the pathologist identifies “high-grade dysplasia” – regardless of its size, this would be considered an advanced adenoma
- A large tubular adenoma – defined as at least 1 cm in diameter – is considered to be an advanced adenoma regardless of whether or not it shows dysplasia
- Adenomas of any size that are described as “villous” or “tubulovillous” are advanced adenomas
Being told that you should return for surveillance in 3 years does not necessarily mean that you will need to have a colonoscopy every 3 years for the rest of your life. The results of your future exams will determine the intervals at which your physician recommends further surveillance.
By the way, if you were surprised to discover you have a polyp when you don’t have any symptoms, you’re in good company, because that’s nearly always the case. Even patients with colorectal cancer seldom have any symptoms until their condition is far advanced. That’s why it’s so important to be screened for colorectal cancer and adenomas, and to follow your physician’s advice regarding follow-up for surveillance at intervals that are determined based on your individual findings.
If your physician used a Third Eye Retroscope during your colonoscopy to look behind the folds and flexures in the colon, you can be fairly confident in following the guidelines for screening and surveillance. If not, and if you and/or your physician are aware of adenoma miss rates for colonoscopy, your physician may recommend follow-up sooner than suggested in the guidelines.
To find a physician in your area trained to perform Third Eye Colonoscopy click here.
Jack Higgins, MD is our Chief Medical Officer and is a clinical contributor to this blog. Dr Jack, (as we like to call him) spent 25 years as a Family Practice physician and was clinical faculty at Stanford University and University of California, Davis. He’s an avid cyclist and regularly rides many of the famous trails in the Northern California coastal area.<<more>>
Debbie Donovan is in the marketing department and is editor of this blog. Part of each day is also spent sharing the myriad of things said about bowel prep, colonoscopy and colorectal cancer on the Third Eye social media channels. Deb ice skates and likes routines with fancy footwork and spins.
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