Polyps look like small mushroom like growths and are often on a stalk, but some are flat. Polyps in the colon are clinically important for two reasons
- They may result in symptoms such as bleeding
- Some colonic polyps develop into cancers
There are polyps that are not pre-cancerous, but only analysis in the laboratory can reliably detect the difference between those that do carry the risk of cancer development and those that don’t – which is why all polyps are removed and then sent to the lab. Polyps that are not pre-cancerous do not require any further therapy unless they result in symptoms. Those polyps that do predispose you to cancer development in the future, are usually called adenomas. These are usually benign at the time of removal.
Patients with adenomatous polyps of the colon are followed up carefully over the years to make sure that they do not grow any further polyps and if they do – have them removed. This is called surveillance. You will now be automatically entered into our surveillance program and a reminder letter will be sent to your referring doctor at a specified interval when we feel that you are due for your next colonoscopy. By looking at your bowel at certain intervals over the years, we should be able to prevent you developing bowel cancer by picking up any polyps when they are still in their benign form. Polyps should be removed when they are discovered. Polyps are removed at the time by using hot biopsy forceps or snares. The use of electric current both cuts the tissue and cauterises blood vessels to reduce the risk of bleeding.
Colonoscopy is the most sensitive means of determining whether you have polyps and how many polyps are present. Barium enema is satisfactory only for detecting large lesions. Small lesions (less than 1cm) may not be detected by Barium enema. Also polyps can not be removed by x-ray examination. Patients who have many polyps (greater than 100) are likely to have one of the hereditary polyp syndromes and further questions will be asked about your family history at that stage. The risk of cancer developing in a benign polyp increases with the size of the polyp. Patients with documented adenomatous polyps of the colon are at a high risk (10-30%) for the subsequent development of additional polyps or colon cancer (2-5 fold increase) and should be screened regularly with colonoscopy. We will let your doctor know when you are next due and an indication may have be given to you today on when that is likely to be.
The incidence of bleeding following polyp removal is said to be about 1%. This risk increases with the size of the polyp. Most patients who are going to bleed will do so within 1-2 days of the procedure. Many patients notice some blood spotting in the toilet bowl after colonoscopy when the clot falls from the surface of the bowel where the polyp has been removed. This is not serious and usually settles. Further action is very rarely required.