Overview

Diagnosis

Screening for colon polyps is essential to detect and remove them before they become cancerous. These screening tests can also help find colorectal cancer early, when treatment is most effective.

Screening Methods

Colonoscopy

A colonoscopy is the most effective screening method for colon polyps and colorectal cancer.

  • A thin, flexible tube with a light and camera is inserted through the rectum to examine the entire colon.

  • Air is used to gently expand the colon for better visibility.

  • The camera transmits real-time images of the colon lining to a monitor.

  • Polyps, which appear as small bumps or raised areas, can be removed immediately or sampled for lab testing.

  • Other abnormal areas can also be biopsied during the procedure.

Virtual Colonoscopy (CT Colonography)

  • Uses a CT scan to create images of the colon and rectum.

  • Requires the same bowel preparation as a regular colonoscopy.

  • If a polyp or abnormality is found, a traditional colonoscopy is still needed to remove or test it.

Flexible Sigmoidoscopy

  • Similar to a colonoscopy but examines only the lower third of the colon.

  • Since most of the colon isn’t visualized, some polyps or cancers may be missed.

  • Often repeated more frequently than a colonoscopy or used in combination with a yearly stool-based test.

Stool-Based Tests

Noninvasive tests that can be done at home to detect signs of colon polyps or cancer.

  • Fecal Occult Blood Test (FOBT): Detects hidden blood in the stool and should be repeated every year.

  • Stool DNA Test: Detects blood and DNA changes associated with colon cancer and should be repeated every three years.

If any stool test is positive, a colonoscopy is needed to confirm findings and remove polyps.

Blood-Based Testing

  • The FDA-approved blood screen for colon cancer should be repeated every three years.

  • If results are positive, a colonoscopy is recommended for further evaluation.

Treatment

If colon polyps are found, they are usually removed immediately to prevent cancer development.

Polypectomy

Performed during colonoscopy using different techniques:

  • Forceps are used for very small polyps.

  • A wire loop (snare) is used for small to medium polyps.

  • Electric current may be applied to cut and seal tissue to prevent bleeding.

Removing polyps eliminates the chance of them turning into colorectal cancer.

Minimally Invasive Surgery

  • Used for large or complex polyps that can’t be safely removed during colonoscopy.

  • A laparoscope is inserted into the abdomen to remove the affected part of the colon.

Total Proctocolectomy

  • Recommended for people with inherited syndromes such as Familial Adenomatous Polyposis (FAP).

  • The colon and rectum are removed to prevent colorectal cancer.

After removal, a pathologist examines the tissue to determine the type of polyp and its potential to become cancerous.

Follow-Up Care

Follow-up depends on the number, size, and type of polyps removed:

  • 1–2 small adenomas: Repeat colonoscopy in 7–10 years.

  • 3–4 adenomas: Repeat in 3–5 years.

  • 5–10 adenomas or any larger than 10 millimeters: Repeat in 3 years.

  • More than 10 adenomas or very large polyps: Repeat in 6 months to 1 year.

For serrated lesions, follow-up timing is similar to that of adenomas.

Preparing for Your Colonoscopy

Proper bowel preparation is crucial for accurate results.

  • The colon must be completely clean for clear visibility.

  • After proper prep, stool should appear as clear liquid, possibly slightly yellow or green.

  • If your bowel isn’t clean, inform your healthcare team before the exam, as additional preparation may be required.

Medication Guidance

  • Inform your care team if you take aspirin, blood thinners, or heart medicines.

  • Do not stop medications on your own. Your doctor will advise whether to pause or continue them and when to restart after the procedure.

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