• Patient Care & Health Information
  • Diseases & Conditions
  • Colon polyps

Screening tests are important in finding polyps before they become cancerous. These tests also can help find colorectal cancer in its early stages, when you have a good chance of recovery.

Screening methods include:

  • Colonoscopy, in which a small tube with a light and camera is inserted into your rectum to look at your colon. If polyps are found, your health care provider may remove them immediately or take tissue samples to send to the lab for analysis.
  • Virtual colonoscopy, a test that uses a CT scan to view your colon. Virtual colonoscopy requires the same bowel preparation as a colonoscopy. If a polyp is found during the scan, you'll need to repeat the bowel preparation for a colonoscopy to have the polyp examined and removed.
  • Flexible sigmoidoscopy. Like a colonoscopy, this uses a small tube with a light and camera but examines just the last third of your colon, called the sigmoid. Most of the colon is not seen with this screening test, so some polyps and cancers may not be found.
  • Stool-based tests. These tests check for blood in the stool or assess your stool DNA for evidence of a colon polyp or cancer. If your stool test is positive, you will need a colonoscopy soon afterward.
  • Mayo Clinic Minute: What you need to know about polyps in your colon

"Generally speaking, we encourage all adults over the age of 50 – and even older adults who have at least 10 years of very high-quality life expectancy – to participate in screening," Dr. Kisiel says.

He says you might be surprised how often colonoscopies uncover polyps lurking in your colon.

"Precancerous polyps are extremely common," he says. "We expect to find them in more than a quarter of the colonoscopies that we do at a minimum. So, you know, maybe a third or even a half of all patients getting [a] colonoscopy will have precancerous polyps."

Although 1 in 20 Americans will be diagnosed with colorectal cancer in his or her lifetime, Dr. Kisiel says having polyps does not necessarily mean you will get cancer.

"Of all the polyps that we see, only a minority will turn into cancer," he says. "Sometimes they just go away on their own, but removing polyps is thought to be one of the mechanisms by which we can prevent the formation of cancer in the first place."

That's why regular screening is so important.

The downside is that if a polyp is found in your colon, you may have to get screened more frequently. But that's certainly better than having to go through treatment for colorectal cancer.

  • Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your colon polyps-related health concerns Start Here

More Information

Colon polyps care at Mayo Clinic

  • Barium enema
  • Colonoscopy
  • Fecal occult blood test
  • Flexible sigmoidoscopy
  • Genetic testing
  • Needle biopsy
  • Stool DNA test
  • Virtual colonoscopy

Your health care provider is likely to remove all polyps discovered during a bowel exam. The options for removal include:

  • Polypectomy. In the early stage when they are smaller, polyps can be removed by putting a tube with a tool in the rectum and cutting the cancer out.
  • Minimally invasive surgery. Polyps that are too large or that can't be removed safely during screening are usually removed surgically. This is often done by inserting an instrument called a laparoscope into the abdomen to remove the cancerous part of the bowel.
  • Total proctocolectomy. If you have a rare inherited syndrome, such as FAP , you may need surgery to remove your colon and rectum. This surgery can protect you from developing a life-threatening cancer.

Some types of colon polyps are more likely to become cancerous than others. A health care provider who analyzes tissue samples will look at your polyp tissue under a microscope to determine if it could be cancerous.

Follow-up care

If you have had an adenomatous polyp or a serrated polyp, you are at increased risk of colon cancer. The level of risk depends on the size, number and characteristics of the adenomatous polyps that were removed.

You'll need follow-up screenings for polyps. Your health care provider is likely to recommend a colonoscopy:

  • In 5 to 10 years if you had only one or two small adenomas.
  • In 3 to 5 years if you had three or four adenomas.
  • In three years if you had 5 to 10 adenomas, adenomas larger than 10 millimeters or certain types of adenomas.
  • Within six months if you had multiple adenomas, a very large adenoma or an adenoma that had to be removed in pieces.

Preparing for your colonoscopy

It's very important to fully clean out your colon before a colonoscopy. If stool remains in the colon and blocks your health care provider's view of the colon wall, you will likely need another colonoscopy sooner than usual to make sure all polyps are found.

After a good colon preparation, bowel movements should appear as clear liquid. They may be slightly yellow or green-tinged, depending on any liquids consumed while preparing. If you experience trouble with your colon preparation or feel that you have not been fully cleaned out, you should tell your provider before beginning your colonoscopy. Some people need additional steps before having a colonoscopy.

  • Endoscopic mucosal resection

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

Get the latest health information from Mayo Clinic delivered to your inbox.

Subscribe for free and receive your in-depth guide to digestive health, plus the latest on health innovations and news. You can unsubscribe at any time. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing

Your in-depth digestive health guide will be in your inbox shortly. You will also receive emails from Mayo Clinic on the latest health news, research, and care.

If you don’t receive our email within 5 minutes, check your SPAM folder, then contact us at [email protected] .

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

You may be referred to a health care provider who specializes in digestive diseases, called a gastroenterologist.

What you can do

  • Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
  • Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
  • Make a list of all your medications, vitamins and supplements.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Ask a relative or friend to accompany you to help you remember what the health care provider says.
  • Write down questions to ask your provider.

Questions to ask your doctor

  • What's the most likely cause of my symptoms?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available?
  • What are the chances these polyps are malignant?
  • Is it possible that I have a genetic condition leading to colon polyps?
  • What kind of follow-up testing do I need?
  • Should I remove or add any foods to my diet?
  • I have other health conditions. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your provider is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

  • When did you first begin experiencing symptoms, and how severe are they?
  • Have your symptoms been continuous or occasional?
  • Have you or has anyone in your family had colon cancer or colon polyps?
  • Has anyone in your family had other cancers of the digestive tract, the uterus, the ovaries or the bladder?
  • How much do you smoke and drink?
  • Colorectal cancer screening (PDQ) — Patient version. National Cancer Institute. https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq. Accessed Dec. 7, 2022.
  • Colon polyps. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/colon-polyps. Accessed Dec. 7, 2022.
  • Feldman M, et al., eds. Colonic polyps and polyposis syndromes. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 8, 2022.
  • Polyps of the colon and rectum. American Society of Colon and Rectal Surgeons. https://fascrs.org/patients/diseases-and-conditions/a-z/polyps-of-the-colon-and-rectum. Accessed Dec. 8, 2022.
  • Macrae FA. Overview of colon polyps. https://www.uptodate.com/contents/search. Accessed Dec. 9, 2022.
  • Niederhuber JE, et al., eds. Colorectal cancer. In: Abeloff's Clinical Oncology. 6th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 12, 2022.
  • Colon cancer treatment (PDQ) — Patient version. https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq. Accessed Dec. 14, 2022.
  • Brown AY. Allscripts EPSi. Mayo Clinic. Dec. 22, 2020.
  • Storm AC (expert opinion). Mayo Clinic. April 20, 2021.
  • Large colon polyp
  • Small colon polyps

Associated Procedures

Products & services.

