Colonic Polyps

There are numerous different types of polyp that can be found in the bowel. Most are found in the large bowel or colon and that is the focus of this topic. Colonic polyps may be neoplastic, reflecting new growth, and therefore conferring a risk of development into cancers or larger polyps and non neoplastic polyps which do not confer such risk. This is an important distinction because unless they are causing symptoms non-neoplastic polyps do not require further follow up, whereas neoplastic polyps, even when they are removed should lead to consideration of whether further surveillance is indicated (it isn’t always), since many patients with a tendency to develop neoplastic polyps may be at risk of further polyps going forward.

Non neoplastic polyps are usually hyperplastic or inflammatory or a reflection of resolving inflammation (pseudo-polyps) of themselves these polyps do not require removal unless by virtue of their size or bleeding they are causing symptoms, They do not usually require further follow up.

Neoplastic polyps are polyps which reflect new growth. As such they are usually removed at the time of colonoscopy, although particularly large or difficult polyps may require recall so that time and due diligence can be applied to their removal.

Neoplastic polyps may be benign or malignant. Benign polyps may be subclassified depending on their appearance (pit patterns and vascular patterns) size (usually measured in millimetres and centimetres) and shape (pedunclutated – on a stalk, sessile – flat). Benign neoplastic polyps can usually be removed endoscopically, although there are rare exceptions that require further intervention. Malignant neoplastic polyps are colon cancers. Whilst malignant neoplastic polyps can be removed endoscopically there are strong reasons why surgical intervention may be indicated often to exclude nodal spread of disease. Sometimes malignant polyps are removed at endoscopy and subsequent surgery does not reveal any evidence of persistent or residual disease.