Most colon polyps do not cause any problems, but a sample of polyp tissue (called a biopsy) can be removed during screening if you have a flexible sigmoidoscopy or colonoscopy. The tissue is examined to determine if it is the kind of tissue that could become cancer.

Initial treatment

If adenomatous polyps are found during an exam with flexible sigmoidoscopy, a colonoscopy will be done to look for and remove any polyps in the rest of the colon.

The bigger a colon polyp is, especially if it is larger than 1cm, the more likely it is that the polyp will be adenomatous or contain cancer cells and need to be removed.

In some cases, very small polyps [5mm or less] may not be removed. Some studies have concluded that even if they contain adenomatous tissue, these polyps take so many years to grow that they pose little risk of cancer, except in people who have inherited (familial) polyp syndromes.⁴

Most colon polyps are not likely to develop into cancer. If only hyperplastic polyps are found during your flexible sigmoidoscopy, you usually do not need to have a colonoscopy. These polyps do not become cancerous. In this case you can continue your regular screenings, unless you are at an increased risk for colon cancer because of a family history of colon cancer or an inherited polyp syndrome.

Risks of removing polyps during colonoscopy

Complications from colonoscopy are rare. There is a slight risk of:

• Puncturing the colon (less than 1 in 1,000) or causing severe bleeding by damaging the wall of the colon (less than 3 in 1,000). One study found that the risk of perforation from colonoscopy has declined in recent years.⁵
• Bleeding caused by removing a polyp.
• Complications from sedatives given during the procedure.

Ongoing treatment

Regular screenings for colon polyps are the best way to prevent polyps from developing into colon cancer. All men and women ages 50 and older should have either:

• A fecal occult blood test every year or
• A flexible sigmoidoscopy every 5 years or
• A fecal occult blood test every year and a flexible sigmoidoscopy every 5 years or
• A double-contrast barium enema every 5 years or
• A colonoscopy every 10 years.

Most colon polyps can be identified and removed during a colonoscopy. Colon polyps can be identified during a flexible sigmoidoscopy, but you will most likely need to have a colonoscopy to remove the polyps.

If you have had one or more adenomatous polyps removed, you probably need regular follow-up colonoscopy exams every 3 to 5 years. Talk with your doctor about the follow-up schedule that he or she recommends for you.

Treatment if the condition gets worse

Surgery is sometimes needed for large colon polyps that have a broad area of attachment (sessile polyps) to the colon wall. These large polyps often cannot be removed safely during a colonoscopy and may be more likely to develop into cancer.

If cancer is found when the colon polyps are examined, you will begin treatment for colorectal cancer. For more information, see the topic Colorectal Cancer.