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Colonic Polyps

A colonic polyp is a small clump of cells that form on the inner lining of the colon or rectum. Polyps vary in size and shape; they can be flat, raised, or stalk-like (pedunculated). Most polyps do not cause symptoms, which is why planned investigations are important to detect them early.

Though polyps are generally benign, some types can become cancerous over time, especially if left untreated. 

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Types of Colonic Polyps

Adenomatous Polyps (Adenomas)

  • Description: Adenomatous polyps are the most common type of polyp. These polyps have the potential to develop into colon cancer over time. About 1 in 10 adenomatous polyps may turn into cancer if not removed.

  • Risk: The larger the adenoma, the higher the risk of it becoming cancerous. Polyps with a high degree of dysplasia (abnormal cells) are also more likely to progress to cancer.

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Hyperplastic Polyps

  • Description: Hyperplastic polyps are generally small and usually not considered to be precancerous. They are typically found in the rectum and lower colon.

  • Risk: These polyps have a very low risk of becoming cancerous, but larger ones may need to be removed and evaluated.

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Inflammatory Polyps

  • Description: These polyps are often associated with inflammatory bowel diseases (IBD) such as ulcerative colitis or Crohn’s disease. They are a result of chronic inflammation in the colon.

  • Risk: Inflammatory polyps themselves are not usually cancerous, but individuals with long-term IBD may have an increased risk of colon cancer.

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Sessile Serrated Polyps

  • Description: Sessile serrated polyps are flat and often found in the right side of the colon. These polyps are less common but can have a higher risk of developing into cancer, especially if they are large.

  • Risk: Like adenomas, these polyps can evolve into colorectal cancer, particularly if they are not detected and removed early.

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Risk Factors for Colonic Polyps

Certain factors may increase the risk of developing colonic polyps or colorectal cancer. These include:

  • Age: Risk increases with age, particularly after 50.

  • Family history: A family history of colorectal cancer or polyps increases your risk.

  • Personal history of polyps: If you’ve had polyps before, you’re more likely to develop new ones.

  • Inflammatory bowel diseases (IBD): Conditions like Crohn’s disease or ulcerative colitis increase the risk of polyps and colorectal cancer.

  • Diet: A diet high in red or processed meats, and low in fruits and vegetables, may increase your risk of developing polyps.

  • Obesity: Being overweight or obese is linked to a higher risk of polyps and colon cancer.

  • Sedentary lifestyle: Lack of physical activity can increase your risk.

  • Smoking and alcohol use: Smoking and excessive alcohol consumption are associated with an increased risk of colon polyps.

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Symptoms of Colonic Polyps

Most colonic polyps do not cause symptoms, which is why screening is important. However, larger polyps or those that become cancerous may cause symptoms, including:

  • Rectal bleeding: Blood in the stool or on toilet paper, or dark or tarry stools, may indicate a polyp or more serious issue.

  • Changes in bowel habits: Diarrhea, constipation, or a change in the size or shape of your stool may be linked to polyps.

  • Abdominal pain: Unexplained abdominal discomfort or cramping.

  • Iron-deficiency anemia: If polyps bleed over time, they may cause anemia, leading to symptoms like fatigue and weakness.

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It is important to note that many of these symptoms are also associated with other gastrointestinal conditions, so having symptoms doesn’t necessarily mean you have polyps or cancer.

 

Diagnosing Colonic Polyps

Colonic polyps are typically diagnosed through screening tests, which can detect polyps before symptoms appear. The most common diagnostic methods include:

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Treatment of Colonic Polyps

If polyps are found, they are typically removed while undertaking a colonoscopy. This is usually done through a procedure called polypectomy, where the polyp is cut out using specialized tools. In some cases, larger polyps may require additional treatments, such as:

  • Endoscopic mucosal resection (EMR): A technique used to remove larger or sessile polyps using a special tool.

  • Surgery: In rare cases, when polyps are too large or cannot be removed endoscopically, surgery may be necessary to remove part or all of the colon.

After removal, the polyps are typically sent for biopsy to determine whether they are benign or have any precancerous or cancerous changes.

 

Prevention and Monitoring

While there is no sure way to prevent colonic polyps, regular screening is the best way to detect and remove them before they become cancerous. Recommendations for screening vary depending on your risk factors, but general guidelines include:

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  • Average risk: Starting at age 54, individuals with no family history of colorectal cancer or polyps should begin regular screening. The UK National Bowel Cancer Screening Programme will send you a Stool FIT kit every 2 years until you are 74. Mr Ferguson strongly advises you to engage with this process.

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  • Increased risk:

    • Individuals with a family history of polyps or colorectal cancer, or a personal history of IBD, may need to start screening earlier (often by age 40) and may need more frequent screening (every 5 years or more frequently).

    • If you have had polyps before, you may benefit from surveillance tests, which Mr Ferguson will discuss with you in line with National Guidelines

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Additionally, maintaining a healthy lifestyle with a balanced diet, regular exercise, avoiding smoking, and limiting alcohol consumption may help reduce your risk of polyps and colorectal cancer.

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