Bowel polyps: what was removed, and what happens next?
Hearing that a polyp was found can be worrying. Most bowel polyps are not cancer. Removing the types that can become cancer is one way colonoscopy helps prevent bowel cancer.
The key points
A polyp is a growth on the inside lining of the bowel. Most are not cancer.
The laboratory result helps identify the type of polyp and whether further treatment is needed.
Your recommended follow-up will be documented in your endoscopy report and/or histology report once the tissue results are available.
What is a bowel polyp?
A bowel polyp is a growth on the inner lining of the colon or rectum, which together make up the large bowel. Some grow on a stalk; others have a broad base or are almost flat.
Most polyps cause no symptoms. A small polyp found during your colonoscopy may not explain pain, bloating or a change in bowel habit. Please let me or your GP know if those symptoms continue.
Why was it removed?
Some types of polyp can develop into cancer over time. Removing them reduces that risk. It also allows the tissue to be examined in a laboratory.
Many polyps can be removed during the same colonoscopy. If a polyp needs a separate procedure or a different treatment, I will explain the options and the next step.
A biopsy takes a sample. It does not always remove the whole polyp. Your report should say whether a polyp was removed or only sampled.
How long does a polyp take to become cancer?
Most polyps never become cancer. For those that do, the change usually happens over many years. An adenoma can take 10 to 15 years to develop into cancer, but some polyps progress more quickly.
There is no reliable way to predict the time for an individual polyp. The type of polyp, its size and the cell changes affect the risk. Removing a precancerous polyp prevents that polyp from developing further.
The 10 to 15 year estimate is not a reason to delay removal or your recommended follow-up. I use your colonoscopy findings and tissue results to decide when your next check should be.
How are polyps removed?
Polyp removal is called polypectomy. Small instruments pass through a channel inside the colonoscope, the flexible camera used to examine the bowel. They reach the polyp from inside the bowel, without a cut through the skin.
I choose the approach according to the polyp’s size, shape, position and appearance, and your health and medicines. The diagram explains common techniques. Some complex polyps need advanced endoscopic treatment or surgery.
Polyp removal leaves a wound in the bowel lining. After a small polyp is removed, this usually heals quickly. Larger removal sites can take longer. Follow the discharge instructions I give you about medicines, activity and travel.
Bleeding and, rarely, a hole in the bowel wall (perforation) are possible complications. I will discuss the risks for your procedure. The advice below explains when to get help.
What does the laboratory check?
A specialist doctor called a pathologist examines the removed tissue under a microscope. The report identifies the polyp type and checks for abnormal cells or cancer. This is often called the histology or pathology result.
I combine this result with the colonoscopy findings when advising you about the next step. Sometimes more treatment is needed to make sure a polyp has been completely removed.
Words you may see in your report
Adenoma
A common type of polyp that can develop into cancer. An adenoma is not itself an invasive cancer. Tubular, tubulovillous and villous describe patterns seen under the microscope. These findings help guide follow-up.
Sessile serrated lesion (SSL)
Another type of polyp that can develop into cancer. It is often flat or broad-based. You may also see the older terms sessile serrated polyp or sessile serrated adenoma. A traditional serrated adenoma is a less common related type.
Hyperplastic polyp
Small hyperplastic polyps, especially in the lower bowel, usually have very little cancer risk. Larger ones, or many serrated polyps, need a different assessment. I consider the full pattern of findings.
Dysplasia and high-grade dysplasia
Dysplasia means abnormal changes in the cells. High-grade dysplasia describes more advanced changes, but is not the same as invasive cancer. Complete removal and appropriate follow-up are important. I will explain what the findings mean for you.
What if the report says cancer was found?
I will discuss the result and treatment options with you. Some very early cancers can be treated by removing the polyp. Others need surgery or further assessment. The decision depends on the detailed pathology and whether removal was complete.
Will I need another colonoscopy?
Not everyone needs the same follow-up. When recommending your next check, I consider:
The type, size and number of polyps, including polyps removed previously.
Whether there were more advanced cell changes, and whether removal was complete.
How clearly the bowel could be seen and whether the examination was complete.
Your family history, age, health and preferences.
Some people can return to routine bowel screening when eligible. Others need a follow-up colonoscopy, called surveillance. A large polyp removed in pieces may need an earlier check of the removal site. This is different from a later examination to look for new polyps.
I will document your recommended follow-up in your endoscopy report and/or histology report once the tissue results are available. A negative FIT stool test does not replace a colonoscopy that has been recommended for polyp follow-up.
Does this affect my family?
One small polyp does not automatically mean your relatives need colonoscopy. A large number of polyps, polyps at a young age, or a family history of bowel cancer may change the advice. Please let me know which relatives were affected and their ages at diagnosis. We can discuss whether your family needs a separate screening plan.
What should I do now?
Keep your endoscopy report and histology report or results letter. These will record your recommended follow-up.
Check who will tell you the results and when to expect them. Contact our team if a result we are arranging has not arrived when expected. If another service arranged your test, contact that service or your GP.
Ask whether all polyps were removed, whether further treatment is needed, and when your next check is due.
After removal: when to get help
Mild bloating can occur after colonoscopy. Significant bleeding is uncommon after small polyps are removed with modern techniques, particularly a cold snare. The risk is higher with larger polyps and in people taking blood thinners. Bleeding can start several days after removal, including during the following two weeks.
If you take blood thinners
Your medication plan should be documented in your endoscopy report or discharge instructions. It should say whether each blood thinner needs to be withheld and, if so, when to take the last dose and when to restart it. Some medicines can be continued. If the instructions are missing or you are unsure, give our endoscopy team a call before changing a dose.
When to get help
Seek urgent medical assessment for heavy or ongoing bleeding, blood clots, black tarry stools, severe or worsening tummy pain, fever, persistent vomiting, or feeling faint or very unwell. Call our endoscopy team immediately or go to an emergency department.
Call 111 for an ambulance if you collapse, have heavy bleeding with faintness, or are too unwell to travel safely. Do not wait for a routine appointment or an email reply.
This is general information. Your results letter and discharge instructions contain the advice for your own care.
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