What is the difference between types of intestinal polyps?

Intestinal polyps can have different characteristics, and not all carry the same risk of developing into cancer. Adenomas and some serrated lesions can be precursors to colorectal cancer, while other polyps present a very low risk.

Polyps are growths that develop on the inner surface of the large intestine, which consists of the colon and rectum. They are frequently identified during a colonoscopy.

What are the main types of intestinal polyps?

Adenomas are polyps that can be precursors to colorectal cancer. Not all adenomas turn into cancer. The risk varies according to the size, number, and characteristics of the polyp.

Adenomas can be tubular, tubulovillous, or villous. Adenomas 10 mm or larger exhibit characteristics associated with a higher risk. The presence of a villous component or high-grade dysplasia also influences the assessment.

High-grade dysplasia means that the cells show significant changes. This result does not necessarily mean that invasive cancer is already present.

Serrated lesions form another group of polyps. Some of these lesions can also be precursors to colorectal cancer and influence follow-up after colonoscopy.

Hyperplastic polyps generally present a low risk, especially when they are small and located in the rectum or sigmoid colon.

How do we determine the type of polyp?

The type of polyp can be defined by histopathological analysis after the lesion is removed. Histopathological analysis is the microscopic study of tissue performed by a pathologist.

The report provides important characteristics for follow-up. The type of polyp, its size, the number of lesions, and the presence of dysplasia can modify the interval until the next colonoscopy.

Does every intestinal polyp need to be removed?

The strategy for polyp removal depends on the size, shape, location, and characteristics of the lesion.

Many polyps can be removed during the colonoscopy itself through polypectomy. Larger polyps or those with characteristics that make removal difficult may require specific endoscopic techniques for removal.

The removal of precursor lesions helps prevent colorectal cancer. The analysis of the removed polyp also provides information to determine patient follow-up.

When is it necessary to repeat a colonoscopy after polyp removal?

The interval for a new colonoscopy depends on the characteristics of the polyps found and the quality of the examination performed.

After the complete removal of one or two tubular adenomas smaller than 10 mm, the US Multi-Society Task Force recommends a new colonoscopy in 7 to 10 years. This recommendation considers a complete and high-quality initial colonoscopy.

The presence of three or four tubular adenomas smaller than 10 mm may lead to a recommendation for a new colonoscopy in 3 to 5 years.

Adenomas 10 mm or larger generally lead to a recommendation for follow-up in 3 years. The presence of a villous component or high-grade dysplasia can also lead to follow-up in 3 years.

Serrated lesions have specific follow-up recommendations. The interval depends on the number, size, type of lesion, and presence of dysplasia.

The type, size, number, and microscopic characteristics of polyps help estimate the risk and define follow-up after colonoscopy.