  • A Book: Mayo Clinic on Digestive Health
  • Symptoms & causes
  • Diagnosis & treatment
  • Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

  • Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

  • Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
  • The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
  • Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
  • FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
  • Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

We’re transforming healthcare

Make a gift now and help create new and better solutions for more than 1.3 million patients who turn to Mayo Clinic each year.

Which Statement Supports the Hypothesis That Intestinal Polyps Are Benign

Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer?

A) Cancer cells accumulate slower than noncancer cells. B) An accumulation of mutations in specific genes is required to develop cancer. C) Tumor invasion and metastasis progress more slowly in the gastrointestinal tract. D) Apoptosis is triggered by diverse stimuli, including excessive growth.

Correct Answer:

Unlock this answer now Get Access to more Verified Answers free of charge.

Q4: What is the major virus involved in

Q5: What are characteristics of benign tumors? A)Benign tumors

Q6: Which term is used to describe a

Q7: The professor explains to students that oncogenes

Q8: Burkitt lymphomas designate a chromosome that has

Q10: Carcinoma in situ is characterized by which

Q11: Carcinoma refers to abnormal cell proliferation originating

Q12: How does the ras gene convert from

Q13: The Papanicolaou (Pap) test is used to

Q14: How do cancer cells use the enzyme

Unlock this Answer For Free Now!

View this answer and more for free by performing one of the following actions

qr-code

Scan the QR code to install the App and get 2 free unlocks

upload documents

Unlock quizzes for free by uploading documents

  • About the Hub
  • Announcements
  • Faculty Experts Guide
  • Subscribe to the newsletter

Explore by Topic

  • Arts+Culture
  • Politics+Society
  • Science+Technology
  • Student Life
  • University News
  • Voices+Opinion
  • About Hub at Work
  • Gazette Archive
  • Benefits+Perks
  • Health+Well-Being
  • Current Issue
  • About the Magazine
  • Past Issues
  • Support Johns Hopkins Magazine
  • Subscribe to the Magazine

You are using an outdated browser. Please upgrade your browser to improve your experience.

From left: Jessica Queen and Cynthia Sears

Image caption: From left, Jessica Queen and Cynthia Sears

Credit: James Trudeau

Researchers explore links between gut bacteria and colon cancer

Johns hopkins researchers suspect gut microbiome could hold clues to rising rates of colorectal cancer among americans under the age of 50.

By Patrick Smith

This article was originally published by Dome in its May/June 2024 issue .

While the incidence of colorectal cancer has decreased among the U.S. population overall, there has been a gradual, and alarming, increase in diagnoses among Americans under age 50. Earlier this year, the American Cancer Society reported that Americans born around 1990 have twice the risk of colon cancer compared with people born in the 1950s.

Johns Hopkins infectious diseases professors Cynthia Sears and Jessica Queen suspect the problems—and maybe the solutions—are hidden among the trillions of tiny bugs that live in our intestines.

Late last year, Sears and Queen led a team that published a review article in the journal Nature Cancer . " Understanding the Mechanisms and Translational Implications of the Microbiome for Cancer Therapy Innovation " presents recent insights in a field with which it can be hard to keep up.

"The whole topic has gotten huge," says Sears, who has studied the microbiome for more than 20 years and was recently named a fellow of the American Association for the Advancement of Science . "There are thousands of studies now. The field has advanced in so many ways."

In the article, the authors discuss how individual organisms, as well as complex communities of microbes, can be factors in the earliest stages of tumor growth.

"We all know that colon polyps can turn into cancer," says Sears. "That's not new. But we know more about how that happens, thanks to all this research."

"First, these little polyps appear. And if you take them out, you remove the risk of cancer. But if we don't take them out and they get bigger, we start to see the microbiota stick to them and go down deeper, into the crypts, where new cells are generated."

Queen says that, although investigations are in their early stages, there's reason to be encouraged.

"The colon holds trillions of bacteria—it represents the most dense population of microorganisms in the human body," she says. "These bacteria are in constant contact with cells of the colon and the immune system, and it makes sense that these interactions could be really important for colorectal cancer development and progression."

The authors detail the mechanics by which four distinct bacteria— H. pylori , E. coli , B. fragilis and F. nucleatum —promote formation and growth of tumors in the gut.

They also discuss the negative effects that tumor neoantigens (the new proteins that form on cancer cells as a result of tumor DNA mutations) can have on cancers. Those same neoantigens, say the authors, can be useful in treating colon cancer.

"Bacteria are the big mystery," says Sears. "We've done pretty well with viruses and how they relate to cancer. We know the viral causes of certain kinds of liver cancer, for example. But we know much less about bacteria and how they work together in tumorigenesis."

If scientists find 30 different bacteria on a tumor, she says, the question is what role each plays:

Which ones matter? Where are they located? If they're present at the beginning, did they cause the cancer? Or once the tumor growth starts, are they affecting what happens? What molecules and proteins they're making and what combinations are most important are tough, tough questions.

As early-onset colorectal cancer continues to rise, Sears says, screening colonoscopies can be life saving.

"Nearly every agency in the field recommends that preventive screening colonoscopies begin at age 45," she says. "Since most early colorectal cancer is in individuals in their 40s to early 50s, starting preventive care on time should have impact on patient well-being."

The greatest challenge Sears and Queen see, though, is convincing the health care and pharmaceutical research industries to spend enough money to translate research into therapeutics that can actually affect patient care.

"The most important thing we can do in the research community is to put the microbiome into action," Sears says. "If we don't do longitudinal studies in humans, then we're not following what we've learned from the science."

Queen says stool samples and biopsies from patients with cancer show that several specific bacteria are commonly associated with specific cancers.

"The field is largely focused now on understanding what those bacteria may be doing mechanistically," says Queen. "And as helpful as mice are as models, they are not humans. We need more data from clinical samples and longitudinal follow-up of patients to better understand how the microbiome impacts progression of disease and response to treatment."

Sears says that rigorous, well-funded studies have helped researchers learn that mucous-invasive groups of microorganisms (polymicrobial biofilms) are present on more than half of colon cancers and surgically removed polyps.

"To date, the strongest experimental evidence for biofilms as direct tumor promoters comes from studies of human colon biofilms," says Sears. "Yes, it's expensive. But that's science, right? Answering questions leads to more questions. And that's what pushes us in the right direction."

Posted in Health

Tagged johns hopkins medicine , colon cancer

You might also like

News network.

