The risk of developing polyps increases after age 50, with the likelihood continuing to rise in subsequent decades.
Colon Polyps
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Colon polyps are growths that develop on the inner lining of the large intestine (colon). These small clumps of cells range from a few millimetres to several centimetres in size. While most polyps remain benign, some can develop into colon cancer over time, typically taking several years for this transformation. Regular screening allows for early detection and removal of polyps before they potentially become cancerous.
Symptoms of Colon Polyps
Most people with colon polyps experience no symptoms, though specific signs may develop as polyps grow.
- Rectal Bleeding: Blood may appear as bright red streaks on toilet paper or make stools look black. This bleeding can be intermittent or persistent.
- Change in Stool Colour: Polyps can cause stools to appear red or black due to bleeding within the digestive tract. These changes may come and go over time.
- Change in Bowel Habits: Constipation or diarrhoea lasting longer than a week may occur when large polyps partially obstruct the bowel. These changes often develop gradually.
- Abdominal Pain: Large polyps can cause cramping, pain, or obstruction. The pain may vary in intensity and location across the abdomen.
- Iron Deficiency Anaemia: Ongoing bleeding from polyps can lead to low iron levels, causing fatigue, weakness, and shortness of breath.
Causes and Risk Factors
Multiple factors can contribute to the formation of colon polyps, including genetic predisposition, lifestyle habits, and underlying health conditions.
Age
Family History
Having first-degree relatives with polyps or colorectal cancer raises the risk of developing polyps, particularly if the relative was diagnosed before age 60.
Inflammatory Bowel Disease
Conditions like ulcerative colitis or Crohn’s disease increase polyp formation risk, especially in cases of long-standing inflammation.
Lifestyle Factors
Smoking, excessive alcohol consumption, and lack of physical activity contribute to polyp development. These factors can be modified to reduce risk.
Diet
Regular consumption of high-fat, low-fibre foods increases the risk of polyp formation. Processed meats and charred foods may also contribute to the risk.
Obesity
Higher body mass index correlates with increased polyp development, particularly in those carrying excess weight around the midsection.
Types of Colon Polyps
- Adenomatous Polyps (Adenomas): These make up about two-thirds of all colon polyps and arise from glandular cells in the colon lining. While not all become cancerous, they have the potential to do so over time. Adenomas are classified into tubular, villous, and tubulovillous types, with villous adenomas carrying the highest risk of malignancy. The likelihood of cancer increases with polyp size and number.
- Hyperplastic Polyps: Formed due to excess cell growth in the colon lining, these polyps are usually small (less than 5mm) and commonly found in the lower part of the colon. Most remain benign, but larger hyperplastic polyps in the right colon may require removal and further evaluation..
- Serrated Polyps: Characterised by a sawtooth appearance under a microscope, this group includes sessile serrated polyps and traditional serrated adenomas. These polyps follow different molecular pathways to cancer compared to conventional adenomas. Often flat and harder to detect during colonoscopy, they may grow more rapidly than other polyp types.
Diagnostic Methods
- Colonoscopy: This procedure involves inserting a flexible tube with a camera into the colon to examine its lining in detail. It allows for both the detection and removal of polyps during the same session. Any removed tissue is sent for laboratory analysis to determine the type of polyp and assess for any abnormal changes.
- CT Colonography (Virtual Colonoscopy): This imaging technique uses CT scans to generate detailed images of the colon, helping to identify polyps larger than 5mm. However, since polyps cannot be removed during this procedure, a follow-up colonoscopy is needed if abnormalities are found. CT colonography may be recommended for patients who are unable to undergo a traditional colonoscopy.
- Flexible Sigmoidoscopy: Using a shorter, flexible tube, this procedure examines only the lower third of the colon. While less invasive and requiring minimal preparation, it does not detect polyps in the upper colon. The procedure takes about 20 minutes and may be used for initial screenings or ongoing monitoring of known conditions.
Treatment Options
Removing colon polyps helps prevent their potential progression to cancer and supports overall colon health. Early detection and removal reduce the risk of complications and the need for more invasive treatments:
Non-Surgical Treatment
- Polypectomy During Colonoscopy: Most polyps can be removed during a colonoscopy using specialised instruments. A wire loop is placed around the polyp base, and an electric current may be applied to detach it. The procedure typically lasts between 15 and 60 minutes, depending on the size and number of polyps.
- Endoscopic Mucosal Resection: This technique is used for larger or flat polyps that may be more challenging to remove. A fluid is injected beneath the polyp to lift it from the colon wall before excision with specialised tools. While requiring additional expertise, EMR avoids the need for surgery in many cases.
Surgical Treatment
- Laparoscopic Surgery: When polyps cannot be removed during colonoscopy due to size or location, minimally invasive surgery may be necessary. This involves making small incisions in the abdomen to remove the affected portion of the colon containing the polyp. Recovery typically takes 2-3 weeks.
- Traditional Surgery: In some cases, open surgery may be required for very large polyps or when cancer is suspected. This involves removing the affected section of the colon through a larger abdominal incision. Recovery time ranges from 4-6 weeks, depending on the extent of surgery.
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Prevention and Management
Regular screening through colonoscopy starting at age 45 helps detect and remove polyps before they develop into cancer. A diet rich in fruits, vegetables, and whole grains, combined with regular physical activity, helps reduce polyp formation. After polyp removal, follow-up colonoscopies are scheduled based on the number, size, and type of polyps found, ranging from 1 to 10 years. Those with hereditary conditions or a significant family history may need more frequent screening starting at an earlier age.
Frequently Asked Questions
Will I need time off work after polyp removal?
Most people can resume normal activities the day after a polypectomy during a colonoscopy. However, if polyps are removed through surgery, recovery time may vary. Those undergoing laparoscopic surgery typically need 1 to 2 weeks, while recovery from open surgery may take up to 6 weeks, depending on the procedure and overall health.
Do polyps return after removal?
While removed polyps do not grow back, new ones can develop over time. The likelihood of recurrence varies by individual. Regular screenings help detect and remove new polyps early, with follow-up intervals based on previous findings and personal risk factors.
What are the risks of not removing colon polyps?
If left untreated, certain types of polyps, particularly adenomas and serrated polyps, can develop into colorectal cancer over time. Regular screening and removal help reduce the risk of progression.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 20 years of experience in clinical practice.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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