Polyps: Screening and Family History in Gastroenterology

Polyp issues?

Hello, doctor.
My father had a positive fecal occult blood test in 2015, which led to a recommendation for a colonoscopy.
During the colonoscopy, two polyps the size of rice grains were found and immediately removed.
The doctor advised follow-up in two years.
This year, he underwent another fecal occult blood test, and the results were normal.

1.
I would like to ask if a normal occult blood test result means that it is safer to undergo another colonoscopy, considering he has a history of polyps.

2.
How long does it typically take for a normal tissue to progress to cancer? My uncle has colon cancer, my father has had polyps, but no other family members (grandparents, aunts, or uncles) have been diagnosed.
Does this indicate a hereditary risk?

Dà Huáng, 30~39 year old female. Ask Date: 2017/09/18

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
Colorectal cancer and polyps have some hereditary tendencies, so we still recommend that your father undergo another colonoscopy for follow-up.
Other relatives should also be screened as advised.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2017/09/18

More Info

When it comes to understanding polyps, particularly in the context of family history and screening, there are several important factors to consider. Polyps are abnormal growths in the lining of the colon or rectum, and while many are benign, some can develop into colorectal cancer over time. Given your family history of colorectal cancer, particularly with your father having had polyps removed and your uncle diagnosed with colorectal cancer, it is crucial to approach screening and monitoring with diligence.

1. Screening Recommendations: Since your father had polyps removed, it is advisable for him to continue regular screenings, typically every 1 to 3 years, depending on the number and type of polyps found. The fact that your father had a positive fecal occult blood test (FOBT) in 2015 and subsequently underwent a colonoscopy where polyps were found and removed indicates a higher risk for colorectal cancer. Even though his recent FOBT was normal, it does not eliminate the need for regular colonoscopy screenings. The normal FOBT suggests that there are no visible blood traces in the stool at that time, but it does not rule out the presence of polyps or other abnormalities. Therefore, it would be prudent for him to have a follow-up colonoscopy as recommended by his healthcare provider.

2. Polyp to Cancer Progression: The timeline for a polyp to progress to cancer can vary significantly. Generally, it is estimated that it can take anywhere from 5 to 10 years for an adenomatous polyp to develop into colorectal cancer. However, this timeline can be influenced by various factors, including the type of polyp, genetic predispositions, and lifestyle factors. Given your family history, particularly with your uncle having had colorectal cancer, it is essential to be vigilant and proactive about screenings.

3. Family History and Genetic Risk: Having a family history of colorectal cancer, especially with first-degree relatives (like your father), increases your risk for developing similar conditions. The presence of polyps in your father and colorectal cancer in your uncle suggests a potential hereditary component. Conditions such as Familial Adenomatous Polyposis (FAP) or Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) could be at play, which significantly increase the risk of developing colorectal cancer. It may be beneficial for you and your family members to discuss genetic counseling and testing with a healthcare provider to assess your risk and determine appropriate screening strategies.

4. Lifestyle Modifications: In addition to regular screenings, adopting a healthy lifestyle can help reduce the risk of colorectal cancer. This includes maintaining a balanced diet rich in fruits, vegetables, and whole grains, exercising regularly, avoiding tobacco, and limiting alcohol consumption. These lifestyle changes can contribute to overall health and may help mitigate some of the risks associated with family history.

In summary, given your father's history of polyps and your family's background with colorectal cancer, it is crucial to maintain regular screenings and follow the recommendations of healthcare providers. A normal FOBT is a positive sign, but it should not replace the need for colonoscopy, especially considering the previous findings. Additionally, understanding your family's genetic risks can help guide your healthcare decisions moving forward. Always consult with a gastroenterologist or a healthcare provider for personalized advice and screening plans tailored to your family's medical history.

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