  • Johns Hopkins Magazine
  • Get Email Updates
  • Submit an Announcement
  • Submit an Event
  • Privacy Statement
  • Accessibility

Discover JHU

  • About the University
  • Schools & Divisions
  • Academic Programs
  • Plan a Visit
  • my.JohnsHopkins.edu
  • © 2024 Johns Hopkins University . All rights reserved.
  • University Communications
  • 3910 Keswick Rd., Suite N2600, Baltimore, MD
  • X Facebook LinkedIn YouTube Instagram

Log in using your username and password

  • Search More Search for this keyword Advanced search
  • Latest content
  • Current issue
  • BMJ Journals More You are viewing from: Google Indexer

You are here

  • Online First
  • Risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps: a comprehensive evaluation of risk factors and surveillance use
  • Article Text
  • Article info
  • Citation Tools
  • Rapid Responses
  • Article metrics

Download PDF

  • http://orcid.org/0000-0002-9819-8179 Georgios Polychronidis 1 , 2 , 3 ,
  • Ming-Ming He 1 , 4 ,
  • http://orcid.org/0000-0002-1457-4385 Mathew Vithayathil 1 , 5 ,
  • Markus D Knudsen 1 , 6 , 7 ,
  • Kai Wang 1 ,
  • http://orcid.org/0000-0002-1324-0316 Mingyang Song 1
  • 1 Department of Epidemiology , Harvard University T H Chan School of Public Health , Boston , Massachusetts , USA
  • 2 Department of General,Visceral and Transplantation Surgery , Heidelberg University Hospital , Heidelberg , Germany
  • 3 Study Centre of the German Surgical Society , German Surgical Society/Heidelberg University Hospital , Heidelberg , Germany
  • 4 State Key Laboratory of Oncology in South China, Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine , Sun Yat-sen University Cancer Center , Guangzhou , China
  • 5 Imperial College Healthcare NHS Trust , London , UK
  • 6 Section for Colorectal Cancer Screening , Cancer Registry of Norway , Oslo , Norway
  • 7 Department of Transplantation Medicine, Division of Surgery,Inflammatory Diseases and Transplantation , Oslo University Hospital , Oslo , Norway
  • Correspondence to Dr Mingyang Song, Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA; mis911{at}mail.harvard.edu

Background Surveillance colonoscopy after polyp removal is recommended to prevent subsequent colorectal cancer (CRC). It is known that advanced adenomas have a substantially higher risk than non-advanced ones, but optimal intervals for surveillance remain unclear.

Design We prospectively followed 156 699 participants who had undergone a colonoscopy from 2007 to 2017 in a large integrated healthcare system. Using multivariable Cox proportional hazards regression we estimated the subsequent risk of CRC and high-risk polyps, respectively, according to index colonoscopy polyps, colonoscopy quality measures, patient characteristics and the use of surveillance colonoscopy.

Results After a median follow-up of 5.3 years, we documented 309 CRC and 3053 high-risk polyp cases. Compared with participants with no polyps at index colonoscopy, those with high-risk adenomas and high-risk serrated polyps had a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy (multivariable HR 5.44 (95% CI 3.56 to 8.29) and 8.35 (95% CI 4.20 to 16.59), respectively). Recurrence of high-risk polyps showed a similar risk distribution. The use of surveillance colonoscopy was associated with lower risk of CRC, with an HR of 0.61 (95% CI 0.39 to 0.98) among patients with high-risk polyps and 0.57 (95% CI 0.35 to 0.92) among low-risk polyps. Among 1548 patients who had high-risk polyps at both index and surveillance colonoscopies, 65% had their index polyps in the proximal colon and 30% had index and interval polyps in the same segments.

Conclusion Patients with high-risk polyp findings were at higher risk of subsequent CRC and high-risk polyps and may benefit from early surveillance within 3 years. The subsite distribution of the index and recurrent high-risk polyps suggests the contribution of incomplete resection and missed lesions to the development of interval neoplasia.

  • colorectal cancer
  • surveillance
  • colonic polyps
  • colonoscopy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/gutjnl-2023-331729

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

WHAT IS ALREADY KNOWN ON THIS TOPIC

Colorectal cancer (CRC) screening and removal of polyps are commonly used strategies to prevent this disease.

However, there is a lack of consistency in existing recommendations for postpolypectomy surveillance, leading to overuse in low-risk patients and underuse in high-risk patients.

Other factors than index polyp features influencing postpolypectomy CRC risk are less studied.

WHAT THIS STUDY ADDS

The risk elevation of CRC associated with high-risk adenomas and serrated polyps was particularly high in the first 3 years after the index colonoscopy, whereas lower time-dependent risk elevation was found after removal of low-risk adenomas or serrated polyps. Similar patterns were found for recurrent high-risk polyps.

We identified factors associated with risk of colorectal neoplasia after polypectomy, including patient characteristics, quality of colonoscopy, index polyp findings and the use of surveillance.

The use of surveillance colonoscopy mitigated the risk elevation of CRC associated with high-risk polyps.

Among 1548 patients who had high-risk polyps at both index and surveillance colonoscopies, 65% had their index polyps in the proximal colon and 30% had index and recurrent polyps in the same segments.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Our findings support the recommendations for a repeat colonoscopy within 3–5 years for individuals with high-risk adenomas or serrated polyps, and a longer interval for those with low-risk adenomas or serrated polyps.

Improved quality of colonoscopy examinations, coupled with the use of colonoscopy surveillance, may help mitigate the risk of interval colorectal neoplasia.

Introduction

Colorectal cancer (CRC) is a significant public health concern, with high incidence and mortality rates. 1 Timely screening and removal of polyps, the precursor lesions of CRC, is a common strategy to reduce the risk of this disease. However, despite polypectomy being regarded to be an effective preventive measure, a significant number of patients still develop CRC after polypectomy. The reasons for this are not well understood and there is a lack of consistency in the existing recommendations on the interval of postpolypectomy surveillance. 2–5 As a result, surveillance colonoscopy is poorly delivered in the clinic, with the coexistence of overuse in low-risk patients and underuse in high-risk patients. 6 7

Advanced histopathological features of index polyps, including large size, villous histology, multiplicity and proximal colon location, have been associated with a higher risk of subsequent CRC in patients with polypectomy, compared with those with no polyps. 8–14 However, data are less consistent for patients with removal of non-advanced polyps. Furthermore, there is a lack of understanding about the time window when CRC risk is most elevated according to index polyp features and the role of surveillance colonoscopy in modulating that risk. 8–15 In addition, besides polyp features, the independent contribution of other factors to CRC, such as patient characteristics and colonoscopy quality measures, remains to be determined.

Therefore, we conducted a prospective study to comprehensively characterise the risk factors of CRC and recurrent high-risk polyps (both defined as those diagnosed at least 6 months after the index CRC-free colonoscopy) using real-world data from a large integrated healthcare system. We considered detailed features related to index polyps and colonoscopy examinations, time since polypectomy, patient characteristics and the use of surveillance colonoscopy. The findings could help better understand the risk factors of colorectal neoplasia after polypectomy and inform the improvement of postpolypectomy surveillance and management.

