Colon polyps are common, with about 1 in 5 people having them (per the Colon Cancer Coalition). While most polyps are not cancerous, some can develop into cancer over time. The good news is that most colon polyps can often be found and removed during a colonoscopy screening.
What are colon polyps?
Nasser Hajar, MD, a gastroenterologist with ProMedica Physicians, says that colon polyps are growths in the large intestine. “Normally, the colon lining renews itself in a controlled way. Colon polyps form when cells begin to grow abnormally and cluster together. It creates a small bump on the inner wall.”
Colon polyps can be tiny or several inches wide in size. Sometimes colon polyps can cause changes in bowel habits or even rectal bleeding. However, most of the time, even larger polyps go unnoticed without symptoms. A colonoscopy is the most reliable way to detect polyps and to remove them.
How are colon polyps removed?
Most polyps never become cancer, but some are “precancerous,” meaning that they can turn into cancer. When this happens, the process usually takes about seven to 10 years.
Removing polyps is important for reducing colorectal cancer risk. Most polyps can be removed during a routine screening colonoscopy.
“When we remove a polyp, we send it to pathology,” explains Dr. Hajar. “They examine the cells under a microscope to determine the type of polyp and the risk for cancer.”
If the polyp is a noncancerous growth, then the patient may still only have an average risk for colorectal cancer. With an average risk, a colonoscopy is recommended every 10 years. If the polyp is precancerous, the risk for colorectal cancer is higher and more frequent surveillance is recommended.
What should patients know about a colonoscopy?
“For patients, the toughest part of having a screening test is often the preparation,” says Dr. Hajar. This includes drinking a bowel cleansing solution that empties your intestines before the colonoscopy. The patient drinks half the day before the procedure and the other half the morning of the procedure.
If you’re worried about the preparation, Dr. Hajar recommends speaking to your care team about options. You may be able to use a smaller volume of bowel preparation if you typically have regular bowel movements and healthy kidney function.
Dr. Hajar also shares that sedation during the procedure has improved over the years. “We use Propofol to provide sedation, rather than twilight sedation. This helps patients feel more comfortable and have a better experience,” he explains.
During the procedure, the doctor will check the colon and rectum for polyps, as well as inflammation, infection and bleeding. Gastroenterologists are usually the best specialists to perform a colonoscopy, because of their training in identifying and removing polyps. However, general surgeons and colorectal surgeons may also be highly qualified for this procedure. Talk with your primary care provider about which specialist may be best for you.
Due to the sedation, patients should plan for someone to drive them home. Dr. Hajar adds, “Patients should also avoid operating heavy machinery and making important decisions the day of their procedure.”
If you have average health, you may not need an in-person consult before scheduling your colonoscopy. ProMedica offers open access colonoscopies (OAC). This allows phone call consults in place of a doctor’s visit for those with average risk and under 75 years old. This saves patients the cost and time of an added visit.
Who has a higher risk for colon polyps?
Age is a major risk factor when it comes to colon polyps. The Centers for Disease Control and Prevention recommends that regular screening for colorectal cancer begin at age 45. Individuals should continue to be tested at regular intervals.
Obesity, a low fiber diet, high processed foods, smoking, diabetes, inflammatory bowel disease, heavy alcohol use and family history of colorectal cancer all increase your risk for polyps and colorectal cancer. With these risk factors, you may need screening earlier.
The newest recommended age to start screening for colon cancer is 45. If you have a family history of colon cancer or colon polyps, you should get your first colonoscopy at 45, or 10 years before your family member’s diagnosis, whichever comes first.
If an immediate member of your family had colon polyps but not colon cancer, you may still be considered high risk. Talk with your provider or specialist to determine your risk and screening schedule.
Are there alternatives to a colonoscopy?
If you are nervous about a colonoscopy, ask your primary care provider about a stool test called Cologuard®. Dr. Hajar explains, “A stool test uses a stool sample to help detect colon cancer. It’s easier than a colonoscopy and it’s better than doing nothing.”
However, it’s important to know that at-home stool screening can miss colorectal cancer, advanced polyps and even have a false positive test result. If a person tests negative, it does not confirm the absence of cancer or precancer. If a person tests positive, they will need further evaluation and likely a diagnostic colonoscopy. A diagnostic colonoscopy is typically more costly than a screening colonoscopy. For these reasons, a screening colonoscopy is still the gold standard for colorectal cancer prevention.
If you’re due for a colorectal cancer screening, talk to your doctor about your risk. A colonoscopy can help detect colon polyps and remove them early to prevent cancer.
Nasser Hajar, MD
Dr. Hajar is a gastroenterologist with ProMedica Physicians, practicing in Sylvania, Ohio. View his profile.
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