Your Doctor Finds Polyps During a Colonoscopy: What It Means

November 19, 2020

A screening colonoscopy can give you peace of mind about colorectal cancer.

If you have a clean colonoscopy with no findings and are of average risk, you likely may not need to have another screening for 10 years. You can take comfort in knowing that your colon has been minutely inspected and that you have a clean bill of health.

But what if your doctor finds polyps during your colonoscopy? It doesn’t necessarily mean cancer, says Ted Teknos, MD, President and Scientific Director of UH Seidman Cancer Center. But it could mean a change in your screening schedule. We talked with Dr. Teknos about what happens after a colonoscopy or other types of colon cancer screening tests. Here is what he had to say:

Something Suspicious Is Found During a Colonoscopy: What's Next?

The screening colonoscopy is very important to ensure two things: that you’re at low risk; or if you’re not at low risk, to determine how frequently you should have your follow-up colonoscopy.

If you are found to have certain high-risk polyps, you will likely need to have colonoscopies on a more regular basis. That is because this tells your physician that you are at a somewhat higher risk to develop a malignancy in the future. So you have to have more regular screenings.

Now if you were found to have a malignancy during your colonoscopy, and if you have had screening regularly, you will find a malignancy earlier – so your treatment will be much more successful and have a higher rate of curing your cancer. Once you have a diagnosis, at UH your treatment will be managed by a multidisciplinary team that consists of surgeons, radiation oncologists, medical oncologists, social workers, all the different individuals who will be involved in your care. You will get an opinion from all of those physicians at once and receive the best evidence-based care, based on the discussions of that team.

What Alternatives to Colonoscopy Are Available?

For those who are leery of undergoing a colonoscopy, there are stool tests; there’s three separate ones that you can do. There’s what’s called the fecal immunochemical test (FIT) test, there’s the guaiac test, which tests for blood in the stool, and then there’s stool DNA tests. Those tests have to be performed on a much more regular basis.

The stool tests need to be done on an annual basis, so it’s a little bit more inconvenient yet less invasive. The colonoscopy is a more invasive procedure but it is the gold standard because you can actually visualize the whole colon and look to see if there are polyps or, frankly, pre-malignant lesions in the colon. The stool DNA tests only look for blood or they look for DNA of tumors. And it’s an indirect evaluation of the colon, whereas the colonoscopy is a direct inspection of the colon. And, with a clean colonoscopy, you can do it once a decade rather than much more frequently as with the stool DNA tests.

Something Suspicious is Found Through a Stool Test -- Then What?

If you are found to have an abnormal stool test, whether it be blood in the stool or a DNA indicator, then you do have to undergo a definitive colonoscopy, diagnose the problem, and determine the next steps of action. So either way, a colonoscopy is going to be indicated.

When Should I Get My First Colonoscopy?

The best way to diagnose colon cancer and to beat colon cancer is to detect it early. We have many studies that have shown that if you start screening at age 45 for those at average risk, and continue to screen until you’re at least 75 years old, the likelihood you will pass away from colon cancer is negligible. Those with higher risk factors should discuss starting screening earlier with their doctor. So starting at age 45 and continuing for 30 years, and following the guidelines is the best way we know to minimize your risk of developing or having a complication from colorectal cancer.

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