Study population

We drew data from the Mass General Brigham (MGB) Colonoscopy Cohort (MGBCC), a longitudinal cohort of patients who had undergone a colonoscopy examination at the Brigham and Women’s Hospital, the Brigham and Women’s Faulkner Hospital and the Massachusetts General Hospital (collectively known as the MGB, previously known as the Partners HealthCare) between 23 October 2007 and 31 October 2017. The details of the cohort have been documented in a previous publication. 16 Briefly, we collected detailed colonoscopy data (including the indication, quality measures and findings) from the Provation endoscopy reporting system and developed a natural language processing (NLP) algorithm to extract polyp histopathology data from the pathology reports. The NLP algorithm has been validated through manual review of medical records. 16 We then merged the colonoscopy and pathology data based on the unique patient identifiers and the date of examinations. Individuals can contribute multiple records if they had undergone more than one colonoscopy during the study period. Among a total of 217 823 patients in the MGBCC, we excluded 61 124 who were underaged (<18), were diagnosed with CRC before or at the index colonoscopy, had a follow-up time of less than 6 months or had an index colonoscopy with incomplete bowel preparation (ie, with fair, poor or indeterminate preparation) or no caecal intubation, leaving 156 699 patients for the current study (see the flow chart in online supplemental figure 1 ).

Supplemental material

Polyp features.

We grouped patients with polypectomy at index colonoscopy according to their polyp findings. High-risk adenoma was defined as size ≥10 mm, villous or tubulovillous histology, presence of high-grade dysplasia or ≥3 adenomas. All other adenomas were defined low risk. We used the term serrated polyps (SPs) to collectively refer to hyperplastic polyps (HPs), sessile serrated polyps (SSPs) and traditional serrated adenomas. 17 18 We defined high-risk SPs as those sized ≥10 mm or with the presence of dysplasia, and all other SPs as low risk. There were individuals with presence of multiple polyps of different histology. Individuals detected with both adenomas and SPs at the index colonoscopy were considered to have synchronous lesions. In addition to these broad categories, we also grouped patients according to detailed polyp features (histology, size, location and multiplicity) used in the US Multi-Society Task Force recommendations. 19

Colonoscopy quality and surveillance colonoscopy

Data on bowel preparation and caecal intubation were retrieved from the colonoscopy report. Physicians’ adenoma and SP detection rates (ADR and SDR, respectively) for each year were calculated as the percentage of screening colonoscopies in that year where at least one adenoma and SP were identified, respectively. 20 ADR and SDR for the year when index colonoscopy was conducted were used for our analysis. We defined surveillance colonoscopy as the examination that was conducted at least 6 months after the index examination and for non-symptom indications. We also ran a sensitivity analysis using any colonoscopy conducted at least 6 months after the index examination. The use of surveillance was modelled as a time-varying variable to account for change in surveillance status over time. A participant was considered as no use of surveillance until the first report of eligible surveillance colonoscopy and considered as use of surveillance thereafter.

Ascertainment of CRC and recurrent polyp diagnosis

We identified CRC cases from the pathology reports recorded after the index colonoscopy and through linkage to the Massachusetts Cancer Registry (MCR). 21 The MCR captures cancer diagnoses of Massachusetts residents through interstate record exchange. 22 We grouped subsites based on the pathology reports and reports from the MCR into proximal colon (transverse colon/hepatic flexure/ascending colon/caecum), distal colon (rectosigmoid/sigmoid/descending colon/splenic flexure) and rectum (anus/rectum). We identified recurrent polyps from the surveillance colonoscopies, similar to index polyps as described above.

Statistical analysis

We defined the first colonoscopy recorded in the cohort as the index colonoscopy. The primary outcome was CRC diagnosed at least 6 months after the index colonoscopy (follow-up started at 6 months after index colonoscopy). We calculated person-time of follow-up until the date of CRC diagnosis, death or the end of the study (31 October 2017), whichever occurred first. We plotted the Kaplan-Meier curves according to polyp findings at the index colonoscopy. We computed the multivariable-adjusted HRs and 95% CIs of subsequent CRC incidence and high-risk polyp recurrence using the Cox proportional hazards regression adjusting for potential risk factors, including age, sex, race, year of index colonoscopy, family history of CRC, median household income and median percentage of households with a bachelor’s degree for the reported zip code, number of prior colonoscopy examinations, ADR, SDR and polyp features.

We examined the main effect of surveillance colonoscopy by comparing individuals with and without a surveillance colonoscopy. Due to the limited number of CRC cases, we pooled index adenomas and SPs altogether (ie, index polyps) for the surveillance analysis. We used time-dependent Cox regression model to assess (1) the association of surveillance with the subsequent risk of CRC and (2) the association of index low-risk and high-risk polyps with CRC risk according to surveillance status. 23 Finally, we assessed the segment distribution between the index and recurrent polyps among patients with high-risk polyps. We performed all analyses in SAS software V.9.4 except for Kaplan-Meier curves, which were produced using RStudio (V.1.4.1717). 24–26

The median age of participants at index colonoscopy was 57 years (IQR 51–66 years). During a median of 5.3 years (IQR 2.8–7.6 years) of follow-up, we documented 146 incidences of CRC among 100 872 participants without polyps at index colonoscopy (28 cases per 100 000 person-years), 163 among 55 827 participants who underwent polypectomy during the first colonoscopy, 132 among 40 356 participants with adenomas (68 cases per 100 000 person-years) and 70 among 26 673 participants with SPs (56 cases per 100 000 person-years). The basic characteristics of participants are presented in table 1 . The Kaplan-Meier curves of CRC incidence according to polyp groups are shown in figure 1 .

  • Download figure
  • Open in new tab
  • Download powerpoint

Kaplan-Meier curves of colorectal cancer (CRC) incidence after removal of low-risk and high-risk adenomas (A) and serrated polyps (SPs; B) at index colonoscopy.

  • View inline

Age-standardised characteristics of study participants in the MGB Colonoscopy Cohort according to index colonoscopy findings

Figure 2 shows the time-specific estimates of the association of index polyp findings with subsequent incidence of CRC and high-risk polyps. Compared with individuals with no polyps, those with high-risk adenomas at index colonoscopy had a consistently higher risk of CRC, with the highest risk observed at 3 years after resection (HR=5.44, 95% CI 3.56 to 8.29). For index low-risk adenomas, we found a slightly increased CRC risk over the 10-year period (HR=1.43, 95% CI 1.06 to 1.93). The risk of CRC for high-risk SPs was at its peak at 3 years (HR=8.35, 95% CI 4.20 to 16.59), whereas a constant elevation of CRC risk was found for individuals with low-risk SPs throughout follow-up. Similar time-dependent patterns were observed for recurrent high-risk polyps.

Risk of subsequent colorectal cancer (CRC; A, B) and recurrent high-risk polyps (C, D) among individuals removed with low-risk and high-risk adenomas (A, C) and serrated polyps (SPs; B, D) at 3, 5, 7 and 10 years after index colonoscopy.

