How high is my risk of colon cancer with polyps?

Question

Hi doctor,

Three months ago, I noticed blood in my stool two times and did a colonoscopy two days back. In a colonoscopy, 13 polyps were evident. I wanted to know the following.

1) I asked the doctor if this could be cancer, and he replied it might be pre-cancer. What does that mean?

2) In 13 polyps, the largest is 0.39 inches in measurement.

3) How do you know by looking at the polyps that they are cancerous or pre-cancerous?

4) Is a cancerous polyp called a tumor? And how do they look like?

5) What is the average age of colon cancer?

6) Once the polyps have been removed, will they recur?

7) When should I go again for another colonoscopy?

Kindly help with the answers.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

Question (1) and (3) and (4): Cancers have the appearance of an ulcerated, large mass infiltrating into the wall of the intestine. By the term pre-cancer, he probably meant that it did not have the features mentioned above and instead were smooth-surfaced polyps without any infiltration into the wall of your intestine. A polyp is an overgrowth of cells in the mucosa (the internal lining) of our intestine. Any such overgrowth forms a swelling. The tumors that can invade nearby tissues or can spread to other areas are called cancers. The extent of spread will define the stage of cancer. A polyp can have a spectrum of microscopic changes ranging from an overgrown normal mucosa to becoming cancer, initially superficial cancer that has not invaded deep into the stalk or wall, to frank cancer with involvement of the intestinal wall. This can be assessed accurately only after removing it and examining it microscopically.

Question (2): In 13 polyps, the largest one is 0.39 inches in measurement. 13 polyps are a considerable number. Also, 0.39 inches is the smallest size that raises concerns. As a general rule, the more the number and size, more the chances that any one of these can lead to cancerous changes. Overall, the significance will depend on history of any polyp syndrome running in your family and the changes found on microscopic examination. So just relax for now.

Question (5): What is the average age of colon cancer?

Usually after 50 years age, but with polyp syndromes can be early also.

Question (6) and (7) Polyps can return, that is why coloscopic surveillance is advised on basis of number, size and microscopic features of polys and presence or absence of family disorder. In your case, next colonoscopy should be done after one year if microscopy is normal.

I hope that helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I will try my best to clear all your questions.

1) Polyp of 0.39 inches is big and concerning.

2) If polyps return, they can be removed again. And after the removal, a follow-up colonoscopy is set up to remove the polyps before developing into cancer.

3) Though it is possible to have colon cancer (10% of total cases) before 50 years of age without a family history, it is relatively uncommon.

4) If a polyp has the appearance of an ulcerated mass, especially if it infiltrate into the wall of the intestine, it is considered cancer. But only microscopic examination will help to confirm cancer.

5) As per treatment guidelines, if a baseline endoscopy has five or more small (less than 0.39 inches) adenomas or three or more polyp, with atleast one having a measurement of 0.39 inches is considered to be a high-risk group, warranting a repeat colonoscopy after one to three year. However, if all the polyps are removed and do not recur in the next colonoscopy, this interval can increase.

I hope it helps.

Feel free to get back if you need any information.

Thanks.