What are colon polyps, and when should you be concerned?

Colon polyps are quite common, especially as we age. They’re typically found during a standard colonoscopy screening, which should start around age 45 for most adults. In many cases, colorectal polyps will never cause symptoms or negatively impact your health.

“Most colon polyps are benign and non-cancerous, but they shouldn’t be overlooked,” says Rahul Narang, MD, a colorectal surgeon at Atlantic Health System. “Over time, certain types of colorectal polyps can become cancerous, so whether they’re benign or malignant, it’s important to have them removed.”

4 risk factors that contribute to polyps

Polyps grow on the inner lining of your colon or rectum. Whether to worry about them or not depends on four factors:

1. Type of polyp:
   • Adenomatous polyps are the most common and can become cancerous over time.
   • Hyperplastic polyps are harmless, non-cancerous growths in the digestive tract.
   • Inflammatory polyps are common if you have Crohn’s disease, colitis, or IBD (irritable bowel disease).
2. Size and quantity: Large polyps or multiple polyps are of concern, especially if they’re bigger than 10 millimeters. These should be removed and a follow-up colonoscopy should be scheduled in three to five years. 
3. Genetics: Having a family member with a history of colon cancer or polyps increases your risk, so get your colonoscopy screenings as recommended.
4. Age and lifestyle: Colon polyps are more common in people over age 50. But they can develop earlier from a poor diet, obesity, lack of exercise, excessive alcohol consumption, and smoking.

Removing polyps reduces your risk of colon cancer

“Colon polyps are present in about 15 to 40% of adults,” says Dr. Narang. “If your gastroenterologist finds polyps during your colonoscopy, they will typically remove them and send them to a lab for analysis.”

He explains that whether the growths are small and benign, pre-cancerous, or malignant, they should be removed.  

“Although it is less common, when polyps are left untreated, they can cause rectal bleeding, discharge, or abdominal pain, all of which can be associated with very large polyps and even colon cancer,” says Dr. Narang.

Colonoscopy versus Cologuard for detecting polyps

If you’re deciding between a colonoscopy or Cologuard to detect polyps, there are a few things to consider.

Cologuard is recommended every three years, while colonoscopy is typically recommended every 10 years. This is because colonoscopy has been shown to be more reliable in detecting polyps or colon cancers.

“If you're willing to do the prep and undergo the procedure, at this time, it's better to do the colonoscopy,” says Dr. Narang. “It’s still considered the gold standard of colorectal cancer screening.”

If polyps are found during your colonoscopy, in most cases, your gastroenterologists will remove them. In cases where the polyps are too large to be removed during the colonoscopy or they look very suspicious, they will be biopsied and you may need a colorectal surgeon.