Colon polyps are mushroom-shaped abnormal growths that line the large intestine and protrude into the intestinal canal. Colorectal cancer typically develops from precancerous polyps in the colon or rectum.¹

Colon polyps are one of the most common conditions affecting the colon and rectum, occurring in 15% to 20% of adults.¹⁶

Enough is now known about colon polyps that physicians generally place patients in one of four categories:

• The ordinary polyp—Most sporadic polyps occur between the ages of 40 and 60. There may be only one or two present, and they may take 10 years or more to become cancerous. There is a hereditary link.
• Hereditary familial polyposis—This is a true hereditary condition in which the entire colon is studded with hundreds, even thousands, of polyps. They begin early, even under the age of 10 years old. Virtually every patient with this condition will eventually develop colon cancer. The only known preventive treatment is surgical removal of the colon. Fortunately, this condition is not common.
• Adenomatous polyps or adenomas—These polyps can become cancerous, and they account for approximately 75% of all colon polyps. There are several subtypes of adenoma that differ primarily in the way the cells of the polyp are assembled when they are examined under the microscope. Thus, there are tubular, villous, and tubulo-villous adenomas. Villous adenomas are the most likely to become cancerous, and tubular adenomas are the least likely. Another factor that contributes to a polyp’s likelihood of becoming cancerous is its size. The larger a polyp grows, the more likely it is to become cancerous. Once a polyp reaches approximately one inch in size, the risk of cancer is in excess of 20%. Therefore, it is advisable to remove polyps of any size to prevent their growth and their progression to cancer.
• Lynch syndrome (hereditary non-polyposis colorectal cancer)—This disorder is more common than familial polyposis, but less so than the ordinary polyp. There is a strong tendency for adenoma-type polyps to occur in close blood relatives. Polyps, and even cancer, occur at earlier ages—in the 40s or 30s, or even in the 20s. In some families, there is also an increased incidence of breast, ovarian, and other cancers. A family history of this type warrants very close surveillance of all direct blood relatives.

Most polyps produce no symptoms and often are found incidentally during an endoscopy, or x-ray, of the bowel. Some polyps, however, can produce bleeding, mucous discharge, alteration in bowel function, or, in rare cases, abdominal pain.¹⁶

Total removal of all polyps is advised to prevent cancer development. The majority of polyps can be removed with a wire loop, and small polyps can be destroyed just by touching them with an electrical current. Removing larger polyps, however, may require surgery.¹⁷

The risk of cancer developing in an unremoved polyp increases over time after diagnosis:

• About 3% at 5 years
• About 8% at 10 years
• About 24% at 20 years

The likelihood of any polyp becoming cancerous depends on many factors. After polyps have been removed, the risk of developing colon cancer is only 2.3%, compared to about 8% for people who do not have them removed.¹⁷

During surgery, the polyp is removed through an incision in the abdomen, along with a small length of normal colon on either side of the polyp. The two ends of the colon are then sewn back together.

Sometimes the surgeon cannot reconnect the colon. In this case, a new opening, or stoma, to the outside of the abdomen is created. The intestine is then connected to the stoma, where a bag is attached to collect body waste. This is called a colostomy. In most cases, a colostomy is only temporary. For most people, it is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the colon and closes the stoma.

During traditional open surgery, the surgeon makes an incision up to 12 inches long from the upper to the lower abdomen to view the colon and remove the diseased portions. Because of the nature of this highly invasive procedure, patients often face a long and difficult healing process that results in a hospital stay of at least a week, with recovery time ranging from six to eight weeks.

Advancing technology and research have transformed surgery for the treatment of colon polyps in recent years. In the past, most patients underwent open surgery for colon polyps. However, patients now have a second surgery option, a minimally invasive procedure, also known as laparoscopic surgery.

During a minimally invasive procedure for colon polyps, the surgeon makes a series of small incisions, from a quarter of an inch to four inches, in the patient’s abdomen. A small video camera, or scope, is placed in one of the incisions, providing the surgeon with a magnified view of the patient’s internal organs on a television monitor. Surgical instruments are placed in the other incisions, allowing the surgeon to work inside and remove diseased portions of the colon.⁷

Minimally invasive procedures have been shown to be as effective as open surgery, while offering many benefits over the open procedure. These benefits include:

• Quicker recovery time
• Shorter hospital stay
• Less pain
• Less scarring⁷

Factors that could preclude a patient from undergoing a minimally invasive procedure include obesity, prior abdominal surgery, dense scar tissue, bleeding problems during the procedure, and/or the surgeon’s inability to visualize the organs.¹⁵