Your Doctor Found Colon Polyps—Now What? When To Worry and What Happens Next
Plus learn about the alternatives to a colonoscopy screening for adults with regular risk
After the fasting, the uncomfortable cleanse and a drowsy ride home, it’s a relief to have your colonoscopy screening behind you. But when the report arrives with the words “colon polyps,” some questions may follow. What did they find? Should you be worried? What happens next?
Colon polyps are easy to ignore because they almost never cause symptoms, says Douglas K. Rex, MD, a clinical gastroenterologist with Indiana University Health. While some are harmless, others can follow a slow pathway toward colorectal cancer over many years. Screening identifies these growths early, and removing polyps prevents the cancers they might otherwise become.
“People often don’t realize how routine polyps are,” says Dr. Rex, Professor Emeritus of Medicine at Indiana University School of Medicine. “We see them in nearly half of adults over 45, and most never produce symptoms.”
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Which is why screening carries so much weight. Colonoscopy, which uses a flexible camera to look at the inside of the colon, is the most effective test for identifying these growths, he explains. And removing them is what makes colorectal cancer one of the most preventable cancers when caught early. Here, we break down everything you need to know about colon polyps and colorectal cancer.
What are colon polyps?
A polyp is a small growth on the inside lining of the colon. Some are completely harmless and are the equivalent of skin tags in the sense that they are not a medical problem, Dr. Rex notes. But other types of colon polyps have the potential to change over many years. “Polyps are the precursors of nearly all colon cancers,” he says.
But many precancerous polyps never progress to cancer. Because the changes happen slowly, screening offers a key opportunity to intervene, Dr. Rex says. Polyps seen during colonoscopy are removed on the spot, using instruments passed through the scope, stopping the process before it can advance and they turn into cancer.
Most people never feel these growths at all. Polyps stay silent because they rarely reach a size that affects how the colon works and most of them don’t bleed. “A polyp has to be quite large in order for it to produce symptoms,” Dr. Rex says. “That’s why we emphasize screening. You can be harboring important polyps even when you have no symptoms.”
What happens after polyps in the colon are removed?
After colon polyps are removed during a colonoscopy, they are sent to a pathologist to determine whether they are harmless or the precancerous type. Those findings, along with the number of polyps and their size, guide the timing of your next exam, Dr. Rex explains.
Patients who had only one or two small precancerous polyps are a lower-risk group. “Most people with one or two small adenomas (adenomas are the most common type of precancerous polyp) can return in seven to 10 years,” he says.
When there are more polyps, or when any are larger, the follow-up is scheduled sooner. Large polyps require the closest attention. “If a very large polyp is removed, especially in pieces, we may bring someone back in six months or a year to make sure it’s completely gone,” he explains.
When to worry about colon polyps—and when not
Although colon polyps rarely cause symptoms, certain changes can signal that something else in the colon needs attention, and it could be cancer. At the top of the list, Dr. Rex says, is bleeding, including iron deficiency anemia. (Discover more symptoms of colon cancer here.)
“Blood in the toilet bowl, in any amount, deserves attention,” he says. “Even blood only on the toilet paper should be discussed with a doctor. Unexplained iron deficiency anemia is another important indication for colonoscopy to rule out cancer.”
Other changes—such as a shift in bowel habits, abdominal pain or unintentional weight loss—aren’t as important as bleeding but should be evaluated, and often trigger a colonoscopy. These symptoms have many possible causes, but Dr. Rex stresses that they should never be dismissed, particularly after age 45.
Risk factors that may change your screening schedule
Screening for colorectal cancer now begins at age 45 for people at average risk, a shift made in response to rising cases in adults under 50, Dr. Rex says.
Certain medical histories call for an even earlier start, particularly for those with a close relative diagnosed with colon cancer or an advanced polyp under age 60. “You should begin colonoscopy at age 40, or 10 years younger than the age at which the relative was diagnosed, whichever occurs first” he says.
Long-standing inflammatory bowel disease (IBD) also changes the screening timeline. People living with ulcerative colitis or Crohn’s colitis fall into a higher-risk group, Dr. Rex explains, and often need a colonoscopy every one to three years, depending on how extensive and long-standing their disease has been.
How to reduce your risk of developing colorectal cancer
Changes in the body over time—and daily habits—can influence colon health. Here’s how to help protect against cancer.
Consider HRT
Changes in estrogen levels in midlife may help explain why colon cancer risk rises after menopause for women. Natural estrogen is considered protective, Dr. Rex says. And hormone replacement therapy (HRT) may help.
“Estrogen replacement seems to reduce the risk of developing colon cancer,” Dr. Rex says, though he emphasizes that hormone therapy is not a substitute for screening.
Establish healthy routines
“Everything that we normally think of as a healthy lifestyle—maintaining a normal weight, not smoking cigarettes and exercising regularly—these are all things that reduce the risk of colon cancer,” he says.
Eat a balanced diet
Studies link higher fiber intake and limiting red and processed meats with lower colorectal cancer risk. The World Cancer Research Fund recommends keeping red meat to about 18 ounces per week and avoiding processed meats altogether.
All that said, while healthy habits may lower risk, only screenings can stop cancer from developing by finding polyps early, Dr. Rex stresses.
Have you been putting off a colonoscopy?
For those who hesitate about colonoscopy, there are other options. Stool-based fecal immunochemical tests (FIT), or tests that look for blood and abnormal DNA in the stool, can detect cancer and some large polyps reasonably well and are far better than avoiding screening altogether, Dr. Rex says.
“We would much rather have someone do a stool test than do nothing,” he says. “Colonoscopy is the most sensitive test, but any screening is better than none.”
However, if the less invasive tests do find hidden issues, the next step is clear. “If a stool test for blood or abnormal DNA is positive, then you must have a colonoscopy,” Rex says. “If anything other than colonoscopy is done for screening and it’s positive, it needs to be followed by colonoscopy.”
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