Table 2 shows risk factors for CRC and recurrent high-risk polyps. Lower ADR and SDR were associated with higher CRC risk. For polyp features, compared with no polyps, synchronous high-risk adenomas and/or high-risk SPs were associated with a particularly higher risk of CRC ( table 3 ). For index adenomas, size, advanced histology and multiplicity appeared to be of predominant importance; for SPs, SSPs showed a particularly high HR. These risk factors were similarly associated with recurrent high-risk polyps.

Associations of patient characteristics and index colonoscopy quality with risk of subsequent colorectal cancer (CRC) and recurrent high-risk polyps in the MGB Colonoscopy Cohort

Associations of index polyp findings with risk of subsequent colorectal cancer (CRC) and recurrent high-risk polyps in the MGB Colonoscopy Cohort

Among 55 827 participants with index polyps, 18 985 (34%) received a surveillance colonoscopy. As shown in table 4 , when stratified by the use of surveillance, compared with individuals with no polyps (28 cases per 100 000 person-years), those with any polyps and a surveillance colonoscopy had a comparable risk of CRC (HR=1.27, 95% CI 0.91 to 1.77, 36 cases per 100 000 person-years). Among individuals with polyps, surveillance mitigated the risk elevation of CRC to 0.63 (95% CI 0.45 to 0.88). This was particularly the case for those with high-risk polyps, among whom the HR of CRC associated with the use of surveillance was 0.61 (95% CI 0.39 to 0.98; 62 vs 178 cases per 100 000 person-years for those with vs without surveillance). Similar findings were observed in the sensitivity analysis considering any follow-up colonoscopy ≥6 months as surveillance ( online supplemental table 1 ). Among the 163 participants who developed CRC after polypectomy, 45 CRC cases (28%) occurred to those with the use of surveillance, with a median time of 2.5 years between surveillance examination and CRC diagnosis ( online supplemental table 2 ). Compared with CRC cases in the non-surveillance group, those in the surveillance group had a longer interval between index colonoscopy and CRC diagnosis (median=4.3 vs 2.6 years) and had a lower percentage of stage III (9% vs 26%).

Association of index polyps with risk of subsequent colorectal cancer (CRC) according to the use of postpolypectomy colonoscopy surveillance in the MGB Colonoscopy Cohort

Among 14 190 patients with high-risk polyps at index colonoscopy, 6428 received surveillance colonoscopy, among whom 1548 developed recurrent high-risk polyps. Table 5 shows the subsite distribution of the index and recurrent polyps in these 1548 patients. We found that 467 (30%) of patients had the index and recurrent polyps in the same segment. Proximal colon predominated the subsites of index polyps (65%) compared with distal colon (21%) and rectum (14%).

Segment distribution of index and recurrent high-risk polyps among patients with high-risk polyps at both index and surveillance colonoscopies

Leveraging a large clinical cohort in an integrated healthcare system, we comprehensively characterised the time-dependent pattern and risk factors of colorectal neoplasia after polypectomy. We found that, compared with individuals with no polyps, those with high-risk adenomas and SPs at index colonoscopy had the highest risk elevation of colorectal neoplasia at 3 years after polyp resection, while those with low-risk lesions showed much lower risk elevation at any timepoint. We identified risk factors of colorectal neoplasia, particularly low index colonoscopy quality and features of index polyps (histology, size, multiplicity and synchronous findings). Furthermore, we observed that the use of surveillance colonoscopies mitigated the risk elevation of CRC associated with high-risk polyps. Our findings underscore the need for improved delivery of colonoscopy surveillance to reduce the incidence of interval cancers.

Our time-specific risk estimates provide critical evidence on the risk profiles after polyp removal. 27 The current US recommendations for a 3-year surveillance colonoscopy in individuals with removal of high-risk lesions are based mainly on reports of increased risk of metachronous high-risk neoplasia (including advanced adenomas and CRC) in retrospective cohorts. 28–30 The UK recommendations do not discern between high-risk adenomas and SPs and state that a 3-year follow-up interval after high-risk adenoma or SP excision has a low level of evidence citing ‘no prospective data to validate this recommendation’. 4 Regarding SPs, our data are in line with prior reports that certain high-risk SPs may either rapidly progress to CRC or exert a field effect that predisposes individuals for CRC development in a short interval. 14 31 Collectively, these findings, along with the ongoing randomised controlled trials, should contribute to more informed decision-making in postpolypectomy surveillance. 32–34

Numerous studies have associated index adenoma features with the risk of interval CRC or advanced neoplasia. Our findings are consistent with existing data that high-risk adenoma features, including size larger than 10 mm and villous or tubulovillous histology, are associated with an increased risk of interval colorectal neoplasia. 28 35 36 The incidence rates are similar to previously presented literature, such as data from the UK where the incidence rate of postpolypectomy CRC was 214 cases in 116 248 person-years, and meta-analysis where the incidence of CRC per 10 000 person-years for low-risk and high-risk adenomas was 4.5 and 13.8, respectively (4.8 and 11.3 in our study), as well as data from the Nurses’ Health Study and the Health Professionals Follow-up Study. 17 36–39 In contrast with the extensive data on adenomas, few longitudinal studies have assessed the subsequent risk of CRC after removal of SPs. Some studies reported a higher risk of CRC after removal of even small (<10 mm) SPs, while others asserted that the risk varied by histological subtypes and tended to be lower for HPs than for SSPs. 9 10 40 41 Unlike other international guidelines, 42 43 the US guidelines for surveillance of SPs under 10 mm discern between SSPs and other SPs and recommend a shorter surveillance interval for individuals with more than three SSPs. 2 19 44 45 We observed an elevated CRC risk associated with higher number of HPs, but the association was much weaker than that for SSPs. Furthermore, when assessing index SSPs specifically, we documented a higher risk elevation for index high-risk SSPs than SPs in general. Thus, our findings support the US recommendations.

Another contribution of our study is the consideration of surveillance colonoscopy when assessing CRC risk after polypectomy. Some population-based studies have shown that follow-up colonoscopy after polypectomy may be associated with a lower risk of CRC, whereas other studies showed a persistent risk of CRC despite surveillance, and no CRC risk elevation associated with the lack of surveillance among individuals with lower risk polyps compared with the general population. 28 37 39 46 47 In our study, the use of surveillance colonoscopy after polypectomy was found to mitigate risk of CRC. Although the magnitude of mitigation appeared to be similar between individuals with low-risk and high-risk polyps, those with high-risk polyps but no surveillance were found to have a statistically significant increase in CRC risk, compared with no polyps. Considering that patients with high-risk polyps had a much higher absolute risk of CRC ( figure 1 ), our results support the use of surveillance colonoscopy among high-risk patients. As discussed above, the optimal interval for surveillance remains to be determined. In our analysis, we considered any use of surveillance, regardless of the interval. Given the prior data showing substantial overuse of surveillance in low-risk patients and underuse in high-risk patients, it is possible that the non-discriminatory use of surveillance colonoscopy in the clinic according to the severity of polyps may have limited our ability to assess the efficacy of surveillance colonoscopy on risk of CRC. 48 49 Strengthened clinical guidelines with more supporting evidence, including the ongoing clinical trials, and tailored surveillance according to patient risk profiles may confer greater benefit for prevention of CRC. 48–50

