Colon Polyps

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Types Symptoms Causes Diagnosis Treatment Prevention FAQ

What Are Colon Polyps?

Colon polyps are growths that develop on the inner lining of the colon or rectum. They vary in size and shape, and while most are benign (non-cancerous), some types can become cancerous if left untreated. Early detection and removal of polyps are crucial to prevent the development of colorectal cancer.

Types of Colon Polyps

Adenomatous Polyps (Adenomas)

Adenomatous polyps are considered the most concerning type of colon polyp because they are precancerous, meaning they have the potential to develop into colorectal cancer if not removed. These polyps grow slowly over many years and typically do not cause symptoms.

Hyperplastic Polyps

Hyperplastic polyps are generally small, non-cancerous growths that usually occur in the rectum or lower part of the colon. These polyps are typically benign, meaning they have a very low risk of turning into cancer.

Sessile Serrated Polyps and Traditional Serrated Adenomas

Sessile serrated polyps (SSPs) and traditional serrated adenomas are more challenging to detect because they tend to be flat and blend in with the lining of the colon. Unlike hyperplastic polyps, these serrated polyps are considered precancerous, particularly if they are large. SSPs and traditional serrated adenomas can develop into colorectal cancer if not removed.

Inflammatory Polyps

Inflammatory polyps form as a reaction to ongoing inflammation in the colon. While inflammatory polyps themselves are not typically precancerous, the chronic inflammation that causes them is associated with an increased risk of colorectal cancer.

Symptoms of Colon Polyps

Polyps are often symptomless, but when they do cause symptoms, they may include:

Rectal Bleeding

Polyps can irritate the delicate lining of the colon or rectum, causing small tears or bleeding. This blood may be visible in the stool, which may appear as red streaks, or it may be hidden and only detectable through a lab test (known as occult blood).

Changes in Bowel Habits

When polyps grow large enough, they can partially block the flow of stool through the colon. This obstruction may lead to noticeable changes in bowel habits, such as diarrhoea, constipation, or a narrowing of the stool (thin or ribbon-like).

Abdominal Pain

Polyps can sometimes cause discomfort if they grow large enough to obstruct the passage of stool through the colon. When stool encounters the blockage, the colon may contract more intensely to push the stool through, which can lead to cramps, bloating, or pain. This discomfort is typically felt on and off rather than continuously and may be mistaken for common digestive issues.

Tiredness and Weakness

If a polyp bleeds slowly over time, it can cause a gradual loss of blood, leading to iron deficiency anaemia. This condition occurs when the body doesn’t have enough iron to produce adequate levels of haemoglobin, the protein that carries oxygen in the blood. As a result, the individual may feel unusually tired, weak, or short of breath even with mild physical exertion.

Causes & Risk Factors

Colon polyps develop when there are disruptions in cell growth within the colon or rectum. Risk factors include:

Age: As people age, the cells in the colon undergo more divisions and mutations over time. This accumulation of cellular changes increases the likelihood of polyps developing, especially after the age of 50. This is why routine colon screening is often recommended starting at this age.

Family History: If close family members have had colon polyps or colorectal cancer, the risk of developing polyps increases. This is often due to inherited genetic mutations that can lead to abnormal cell growth in the colon, making polyps more likely to form. In these cases, regular screening may start earlier than age 50.

Genetic Mutations: Certain inherited genetic conditions, such as familial adenomatous polyposis (FAP) and Lynch syndrome, significantly increase the risk of colon polyps and colorectal cancer. Individuals with these conditions may develop polyps at a young age and in large numbers. Genetic testing and early screening are typically recommended for those with a family history of these conditions.

Diagnosing Colon Polyps

Colon polyps are often detected through regular screenings since they may not cause symptoms:

Colonoscopy

A colonoscopy is the most thorough method for detecting colon polyps. During the procedure, a long, flexible tube with a small camera (called a colonoscope) is inserted into the rectum to examine the entire colon. If polyps are found, they can be removed immediately, reducing the risk of them becoming cancerous.

Flexible Sigmoidoscopy

A flexible sigmoidoscopy uses a shorter tube than a colonoscopy, allowing doctors to examine the rectum and the lower part of the colon. While this procedure is useful for detecting polyps in the lower colon, it may miss polyps that are higher up in the large intestine. If polyps are detected, a full colonoscopy may be recommended to check the rest of the colon.

Stool Tests

Stool tests, such as the faecal occult blood test (FOBT) or the faecal immunochemical test (FIT), are non-invasive ways to detect hidden blood in the stool, which can be a sign of polyps or colorectal cancer. While these tests are convenient, they cannot detect polyps directly. If blood is found, further investigation with a colonoscopy is usually needed to determine the cause.

CT Colonography (Virtual Colonoscopy)

A CT colonography, also called a virtual colonoscopy, uses a CT scan to produce detailed 3D images of the colon and rectum. This method can help identify polyps and other abnormalities. However, if polyps are found, a traditional colonoscopy will still be needed to remove them. CT colonography is less invasive but not as comprehensive as a regular colonoscopy.

Surgical Treatment Options for Colon Polyps

Polypectomy

A polypectomy is a minimally invasive procedure where polyps are removed during a colonoscopy or sigmoidoscopy using special instruments. It is commonly used for small and medium-sized polyps and is typically done as part of a screening test.

Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection(ESD)

For larger or more complex polyps, EMR or ESD is used. During this procedure, the polyp is first injected with a liquid to lift it away from the colon wall, making it easier to remove. This method helps remove larger polyps safely that might otherwise require surgery.

Surgical Resection

When polyps are too large, too numerous, or difficult to remove via less invasive methods, surgical resection may be necessary. In this procedure, a surgeon removes a portion of the colon that contains the polyps. This lowers the risk of colorectal cancer but requires a longer recovery period.

Procto-Colectomy

In cases where a genetic condition, such as familial adenomatous polyposis (FAP), causes the development of hundreds or thousands of polyps, a procto-colectomy may be recommended. This surgery involves removing part or all of the colon and rectum to prevent the progression to colorectal cancer. While this procedure is effective in cancer prevention, it requires a lengthy recovery and can result in long-term changes to bowel habits, such as more frequent or looser stools.

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Prevention of Colon Polyps

Preventing colon polyps involves adopting a healthy diet rich in fruits, vegetables, and fibre while avoiding red and processed meats. Regular exercise, not smoking, and limiting alcohol intake can further reduce the risk. Routine screenings are essential, particularly for individuals over 50 or those with a family history of colon polyps or colorectal cancer. Colonoscopies are effective for detecting and removing polyps before they can develop into cancer.

Dr Calvin Ong Jianming

Senior Consultant, Colorectal & General Surgeon

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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