Being told you have a colon polyp can sound frightening. In most cases it is good news in disguise: a polyp found during a colonoscopy can usually be removed on the spot, long before it has any chance to become cancer. This page explains what polyps are, which kinds matter, what your pathology report means and when you need your next exam. Dr. Pimienta sees adults from across Los Angeles County at his Wilshire Boulevard office, in English or Spanish.
What is a colon polyp?
A polyp is a small growth on the inner lining of the colon (the large intestine) or the rectum (the last part of the colon, just above the anus). Some are flat. Others are raised, like a small bump or a mushroom on a stalk. Most are smaller than a pencil eraser.
Polyps are common, and they become more common with age. Most never cause harm. A few kinds, though, can slowly change over many years and turn into colorectal cancer. Doctors cannot always tell which kind a polyp is just by looking at it, so the usual approach is simple: find polyps, remove them, and have them checked under a microscope.
What are the main types of polyps?
Your report will name the type. In plain words, these are the ones you are most likely to hear about:
Adenomas
The most common precancerous polyp. Your report may call it a tubular adenoma (the most common and usually lowest-risk kind), tubulovillous or villous. Removing adenomas is one of the main ways a colonoscopy prevents cancer.
Serrated polyps
Named for their saw-tooth look under the microscope. Sessile serrated lesions (also called sessile serrated adenomas or polyps) and traditional serrated adenomas can turn into cancer. They are often flat and pale, so a careful exam with a clean colon matters.
Hyperplastic polyps
Very common, especially small ones in the lower colon and rectum. Small hyperplastic polyps carry little or no cancer risk. They are still removed, because they can look like other types during the exam.
Less often, polyps form because of inflammation, such as in inflammatory bowel disease. These are usually not precancerous on their own.
Do colon polyps cause symptoms?
Usually not. Most people with polyps feel completely well, which is exactly why screening matters. A test done before any symptoms start is how most polyps are found.
Larger polyps sometimes bleed. You might see blood on the toilet paper or in the stool, or a blood test might show low iron (anemia). Rarely, a large polyp changes bowel habits. These signs have many possible causes, and they always deserve a visit. Our page on rectal bleeding explains what to look for.
Call 911 or go to the nearest emergency room if you pass a large amount of blood or clots, have black or bloody stools with dizziness or fainting, or have severe or worsening abdominal pain. This is also true in the days after a polyp is removed.
Who is more likely to get polyps?
Anyone can get polyps, but the chance goes up with:
- Age. Polyps are more common after 45 and keep becoming more common with each decade.
- Family history. A parent, brother, sister or child who had colorectal cancer or an advanced polyp.
- Your own history. Having had adenomas or serrated polyps before.
- Lifestyle factors. Smoking, heavy alcohol use, excess body weight, little physical activity, and a diet high in red and processed meat.
- Some health conditions. Long-standing ulcerative colitis or Crohn's disease of the colon, type 2 diabetes, and rare inherited conditions such as Lynch syndrome or familial adenomatous polyposis.
How are polyps found and removed?
A colonoscopy is the one test that can both find and remove polyps in the same visit. Dr. Pimienta performs colonoscopy at Specialty Surgical Center of Beverly Hills, less than a mile west of his office.
A clean colon
The day before, you drink a bowel prep that empties the colon so even small, flat polyps can be seen. Our guide to preparing for your procedure walks you through it.
A careful look
While you rest under sedation, a thin, flexible tube with a camera is passed through the whole colon. Dr. Pimienta checks the lining closely as the scope is slowly withdrawn.
Removal on the spot
Most polyps are lifted off with tiny forceps or a thin wire loop. You do not feel this, because the lining of the colon does not sense cutting the way skin does.
The lab report
Each polyp goes to a pathologist, a doctor who examines tissue under a microscope. Results usually take several days, and Dr. Pimienta goes over them with you.
Very large or unusually shaped polyps sometimes need a separate, specialized procedure. If that happens, Dr. Pimienta will talk with you about the options and next steps.
What does my pathology report mean?
A pathology report can be full of unfamiliar words. These are the ones that matter most:
- Type, such as tubular adenoma, sessile serrated lesion or hyperplastic polyp.