In addition, by comparing the subsite distribution of index and interval high-risk polyps, we found that most of the patients had the index polyps either in the proximal colon or in the same segment as the recurrent polyps. Given that polyps in the proximal colon are more difficult to detect and completely resect, our findings highlight the importance of improved colonoscopy quality. This is consistent with our observation for the strong association of ADR/SDR with CRC risk. For polyps that recur in the same segment, they are likely due to incomplete resection and field effect. However, differentiating the two contributors is not straightforward because of the difficulty in assessing incomplete resection at the time of polypectomy and no objective measure to quantify field effect. A prior study attempted to address this question through detailed segment analysis of 166 patients who underwent surveillance colonoscopy after polypectomy. 51 That study showed a 28% difference in risk of interval neoplasia between segments with and without complete resection and a 9% difference between segments with complete resections and those without a prior polyp, the latter of which was interpreted as the field effect. However, these estimates were based on certain assumptions (eg, the influences of incomplete resection and field effect are mutually exclusive) and a small sample size and did not account for multiple polyps in the same segment. We were not able to conduct similar analysis due to our lack of data on incomplete resection and will consider pursuing that in further studies.

Our study has several strengths, including the prospective design, large sample size, long-term follow-up and detailed collection of histopathological data of index polyps. Despite these strengths, our results should be interpreted with consideration of limitations. First, it is possible that some participants may have had a previous screening or surveillance colonoscopy at a non-MGB hospital or had CRC diagnosed in other states that were not captured by our cohort. However, the rate of loss to follow-up is anticipated to be low, based on our observation that over 93% of study participants were residents of Massachusetts and that ~50% of patients with high-risk adenomas had a second colonoscopy within 5 years in the same hospital, consistent with the reports from other studies. 6 16 48 52 Moreover, the definition and identification of recurrent high-risk polyps present a complex challenge, influenced by the variability in the timing between index and follow-up colonoscopies, which may introduce a lead time bias in the screening process for CRC. This complexity is compounded by the observed substantial non-adherence to guideline-recommended surveillance intervals in clinical practice, a phenomenon consistent with findings from other studies. 6 49 50 Our analysis, detailed in table 1 , demonstrates that the frequency of surveillance colonoscopies and the intervals between index and subsequent examinations show minimal variation across different categories of initial colonoscopic findings, underscoring a widespread deviation from established surveillance guidelines. This observation emphasises the need for a nuanced understanding of surveillance patterns and their implications on the detection and management of high-risk polyps in the real-world setting. Finally, it should be noted that the quality of colonoscopy procedures has significantly advanced in the past decade. Consequently, the outcomes of our study might have varied if conducted in the present context, particularly concerning the detection and management of SPs.

In a large prospective cohort, we demonstrate an increased risk of colorectal neoplasia in individuals removed with high-risk adenomas and SPs, particularly within the first 3 years after removal. Lower quality of index colonoscopy was strongly associated with higher colorectal neoplasia risk, whereas the use of surveillance colonoscopies appeared to mitigate the CRC risk elevation associated with high-risk polyps. Our findings support the current US recommendations for surveillance colonoscopy and stress the need for further investigations of risk stratification for colonoscopy surveillance in individuals with a history of polyps.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by the MGB Human Research Committee (Institutional Review Board Protocol 2018P002052). Participants gave informed consent to participate in the study before taking part.

Acknowledgments

The authors thank Mr Scott Smith for his programming assistance with data analysis.

  • Siegel RL ,
  • Cercek A , et al
  • Lieberman D ,
  • Anderson JC , et al
  • Jaramillo D , et al
  • Rutter MD ,
  • Rees CJ , et al
  • Antonelli G ,
  • Dumonceau J-M , et al
  • Knudsen MD ,
  • Berstad P , et al
  • Ladabaum U ,
  • Dominitz JA ,
  • Kahi C , et al
  • Burnett-Hartman AN ,
  • Newcomb PA ,
  • Phipps AI , et al
  • Pinsky PF ,
  • Hickey T , et al
  • Fournel I , et al
  • Matsuda T ,
  • Sano Y , et al
  • Hua X , et al
  • Passarelli MN ,
  • Adams SV , et al
  • Sweetser S ,
  • Altenhofen L ,
  • Kretschmann J , et al
  • Vithayathil M ,
  • Goryachev S , et al
  • Wu K , et al
  • Doherty AR ,
  • Raju M , et al
  • Kaminski MF ,
  • Kraszewska E , et al
  • Registry, M.C
  • Millar MM ,
  • Jozwik D , et al
  • Kassambara A
  • Therneau TM ,
  • Meester RGS ,
  • Lansdorp-Vogelaar I ,
  • Winawer SJ , et al
  • Wooldrage K ,
  • Brenner A , et al
  • Jung YS , et al
  • Anderson JC ,
  • Butterly LF ,
  • Robinson CM , et al
  • Sawhney M ,
  • Sheikh S , et al
  • Bretthauer M ,
  • Dekker E , et al
  • Nakamura H , et al
  • De Palma FDE ,
  • Guadagno E , et al
  • Wieszczy P ,
  • Franczyk R , et al
  • Ogino S , et al
  • Robbins EC ,
  • Pack K , et al
  • Li Y , et al
  • Duvvuri A ,
  • Chandrasekar VT ,
  • Srinivasan S , et al
  • Erichsen R ,
  • Hamilton-Dutoit SJ , et al
  • Eide TJ , et al
  • Baretton GB ,
  • Bateman AC , et al
  • IJspeert JEG ,
  • van der Vlugt M , et al
  • Vermeulen L ,
  • Meijer GA , et al
  • Brenner H ,
  • Chang-Claude J ,
  • Seiler CM , et al
  • Laiyemo AO , et al
  • Murphy CC ,
  • Sandler RS ,
  • Grubber JM , et al
  • van Heijningen E-MB ,
  • Steyerberg EW , et al
  • Schoen RE ,
  • Weissfeld JL , et al
  • Aguilera-Fish A , et al
  • McLerran D ,
  • Zheng Y , et al

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

  • Data supplement 1

X @MingyangSong3

Contributors GP: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis, obtained funding. M-MH: analysis and interpretation of data, drafting of the manuscript, statistical analysis. MV: technical support, analysis and interpretation of data, drafting of the manuscript, statistical analysis. MDK: technical support, critical revision of the manuscript for important intellectual content. KW: acquisition of data, material support, critical revision of the manuscript for important intellectual content. MS: guarantor, study concept and design, statistical analysis, critical revision of the manuscript for important intellectual content, technical and material support, study supervision, obtained funding.

