Colorectal polyp

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Colorectal polyps: a simple guide

What is a colorectal polyp?
- A colorectal polyp is a small growth on the lining of the colon or rectum. Most polyps are not cancer, but some can turn into cancer if not treated.

Symptoms
- Many polyps cause no symptoms.
- If present, symptoms can include blood in the stool, changes in bowel habits (new constipation or diarrhea), fatigue from blood loss, or, with larger polyps, belly pain or obstruction.

How polyps are classified
- By behavior: benign (not cancer), pre-cancer (can become cancer), or cancer (malignant).
- By appearance: pedunculated (on a stalk) or sessile (flat on the wall).
- By tissue type: hyperplastic (usually harmless); adenomatous polyps (tubular, tubulovillous, villous) which can become cancer; serrated polyps (sessile serrated or traditional serrated adenomas) which also have cancer potential; hamartomatous polyps (common in certain syndromes).

Size and cancer risk
- Bigger polyps have a higher risk of cancer.
- In general, polyps larger than about 1 cm are more likely to need removal. Very large or difficult polyps may require special techniques or surgery.

How polyps are found
- Most are found during a colonoscopy, a procedure where a doctor looks inside the colon with a scope.
- Other tests include fecal tests, flexible sigmoidoscopy, CT colonography, or a pill camera.

Treatment and removal
- Many polyps are removed during colonoscopy with a small wire loop (snare) and cautery to stop bleeding.
- Larger or flat polyps may be removed with endoscopic mucosal resection (EMR), a technique that lifts the polyp before removing it.
- If a polyp is too large or in a difficult spot, or if it has already become cancer, surgery to remove part of the colon may be needed.

Follow-up care
- After removal, most people need regular follow-up colonoscopies to check for new polyps.
- The frequency of check-ups depends on the number, size, and type of polyps found, as well as any family history.

Hereditary syndromes (brief overview)
- Some people have inherited conditions that raise the risk of many polyps and cancer:
- Familial adenomatous polyposis (FAP): many polyps appearing early in life; high cancer risk; usually managed with surgery and early screening.
- Lynch syndrome (HNPCC): higher cancer risk, often at a younger age; linked to DNA repair gene mutations.
- Peutz–Jeghers syndrome: hamartomatous polyps with pigmented lips/mouth; higher risk of several cancers.
- Juvenile polyposis syndrome: multiple juvenile polyps with increased cancer risk.
- People with these syndromes typically need earlier and more frequent screening.

Lifestyle and prevention
- Diet and lifestyle may influence polyp formation. Some evidence suggests that eating vegetables, legumes, whole grains, and dried fruit may be protective.
- Regular screening and removing polyps are the best ways to prevent colorectal cancer.

When to talk to a doctor
- If you notice blood in your stool, have persistent changes in bowel habits, or feel unusually tired or pale (possible anemia), see a healthcare provider.
- Regular screening is important, especially if you have a family history of polyps or colorectal cancer.