Understanding polyps

About 3 to 5 out of every 10 persons older than 50 will have a polyp seen on their colonoscopy. Usually polyps are removed as this reduces the risk of developing bowel cancer over the years. Tissue that is removed is sent for review by a medical specialist called a pathologist. Some polyps have a low risk of eventually developing into cancer. Others have a higher risk. The number, size, and kind of polyp along with other factors such as your family history, all influence when it is recommended that you have another colonoscopy. Follow up may be after one, three, five, or ten years.

The pathology report tells the colonoscopy doctor and your family doctor the diagnosis in each of the samples to help manage your care. If you have questions about polyps that are removed it is helpful to ask your doctor.

This information is designed to help you understand the medical language used in the colonoscopy and the pathology report.

This material for Colon polyps is adapted from that originally developed by Association of Directors of Anatomic and Surgical Pathology (used with permission). Copyright © 2014 Association of Directors of Anatomic and Surgical Pathology

1. What if my report mentions “cecum”, “ascending colon”, “transverse colon”, “descending colon”, “sigmoid colon”, or “rectum”
The cecum is the beginning of the colon where the small intestine empties into the large intestine.  The ascending colon, transverse colon, descending colon, sigmoid colon, and rectum are, in order other parts of the colon beyond the cecum.  The colon ends at the rectum and waste exits through the anus.
2. What is a polyp in the colon?
A polyp is a projection (growth) of tissue from the inner lining of the colon into the lumen (hollow center) of the colon. 
3. What is an adenoma?
An adenoma is a polyp that resembles the normal lining of your colon but differs in several important microscopic aspects.
4. What are “tubular adenomas”, “tubulovillous adenomas”, and “villous adenomas”?
Adenomas have several different growth patterns that can be seen by the pathologist under the microscope. There are two major growth patterns: tubular and villous. Because many adenomas have a mixture of both growth patterns, some polyps may be called tubulovillous adenomas. Most adenomas are small (less than ½ inch) and have a tubular growth pattern. Larger adenomas are more likely to  have a villous growth pattern and more often found to have cancers developing in them. Adenomas with a villous growth pattern are also more likely to have cancers develop. As long as your polyp has been completely removed and does not show cancer, you do not need to worry about the type of growth pattern seen in your polyp. These growth patterns are mostly used to try and determine how often you will need to have colonoscopy to make sure you don’t develop colon cancer in the future (see question 10).
5. What if my report used the term “sessile”?
Polyps that tend to grow as slightly flattened, broad-based polyps are referred to as ‘sessile’. 
6. What if my report uses the term “serrated”?
Serrated polyps have a ‘saw tooth’ appearance under the microscope and that is why they are called ‘serrated’.
7. What if my report uses the term “traditional serrated”?
The term ‘traditional serrated’ has slightly different features seen with the microscope than the sessile serrated adenoma (also called sessile serrated polyp).  Both types need to be removed from your colon. 
8. What is the significance of the diagnosis of sessile serrated adenoma or traditional serrated adenoma or adenoma (adenomatous polyp)?
These types of polyps are not cancer, but are precancerous and therefore, you have some increased risk of subsequently developing cancer of the colon. However, most patients with these polyps never develop cancer. 
9. What if my report mentions “dysplasia”?
“Dysplasia” is a term that describes how much your polyp looks like cancer under the microscope. All adenomas and many serrated polyps have some amount of dysplasia in them. Polyps that are only mildly abnormal are said to have low-grade (mild or moderate) dysplasia, while polyps that are more abnormal and look more like cancer are said to have high-grade (severe) dysplasia. As long as your polyp has been completely removed and does not show cancer, you do not need to worry about dysplasia in your polyp.
10. How does having the various types of adenoma and serrated polyps affect future clinical treatment?

Since you had an adenoma or a serrated polyp, you will need to have a colonoscopy every so often to make sure that you don’t develop any more adenomas or serrated polyps. In general, those with one or more polyps with villous, tubulovillous growth pattern, sessile serrated polyp with dysplasia, traditional serrated polyp, a polyp larger than a centimeter in size or any more than two adenomas should have a repeat colonoscopy in three years. Those with one or two, less than centimeter tubular adenomas can wait for five to ten years for their next colonoscopy.

The frequency of recommended endoscopy exams depends on a number of factors  (such as family history and how clean your colon was at time of colonoscopy), and should be discussed with your treating doctor as it may be individualized to your specific case.

11. What if my adenoma or serrated polyp was not completely removed?
If your adenoma/serrated polyp was  not completely removed, you will need talk to your doctor to determine what further treatment is best for you. In general, all adenomas/serrated polyps need to be completely removed. In some cases, more than one colonoscopy may be required. In other cases, the adenoma/serrated polyp may be too large to remove with a colonoscopy. You may be sent to a surgeon to have the adenoma/serrated polyp removed.
12. What if my report mentions “hyperplastic polyps”?
Hyperplastic polyps are totally benign (non-cancerous) and have no significance. Therefore, hyperplastic polyps by themselves are not a reason to have repeat colonoscopy. Many polyps in the rectum are hyperplastic.