- Size, usually in millimeters. Polyps of 10 millimeters (a little less than half an inch) or more carry more risk.
- Number of polyps of each type.
- Dysplasia, which describes how abnormal the cells look. Low-grade dysplasia is typical of adenomas. High-grade dysplasia means the cells are further along the path toward cancer, even though it is not cancer.
- Margins or completeness, which tells whether the polyp appears fully removed.
Very rarely, a polyp already contains cancer. When that happens, it is often found at an early stage, and Dr. Pimienta will explain what it means and what comes next.
When do I need my next colonoscopy?
Your follow-up schedule, called surveillance, depends on what was found. National guidance from the US Multi-Society Task Force on Colorectal Cancer gives these general ranges:
| What was found | Usual next colonoscopy |
|---|---|
| No polyps, or only small hyperplastic polyps | About 10 years |
| 1 or 2 small adenomas (under 10 millimeters) | About 7 to 10 years |
| 1 or 2 small sessile serrated lesions | About 5 to 10 years |
| 3 or 4 small adenomas | About 3 to 5 years |
| 5 to 10 small adenomas, a precancerous polyp 10 millimeters or larger, or high-grade dysplasia | About 3 years |
| More than 10 adenomas | About 1 year, often with genetic counseling |
| A large polyp removed in pieces | About 6 months, to make sure it is all gone |
These are starting points, not rules for every person. Your family history, how clean the prep was and your overall health all count. Your plan depends on your health; Dr. Pimienta will talk with you about what fits you. Our page on colorectal cancer screening and surveillance explains the bigger picture.
What if colon polyps or cancer run in my family?
Tell your doctor exactly who had what, and at what age. If a parent, brother, sister or child had colorectal cancer or an advanced polyp, especially before age 60, guidelines often recommend starting colonoscopy at 40, or 10 years before the age your relative was diagnosed if that comes first, and repeating it more often than usual. Very strong family patterns, or cancer at a young age, may point to an inherited condition, and genetic counseling can help.
It is worth sharing your own results with your family too. Your polyp history can help your brothers, sisters and children plan their own screening.
Can I lower my risk of polyps?
No habit replaces screening, but several can lower your risk of colorectal cancer:
- Get screened on time, starting at 45 for most adults, and keep your surveillance dates.
- Stay active most days of the week.
- Eat plenty of vegetables, fruit, beans and whole grains, and limit red and processed meat.
- Aim for a healthy weight. If that has been hard, medical weight management can help.
- Do not smoke, and keep alcohol low.
Getting seen in Los Angeles
If you are due for screening, were told you need a follow-up colonoscopy, or want help reading an old report, Dr. Pimienta can see you in person at his Wilshire Boulevard office or by secure video if you are in California. He accepts Medicare, and other patients are seen as self-pay. Send a request online or call (424) 281-7392, and bring any past colonoscopy and pathology reports you have.
Questions patients ask
Does finding a polyp mean I have cancer?
No. Most polyps are not cancer, and many are not even precancerous. Removing precancerous polyps is how colonoscopy helps prevent cancer from forming in the first place.
Does polyp removal hurt?
No. You are sedated during the colonoscopy, and the inner lining of the colon does not feel cutting or heat. Some people have mild gas or cramping afterward, which usually passes within hours.
Is it normal to see a little blood after a polyp is removed?
A small streak of blood can happen, sometimes even a week or two later. Call the office if you see more than a small amount. If you pass a lot of blood or clots or feel dizzy, call 911 or go to the nearest emergency room.
Can a stool test find polyps?
Stool tests are good screening tools, but they miss many polyps because most polyps do not bleed. If a stool test is positive, you need a colonoscopy to look for the cause.
Do polyps come back?
A polyp that was fully removed usually does not regrow, but people who form polyps tend to form new ones over time. That is why follow-up colonoscopies are timed to your results.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Colon Polyps.
- Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. 2020.
- American Cancer Society. Understanding Your Pathology Report: Colon Polyps (Sessile or Traditional Serrated Adenomas).
- US Preventive Services Task Force. Colorectal Cancer: Screening. 2021.