Funding German Research Foundation (Deutsche Forschungsgemeinschaft (DFG)—Project No 426308975 to GP).

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Read the full text or download the PDF:

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

  • Advanced Search
  • Journal List
  • Autops Case Rep

A juvenile polyp on screening colonoscopy

Spyridon vrakas.

1 Tzaneio General Hospital, Department of Gastroenterology, Athens, Greece

Simone Ignatova

2 University Hospital of Linkoping, Department of Pathology, Linkoping, Sweden

Giorgos Karapiperis

3 Tzaneio General Hospital, ICU, Athens, Greece

Sofia Kartsoli

Dimitrios karapiperis.

4 Vrinnevi General Hospital of Norrkoping, Department of Gastroenterology, Norrkoping, Sweden

Authors’ contributions: Spyridon Vrakas and Dimitrios Karapiperis were in charge of the manuscript writing. Simone Ignatova, Sofia Kartsoli and Giorgos Karapiperis were responsible for the manuscript review.

The most common polyps in the large bowel are adenomas and serrated polyps. Diamond 1 first described Juvenile polyps in 1939, and Helwig 2 in 1946 reported what currently is coined as hamartomatous polyps. They are typically lobulated and pedunculated with erosions in the surface and appear cystic with dilated glands and inflammatory cells. They vary in size from a few millimeters to several centimeters. Juvenile polyps are rare in the general population, and the prevalence is difficult to determine. In the adult population, they comprise less than 1% of all detected polyps, and in children, over 90% of the polyp cases. 3

The clinical management varies according to their localization and size. Polyps in the large bowel are detected during endoscopy and removed with polypectomy, in the stomach and duodenum during gastroscopy and in the small bowel with device-assisted enteroscopy. 4

The risk of cancer when detecting one juvenile polyp is not clear. A single juvenile polyp is believed to not increase the risk of cancer. This is based on a few studies with a limited number of patients. Nugent et al. 5 studied the survival rate and cancer occurrence in 82 patients with solitary juvenile polyps and found no increased risk of cancer.

Several hypotheses exist for the mechanism by which juvenile polyps become malignant. The first hypothesis is that polyps follow a hamartoma-carcinoma sequence similar to adenoma-carcinoma. They grow more prominent, dysplasia develops, and eventually transforms into invasive carcinoma. The second theory is that cancer results not from the polyps themselves but from asymmetrical stem cell divisions, leading to altered stem cell lineage turnover rates and accelerated progression to cancer. The third hypothesis is based on the idea that juvenile polyps may develop foci of adenomas, which then can proceed to malignant degeneration. 6

Juvenile polyps are most commonly diagnosed in children during their first decade of life. They are commonly found in the rectum and present with rectal bleeding. Less common presentations include abdominal pain, diarrhea, constipation, anemia, and prolapse of polyp through the rectum. In adults, rectal bleeding is the most common symptom, followed by abdominal pain and prolapse. 7

It is important to distinguish patients with one juvenile polyp from patients with inherited polyposis syndromes. Patients with hamartomatous polyposis syndromes (HPS) have multiple polyps throughout the GI tract, extraintestinal findings (extraintestinal cancers, epistaxis, telangiectasias) and a high risk of cancer. Diagnosis of HPS is based on clinical criteria, and genetic testing is used to confirm the diagnosis. Juvenile polyposis syndrome is a rare hereditary disease characterized by multiple hamartomatous polyps throughout the gastrointestinal tract and the risk for colorectal and gastric cancer is increased. Ιt is important to distinguish the occurrence of one polyp from juvenile polyposis syndrome (JPs), which can be diagnosed based on the following clinical criteria: i) more than 5 juvenile polyps in the GI tract, ii) multiple juvenile polyps throughout the GI tract, or iii) one or more juvenile polyps together with a family history of JPs. Mutations are detected in SMAD4 and BMPR1A genes in 20-30% of cases. 8 Peutz-Jeghers syndrome is characterized by intestinal polyps, especially in the small bowel and mucocutaneous pigmentations. STK11 mutations are detected in more than 90% of patients with Peutz-Jeghers syndrome. PTEN hamartoma tumor syndrome includes Cowden Syndrome, Bannayan-Riley-Ruvalcaba Syndrome, PTEN -related Proteus syndrome, and Proteus-like Syndrome. Sporadic juvenile polyps of the colon are not associated with increased cancer risk and do not need genetic counseling. However, they may undergo dysplastic changes and, therefore, should be resected. 3

Figure 1 refers to a 60‐year‐old woman who was submitted to a screening colonoscopy. She reported no previous endoscopic examination and had no family history of colorectal polyps or cancer. Endoscopic examination revealed a 15 mm pedunculated polyp ( Figure 1A ) in the transverse colon and was successfully removed endoscopically. The polyp’s histologic examination showed cystically dilated glands with chronic inflammatory cells, consistent with a juvenile polyp ( Figure 1B ). Finding a solitary polyp should prompt a search for such polyps at other locations in the gastrointestinal tract. Our patient underwent gastroscopy and capsule endoscopy, which revealed no other findings.

An external file that holds a picture, illustration, etc.
Object name is autopsy-13-e2021414-g01.jpg

How to cite: Vrakas S, Ignatova S, Karapiperis G, Kartsoli S, Karapiperis D. A juvenile polyp on screening colonoscopy. Autops Case Rep [Internet]. 2023;13:e2021414. https://doi.org/10.4322/acr.2021.414

This study carried out at the Tzaneio General Hospital Piraeus, Athens, Greece.

Ethics statement: The authors confirm they retain informed consent signed by the patient authorizing the data publication. The manuscript was approved by the Institutional Ethics Committee.

Financial support: None.

COMMENTS

  1. Chapter 12: Cancer Biology Flashcards

    Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? a. Cancer cells accumulate slower than noncancer cells. b. An accumulation of mutations in specific genes is required for the development of cancer. c. Tumor invasion and metastasis progress more slowly in ...

  2. Cancer Patho Final Flashcards

    7. Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? a. Cancer cells accumulate slower than noncancer cells. b. An accumulation of mutations in specific genes is required for the development of cancer. c.

  3. Advanced Patho: Cancer Biology Flashcards

    Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage of development of colon cancer? An accumulation of mutations in specific genes is required for the development of cancer. Autocrine stimulation is the ability of cancer cells to:

  4. Colorectal Cancer: Genetic Abnormalities, Tumor Progression, Tumor

    Few colon polyps, frequent hamartomatous polyps, presence of intramucosal lipomas. ... The ensemble of these observations supports the view that a colon cancer stem/progenitor cell is the cell of origin of colon cancer. ... nuclear β-catenin accumulation observed in CACs; these observations support the hypothesis that Wnt/β-catenin activation ...

  5. Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer

    These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)

  6. Colon Polyps Causes, Symptoms, and Treatments

    Risk factors for getting colon polyps include: A diet high in red and processed meat, and low in fiber, fruits, and veggies. Being of African American or eastern European descent. Being over 45 years old. Drinking more than 3 alcoholic drinks per day. A family history of IBD, colon cancer, or rectal cancer. Obesity.

