What Are Colon Polyps?
A polyp is an abnormal growth in the lining of the colon or rectum. Most are small and cause no symptoms — no pain, no bleeding, no noticeable sign. The only way to know they’re there is to look.
The majority of polyps are benign. But adenomas carry the potential to become cancerous over time through the adenoma-to-carcinoma sequence: normal colon cells develop mutations, form a polyp, and — over years to decades — can progress to cancer. Removing an adenoma during colonoscopy interrupts that sequence entirely.
Types of Polyps and What They Mean
Hyperplastic polyps: Generally benign, don’t change follow-up interval.
Adenomas: Require attention. Subtypes (tubular, villous, tubulovillous) vary in risk; size matters (10mm+ carries higher risk); high-grade dysplasia elevates risk further.
Serrated polyps / sessile serrated lesions (SSLs): Harder to detect because they lie flat and may appear pale. Carry meaningful cancer risk.
Traditional serrated adenomas (TSAs): Less common but elevated risk.
How Polyps Are Found
The colonoscope advances through the entire colon. Thorough, methodical examination during the withdrawal phase — looking behind every fold and curve — is what separates a high-quality colonoscopy from a hurried one. The adenoma detection rate (ADR) is a quality metric directly correlated with lower rates of interval colorectal cancer. Your GI Center’s physicians maintain ADR standards consistent with national quality benchmarks.
How Polyps Are Removed: Polypectomy
When a polyp is found, it’s removed during the same procedure — no separate procedure, no additional sedation.
Cold snare polypectomy: Standard for small polyps (<10mm) — a wire loop removes the polyp by cold mechanical cutting. Quick, effective, very low complication rate. Hot snare polypectomy: Uses electrical current for larger polyps where hemostasis is a consideration. Endoscopic mucosal resection (EMR): For larger or flat polyps, fluid is injected beneath the polyp to lift it, then it’s removed with a snare.
All removed polyps go to a pathology lab. Results determine your follow-up schedule.
Surveillance Schedule After Polypectomy
- No polyps: 10 years
- 1–2 small tubular adenomas (<10mm): 3–5 years
- 3–4 adenomas, or any ≥10mm: 3 years
- 5–10 adenomas, or high-grade dysplasia or villous histology: 3 years
- More than 10 adenomas: 1 year + genetic evaluation referral
- SSL <10mm, no dysplasia: 3–5 years; SSL ≥10mm or with dysplasia: 3 years
Following your recommended surveillance interval is the point where patients most commonly fall through the cracks.
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