Why are Polyps Concerning During a Colonoscopy?

Colonoscopies are crucial in the fight against colorectal cancer. They involve a thorough examination of the colon and rectum using specialized tools to obtain visualizations and gather information for diagnoses. As gastroenterologists screen for abnormalities in the lower gastrointestinal (GI) system, special attention is paid to the presence of inflammation, ulcers, or, most importantly, polyps.  

The discovery of polyps during a routine colonoscopy can significantly alter the course of the procedure. If detected, gastroenterologists typically remove the polyps and submit them for laboratory analysis to accurately diagnose any underlying conditions, including cancer. Here, we will explore the importance of regular colonoscopy screenings for early cancer detection and the proactive removal of potentially harmful polyps.

What is a Polyp?

Polyps are abnormal growths that may develop throughout the human body. During a colonoscopy, polyps often develop on the inner lining of the colon. Polyps can vary in shape, ranging from small, flat growths to larger mushroom-shaped growths. While most polyps are benign, adenomatous polyps have the potential to develop into cancer over time.

Polyp removal during a colonoscopy is intended to prevent the development of colorectal cancer. By removing all polyps during regular colonoscopy screenings, doctors can minimize the overall risk of cancer development. 

The Link Between Polyps and Colorectal Cancer

While not all polyps are inherently cancerous, research suggests that an estimated 5-10% of all polyps or adenomas eventually progress into cancer. As the human body ages, polyps become more common in the gastrointestinal tracts, undergoing genetic and cellular changes. While most polyps appear benign at first sight, constant changes in the human body can transform benign polyps into malignant tumors. Removing polyps during a colonoscopy allows gastroenterologists and lab researchers to diagnose accurately based on tissue biopsies.

If a removed polyp is cancerous, doctors can determine the cancer stage and offer any next steps for treatment. Regular colonoscopy screenings ensure that doctors can detect these precancerous conditions and remove polyps before they progress into the next stage of cancer. 

Types of Polyps

Several types of polyps can be found during a colonoscopy, each with varying degrees of cancer risk. In some cases, benign polyps can develop into more cancerous forms of polyps, further highlighting the importance of detection and removal. The different types of polyps that may be identified are:

Hyperplastic Polyps: The most common type of polyp, hyperplastic polyps are generally the most benign and of least concern.These polyps rarely develop into cancer, but large hyperplastic polyps should be monitored and examined thoroughly.  Patient with large numbers of hyperplastic polyps may also be at increased risk.

Inflammatory Polyps: Inflammatory polyps are often associated with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis. These polyps typically develop due to increased inflammation and irritation of the gastrointestinal lining.

Adenomatous Polyps: Adenomatous polyps often have the potential to become cancerous, making them the most concerning type of polyp. When adenomatous polyps are detected, they can be categorized into three sub-categories based on cancer risk and concern:

• ‍Tubular Adenomas: Tubular adenomas are the most common type of adenomatous polyp and are generally considered the least concerning due to their lower risk profile.‍
• Villous Adenomas: With a more complex structure, villous adenomas exhibit a higher risk of malignant transformation than tubular adenomas.‍
• Sessile Serrated Adenomas: As indicated in their name, sessile serrated adenomas have a unique appearance, distinguishing them from the other types of adenomas. Under a microscope, sessile serrated adenomas have a sawtoothed or serrated shape, making them highly recognizable. Sessile serrated adenomas also have a chance of progressing to colon cancer. 

Polyp Removal Techniques

Depending on their location and characteristics, gastroenterologists utilize various techniques to remove polyps during colonoscopy. 

Snare polypectomy is a standard method involving a small wire loop (snare) inserted through the colonoscope. The polyp is then captured in the snare and the wire loop shears it from the wall of the colon.

Cold biopsy forceps utilize a cup shaped forcep to simply pinch off a piece of the mucosa. Only a very small wound is created and heals rapidly after biopsy.

Hot biopsy forceps may be employed for polyps located in areas with a higher risk of bleeding, such as near major blood vessels or inflamed tissues. These forceps cauterize the polyp's base during removal, minimizing the risk of bleeding. 

More complex procedures may be necessary for larger polyps or those situated in difficult-to-reach areas or deeply embedded within the organ tissue.

Factors Influencing Polyp and Cancer Risk

Several factors can increase an individual's risk of developing polyps in their GI system. Regular colonoscopy screenings for individuals over 45 are crucial for identifying risk factors and monitoring the progression of conditions contributing to polyp formation. A few factors that can increase the risk of polyps are:

Age: As tissue linings begin to weaken with age, adults over 50 are more susceptible to the formation of polyps. Starting at age 45, colonoscopies should be scheduled and performed to screen for colon cancer. 

Family History: A family history of colon disease or colorectal cancer can significantly increase the risk of polyp formation and cancer development. Individuals with a family history are screened at more frequent intervals.

Personal Medical History: Individuals with inflammatory bowel disease (IBD), or certain genetic conditions, such as Lynch syndrome and familial adenomatous polyposis (FAP), are at higher risk of developing polyps. 

Lifestyle Factors: Lifestyle factors, including diet, obesity, alcohol consumption, and tobacco use, significantly increase the risk of polyp development. A diet rich in red and processed meats and saturated fats can promote polyp formation. Conversely, a diet emphasizing fruits, vegetables, and whole grains, rich in fiber, can create a healthier environment within the GI tract, potentially reducing the risk of polyp development.

Dr. Ernest Castro, M.D — Denver’s Choice for Personalized and Efficient Gastrointestinal Care

Regular colonoscopies are crucial for the early detection, removal, and subsequent testing of polyps within the gastrointestinal system. To minimize the risk of polyp development, prioritize a healthy lifestyle, assess your personal risk factors, and schedule regular colonoscopy screenings as recommended by your physician.

Dr. Ernest Castro, M.D., a leading gastroenterologist in Denver, is dedicated to providing personalized and efficient care, emphasizing accurate and thorough diagnoses to ensure the best possible patient outcomes. To request an appointment or to get more information, visit our website or call (720) 706-6157.