Does a colon polyp = colon cancer? A colonoscopy will tell you.

Let’s be real, even the word colonoscopy, let alone colon polyp, can make us cringe.

One-third of eligible adults choose not to have a colonoscopy, a relatively painless exam that saves lives. The American Cancer Society recommends a colonoscopy, an endoscopic exam of the colon and rectum, at the age of 45, and before age 45 if you have a family history of colon cancer or if you experience bowel related symptoms.  It’s a good idea to check whether your insurance will cover a colonoscopy at age 45, since this is a relatively new guideline.

Dr. Robert Bennett, a colorectal surgeon at USF Health, takes care of the patients who might have skipped this life-saving screening. As a colorectal surgeon for USF Health, he said he can’t stress enough the importance of getting routine colonoscopy screenings.

“Diagnosis at the precancerous stage, along with polyp removal, can be a complete cure and lifesaving procedure for most people,” said Dr. Bennett. Colon and rectal cancer collectively is the 3rd most commonly diagnosed cancer in both men and women in the United States, and is the 2nd leading cause of cancer-related death in the U.S. According to data from the American Cancer Society, more than 150,000 cases of colon and rectal cancer are expected to be diagnosed in 2019.

“Further, colon cancer is expected to kill more than 50,000 Americans in 2019,” he said. “The lifetime risk of developing colon or rectal cancer is 4-5%. While these statistics can be scary, colorectal cancers are also some of the most preventable. We know that the majority of colon and rectal cancers develop within polyps that can be easily detected by screening colonoscopy before they become cancerous.“

Here are some points Dr. Bennett wants us to consider:
– Pre-cancerous polyps can be identified and removed during a colonoscopy, preventing cancer.
– Colonoscopy is a relatively painless procedure and many patients don’t even remember the exam due to anesthesia.
– When your next colonoscopy will be recommended depends on whether polyps are found and what type of polyps are found. However, there is a good chance, you won’t need another colonoscopy for 10 years.

The good news, Dr. Bennett added, is that the death rate from colorectal cancer has dropped in both men and women. “For several decades, we have seen fewer cases of colon cancer overall, and that may be in part due to increased screening by colonoscopy and identification and removal of precancerous polyps. We are essentially getting the polyps before they become cancer, and thus saving lives.”

Let’s start with what colorectal surgeons are looking for in a colonoscopy….a colon polyp.
A polyp is a tissue growth, typically non-cancerous, which is found in the inner lining of the colon. If left alone, some types of polyps may become cancerous.

In general, patients have no symptoms of having colon polyps, thus making screening so important. Some people with colon polyps experience:
– Rectal bleeding
– Change in stool color
– Change in bowel habits
– Pain
– Iron deficiency

Are all polyps the same? When should I be concerned?
At USF Health, we remove all polyps during colonoscopy as a precaution, as there is no way of definitively knowing whether they are benign, pre-cancerous, or contain a cancer until we are able to look at them under a microscope after removal. Some visual features of a polyp as seen during colonoscopy can suggest that it may have cancer within it. Dr. Bennett commonly discusses the findings of the colonoscopy with his patients immediately after completing the colonoscopy, most often alleviating any anxiety patients may have.

Not all polyps will become cancer. There are two main categories of polyps that can be identified via a pathology report: non-neoplastic and neoplastic. Non-neoplastic polyps, which include hyperplastic, inflammatory, and hamartomatous polyps, are considered non-cancerous. Neoplastic polyps, which include adenomas and sessile serrated adenomas, are considered potentially cancerous. These are the types of polyps in which cancer typically develops. The typical pathway by which cancer develops within a polyp takes many years, again highlighting the importance of a regular screening colonoscopy so that we can find the polyps early and remove them before the development of cancer.

If I’m diagnosed with colon cancer, now what?
If your colonoscopy does find cancer, the next step will include additional tests to determine if the cancer has spread anywhere else. This may include a CT scan, an MRI scan and sometimes a PET scan. Based on those results, you and your doctor will discuss the most appropriate course of treatment, which depends on several things, including the stage of the cancer as determined by the imaging tests listed above.

Treatments may include any of the following, or a combination thereof:
1. Surgery – most often a partial colectomy, or removal of part of the colon, to remove the cancer and related lymph nodes
2. Chemotherapy – to kill cancer cells
3. Radiation therapy – to destroy cancerous tissue

“Treatment for colorectal cancer has improved dramatically over the last few decades,” said Dr. Bennett. It is important for patients to know that even if they do require chemotherapy as part of their treatment for colorectal cancer, the current chemotherapy regimens are most often very well tolerated by the patient, with very few side effects.

As a result of impressive improvements in treatment of colon and rectal cancers, there are now more than 1.5 million survivors of colorectal cancer in the United States alone. This is a remarkable statistic that would not be possible without raising awareness about colorectal cancer and the importance of screening.

Call the Colorectal team at USF Health at (813) 974-2201 to schedule your colonoscopy today if you are age 45, younger if you have a colon cancer family history or if you are experiencing bowel related symptoms.

Written By: Kathleen Rogers