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Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Bhupinder Anand, MD

In this Article

• Colon polyp facts
• What are colon polyps?
• How common are colon polyps?
• Why are colon polyps important?
• Are all colon polyps the same?
• What are the symptoms and signs of colon polyps?
• How are colon polyps diagnosed?
• How are colon polyps treated?
• How is screening for colon polyps done?
• How should patients with colon polyps be followed?
• Are all colon cancers associated with polyps?
• Can colon polyps be prevented?
• How is genetic testing used in patients with colon polyps?
• Patient Comments: Colon Polyps - Describe Your Experience
• Patient Comments: Colon Polyps - Treatments
• Find a local Gastroenterologist in your town
• Colon Polyps Index

Several expert groups have made recommendations for surveillance in individuals who have been found to have polyps on their initial examination, which usually is endoscopic colonoscopy but occasionally virtual colonoscopy or flexible sigmoidoscopy. The recommendations vary slightly from group to group but not in important ways. They all make recommendations on the basis of factors such as family history of polyps and colon cancer, the number of polyps that are found, the size of the polyps, and the polyps' histology. By using these factors, the interval between surveillance procedures can be tailored to the risk of developing further polyps and malignancy in the future - the higher the risk, the shorter the interval between surveillance procedures. The recommendations that follow are modified from the guidelines proposed by the U.S. Multi-Society Task Force on Colorectal Cancer published in 2012.

• If no polyps are found on the first examination it is recommended that a second examination should be done 10 years later.
• If the only polyps that are found are hyperplastic polyps, and they are limited to the rectum and sigmoid colon and they are all less than one centimeter in size, a second examination is recommended in 10 years.
• If one or two tubular adenomas are found and they are less than one centimeter in size, a second examination is recommended in five years though a longer interval may be reasonable as well.
• If three to ten adenomas are found, it is recommended that a second examination be done in three years.
• If more than ten adenomas are found, it is recommended that a second examination be done in three years or less.
• If one or more tubular adenomas are found that are greater than one centimeter in size, a second examination is recommended in three years.
• If one or more adenomas are found of any size and their histology is villous, a second examination is recommended in three years.
• If one or more adenomas are found and any show high grade dysplasia, a second examination is recommended in three years.
• If serrated polyps are found, recommendations are less secure because much less information is available about the future risk of polyps and cancers. Concerns are greater (and the interval to the next examination should be shorter) if the polyps are proximal (in the ascending colon), are larger (more than one centimeter in size), and particularly if they show dysplasia.

Adenomas can be classified as low risk (LRA) and high risk (HRA) for cancer.

LRA is defined as one to two tubular adenomas less than one centimeter in size.

HRA is defined as three or more adenomas, with one tubular adenoma greater than one centimeter in size, or an adenoma with villous histology or high-grade dysplasia.

Recommendations regarding when to have the third and subsequent examinations depend on the presence of LRA or HRA on the first and second examinations and can vary between three and 10 years.