Colon Polyps: Monitoring and Management Strategies

Colorectal polyp

Hello Doctor, I have been monitoring my colorectal polyps for four years now.
Each year, I have developed some small polyps, which the doctor said are hyperplastic and related to my constitution.
The doctor has removed the small ones using a biopsy forceps.
During this year's examination, I found out that there are four polyps, three of which are hyperplastic, and one small area (which looks red and has a flat surface) that the doctor said is close to becoming a polyp.
The doctor showed me a photo of it.
A biopsy was performed, and it was reported as an adenoma, which is benign.
The doctor mentioned that this type can potentially develop into a more serious polyp, so it needs to be monitored.
They advised that I should have a follow-up examination in one year.
If the results remain the same next year, I may not need to have such intensive monitoring every year.
Could you please clarify if this is concerning? Why was only a biopsy performed and not an excision? Thank you, Doctor.

A Bin, 30~39 year old female. Ask Date: 2014/03/06

Dr. Ke Fangxu reply Surgery

The guidelines for monitoring colorectal polyps state that if polyps are found during a colonoscopy and removed, a follow-up colonoscopy should be performed two years later.
If polyps are again found during the second colonoscopy and removed, another colonoscopy should be conducted three years later.
If no polyps are found during the second colonoscopy, the next examination can be spaced out to every 2-3 years.
Whether to remove the polyps or take biopsies depends on the individual physician's clinical judgment, and personal comments on this matter are not appropriate.

Reply Date: 2014/03/06

More Info

Understanding colon polyps is crucial for effective monitoring and management strategies, especially for individuals like you who have a history of developing polyps. Colon polyps are growths on the lining of the colon or rectum that can vary in size and type. The most common types include hyperplastic polyps, adenomatous polyps (which can be further classified into tubular adenomas and tubulovillous adenomas), and sessile serrated adenomas.
From your description, it seems that you have been diagnosed with hyperplastic polyps, which are generally considered benign and have a low risk of progressing to colorectal cancer. However, adenomatous polyps, particularly those with dysplasia, are of greater concern because they have the potential to become cancerous over time. The fact that your doctor mentioned a specific area that appears to be "almost a polyp" and subsequently diagnosed it as a tubular adenoma with low-grade dysplasia indicates that this particular polyp has the potential to progress if not monitored closely.

The management of colon polyps typically involves regular surveillance colonoscopies. The frequency of these procedures is determined by the type, size, and number of polyps found during previous examinations. In your case, since you have a history of adenomatous polyps, your doctor has recommended a follow-up colonoscopy in one year. This is a common practice, as it allows for close monitoring of any changes in the polyps and ensures that any new growths are detected early.

Regarding your concern about why the doctor only performed a biopsy instead of removing the polyp, this decision can depend on several factors. If the polyp is small and appears benign, a doctor may choose to monitor it rather than remove it immediately, especially if it is not causing any symptoms. The biopsy can provide valuable information about the polyp's characteristics, such as whether it shows any signs of dysplasia or malignancy. If the biopsy results indicate that the polyp is benign, the doctor may decide that it is safe to monitor it rather than subject you to an unnecessary procedure.

It's also important to consider that not all polyps need to be removed immediately. Some may be small enough that they can be safely monitored with regular colonoscopies, especially if they are not showing any concerning features. The key is to maintain open communication with your healthcare provider about your concerns and to follow their recommendations for surveillance.

In summary, your situation appears to be manageable with regular monitoring. The recommendation for a follow-up colonoscopy in one year is a standard approach for individuals with a history of adenomatous polyps. It is essential to adhere to this schedule, as early detection of any changes can significantly impact your long-term health. If you have any further concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for guidance. Regular screenings and proactive management are vital in reducing the risk of colorectal cancer, especially for those with a history of polyps.

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