  7. Colon polyps

    A colon polyp is a small clump of cells that forms on the lining of the colon. Most colon polyps are harmless. But over time, some colon polyps can develop into colon cancer. Colon cancer can be fatal when found in its later stages. Anyone can develop colon polyps. You're at higher risk if you are 50 or older, are overweight or are a smoker.

  8. Colon polyps: 10 things to know

    Colon polyps can appear in a number of ways: Pedunculated: A little ball of tissue on the end of a stalk, like a broccoli floret or a mushroom. Sessile: A smooth bump or a gradually sloping "hill" on the lining of the colon. Flat: These are often very hard to see, as they may have no visibly raised portion at all.

  9. All About Colon Polyps

    A colon polyp is a mass of tissue on the inside wall of the colon that protrudes (sticks out) into the colon "tube." Most colon cancers start from a polyp; but, only a very small percentage of colon polyps become cancer. Polyps can be non-neoplastic (do not turn into cancer) or neoplastic (can turn into cancer).

  10. Colon Polyps

    Polyps that are 1 centimeter (cm) or larger have a higher cancer risk than polyps smaller than 1 cm. Risk factors include: Age; Family history of colon cancer or polyps; A type of polyp called villous adenoma ; A small number of people with polyps may also be linked to some inherited disorders, including: Familial adenomatous polyposis (FAP)

  11. Pathogenesis of Hyperplastic Polyps of the Colon: A Hypothesis Based on

    The morphology of hyperplastic polyps and the cell kinetics of their cell populations suggests that they result from hypermaturation of epithelium on the colon surface. The morphological features which support this hypothesis are the superficial location of maximal change, cell elongation, increase in the number and length of microvilli, accentuation of lateral intercellular interdigitations ...

  12. Colon polyps

    Screening methods include: Colonoscopy, in which a small tube with a light and camera is inserted into your rectum to look at your colon. If polyps are found, your health care provider may remove them immediately or take tissue samples to send to the lab for analysis. Virtual colonoscopy, a test that uses a CT scan to view your colon.

  13. Maryville University Advanced Pathophysiology Exam 2

    which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? an accumulation of mutations in specific genes is required for the development of cancer. autocrine stimulation is the ability of cancer cells to:

  14. Pathology of Gastrointestinal Polyposis Disorders

    Gastrointestinal polyposis disorders are a group of syndromes defined by clinicopathologic features that include the predominant histologic type of colorectal polyp and specific inherited gene mutations. Adenomatous polyposis syndromes comprise the prototypical familial adenomatous polyposis syndrome and other recently identified genetic conditions inherited in a dominant or recessive manner ...

  15. Polyposis

    Polyps in the gastrointestinal tract are abnormal growths in the colon, small intestine, stomach, or esophagus that are often benign. However, some types of polyps may be able to turn into a cancer if not removed. While otherwise healthy people may develop a few polyps as they age, the term "polyposis" refers to a group of syndromes that ...

  16. Colorectal Polyps and Polyposis Syndromes: Genetic Testing for

    Colorectal cancer is the third most common cancer diagnosed in the United States with up to 3% of cases being attributable to a hereditary polyposis syndrome. Established diagnostic and/or testing criteria exist for many of the recognized polyposis syndromes and are an important tool in guiding physicians in the identification of individuals ...

  17. Which statement supports the hypothesis that intestinal polyps are

    Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? A)Cancer cells accumulate slower than noncancer cells. B)An accumulation of mutations in specific genes is required to develop cancer. C)Tumor invasion and metastasis progress more slowly in the gastrointestinal tract. D)Apoptosis is triggered by diverse ...

  18. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal

    On the other hand, hyperplastic polyps have prevalence rates on colonoscopy studies generally between 10% and 15% but can be up to 30% in certain populations. 11,33,90,97-102 Hyperplastic polyps are typically less than or equal to 5 mm and occur in the distal colon, whereas SSLs are larger and have a predilection for the proximal colon. 81 ...

  19. Which statement supports the hypothesis that intestinal polyps are

    The statement that supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer is: An accumulation of mutations in specific genes is required for the development of cancer. This is because colon cancer is known to develop over time with the accumulation of mutations in specific ...

  20. Topic 4: Ch 12 Cancer Biology Flashcards

    Hormones, enzymes, antigens, and antibodies that are produced by cancer cells. Study with Quizlet and memorize flashcards containing terms like Which cancer originates from connective tissue?, Carcinoma refers to abnormal cell proliferation originating from which tissue origin?, Carcinoma in situ is characterized by which changes? and more.

  21. Evolving management of colorectal polyps

    Polyps ⩾10 mm, however, have an increased incidence of harboring pre-malignant histology; 6.6% in polyps measuring 6-9 mm and 30.6% in ⩾10 mm. 16 In addition to size, morphologic characterization is another critical step that aids in differentiating an adenoma from a serrated polyp or a hyperplastic polyp, and whether the polyp is benign ...

  22. Unlocking the Secrets of Colon Cancer

    Johns Hopkins infectious diseases professors Cynthia Sears and Jessica Queen suspect the problems—and maybe the solutions—are hidden among the trillions of tiny bugs that live in our intestines. "The most important thing we can do in the research community is to put the microbiome into action." Late last year, Sears and Queen led a team ...

  23. McCance Pathophysiology Ch. 12

    Study with Quizlet and memorize flashcards containing terms like Which characterize(s) cancer cells? a. poorly differentiated b. metastasis c. infiltrative growth mode d. poor cellular cohesiveness e. All of the above are correct., Tumor cell markers: a. are proteases. b. are absolutely diagnostic for cancer. c. can monitor the course of cancer. d. indicate metastasis., Telomeres: a. block ...

  24. Risk of colorectal neoplasia after removal of conventional adenomas and

    Results After a median follow-up of 5.3 years, we documented 309 CRC and 3053 high-risk polyp cases. Compared with participants with no polyps at index colonoscopy, those with high-risk adenomas and high-risk serrated polyps had a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy (multivariable HR 5.44 (95% CI 3.56 to 8.29) and 8.35 ...

  25. A juvenile polyp on screening colonoscopy

    A juvenile polyp on screening colonoscopy. The most common polyps in the large bowel are adenomas and serrated polyps. Diamond 1 first described Juvenile polyps in 1939, and Helwig 2 in 1946 reported what currently is coined as hamartomatous polyps. They are typically lobulated and pedunculated with erosions in the surface and appear cystic ...

  26. Association between Nonalcoholic Fatty Liver Disease and Colon Polyps

    These consistent observations support the hypothesis that hepatic metabolic conditions may influence colorectal health. The identification of NAFLD as a potential link to colon polyps has implications for clinical practice and public health. Clinicians should consider assessing colorectal health in individuals with NAFLD and vice versa.