Polypectomy and histology: what you need to know

Colorectal cancer is one of the most common cancers in Hungary and worldwide. But the good news is that in most cases it is preventable. Colon cancer almost always develops from polyps growing on the intestinal wall, which are initially benign. By detecting and removing them in time, the risk of developing a malignant tumour can be significantly reduced.

In this article, we will explain in detail what a polyp is, how it is removed during an endoscopic procedure such as a colonoscopy, and why a histopathological examination is essential. We also discuss the options for painless tests and what to do after the procedure. Our aim is to give you all the information you need to make confident and fearless decisions about your health.

What is an octopus and why is it dangerous?

Polyps are pinhead-like growths that protrude from the intestinal mucosa and can grow up to several centimetres in size. They usually do not cause symptoms on their own, especially if they are small. That's why screening for colorectal cancer is crucial, because removing polyps found when they are asymptomatic can prevent more serious problems.

There are several types of polyps, and not all of them will turn into cancer. The most common types are:

Neoplastic polyps (adenomas): These polyps carry the risk of malignant transformation. There are also several subtypes of adenomas (tubular, villous, tubulovillous), and their histological structure and size influence the likelihood of developing cancer.

Non-neoplastic polyps: Examples include hyperplastic polyps, which are usually small and do not become malignant in most cases. However, certain types, such as structurally different „sessile serous adenomas”, are also considered to be a cancer-preventive condition.

Since it is not possible to determine the type of polyp with 100% certainty by visual inspection during an endoscopic examination, standard medical practice is to remove any polyps found and send them for histological examination.

The procedure for polypectomy (polypectomy)

Polypectomy is most commonly performed during a colonoscopy. This procedure allows a thorough examination of the entire colon and immediate removal of any lesions found.

How is the intervention done?

An endoscope is a thin, flexible tube with a camera and light source, through which various instruments can be passed into the intestine. A special wire loop (polypectomy loop) is used for polyp removal.

Identification of the octopus: The endoscopist uses a monitor to watch the camera image as it moves through the intestinal tract and identifies polyps.

Putting the loop on: The wire loop is threaded through the working channel and placed on the octopus' base or handle.

Removal: By tightening the loop and applying a high-frequency electric current (electrocoagulation), the polyp is cut off the intestinal wall. This method also seals off the resulting small wound, reducing the risk of bleeding. For smaller polyps, removal can also be done using a „cold” technique, without the use of electricity.

Extracting the octopus: The removed octopus is lifted out of the body either through the duct with a suction device or with a special mesh or forceps.

Histopathological examination: The selected tissue sample is placed in a container and sent to a pathology laboratory for histological analysis.

What methods are available?

Depending on the size, shape and location of the polyp, several techniques can be used:

Loop polypectomy: The most commonly used method, which we have detailed above. It can also be used to remove smaller polyps, both pedunculated and squamous.

Endoscopic mucosal resection (EMR): It is used for larger, flat polyps. The procedure involves injecting fluid (e.g. physiological saline) under the polyp to lift it away from the deeper layers of the intestinal wall. This makes removal safer and reduces the chance of complications such as perforation of the intestinal wall.

Endoscopic submucosal dissection (ESD): It is a more complex procedure requiring specialised expertise, developed to remove very large, flat lesions or early-stage tumours in one piece.

Surgical removal: Very rarely, if the polyp cannot be safely removed endoscopically because of its size or location, surgical intervention may be necessary.

Painless testing: the possibility of anaesthesia

Many people are afraid of mirror examinations because of the possible discomfort or pain. It is important to know that Endomedix at its headquarters Mirror examinations can be requested without anaesthesia or with anaesthesia.

Testing without anaesthesia: At this time, the patient is awake but may be given a mild sedative to help them relax. During the test, you may feel tension and pressure as the air is used to dilate the bowel for better visibility.

Testing under general anaesthesia (anaesthesia): In this case, deep sleep is induced with intravenous medication under the supervision of a specialist anaesthetist. You will be asleep throughout the entire test, without any discomfort. After the procedure, you will need a short period of observation and will not be allowed to drive a car that day. The anaesthetic test is more expensive, but it also provides complete comfort and painlessness, making it easier for many people to decide whether to have the necessary screening test.

From Endomedix experienced specialists and assistants will do their utmost to ensure that your examination is as uncomfortable as possible, whichever option you choose.

The importance of histological examination

The fate of the removed polyps is decided in the pathology laboratory. Histological examination is the only way to accurately determine the type of polyp and whether it contains cancer cells.

The pathologist will analyse the tissue sample under the microscope and report the following findings:

The type of octopus: It determines whether the diagnosis is an adenoma, a hyperplastic polyp or another type.

The degree of dysplasia: Dysplasia is a precancerous condition of the cells. It can be mild (low-grade) or severe (high-grade). Severe dysplasia is a precursor to cancer that is growing in situ but has not yet infiltrated its environment (carcinoma in situ).

Invasiveness: The most important question is whether the tumour cells have broken through the base of the mucosa (muscularis mucosae) and penetrated the deeper layers (submucosa). If so, we are talking about invasive cancer, which is already capable of metastasising.

The completeness of the removal: The findings will also include whether the polyp was successfully removed in intact tissue (R0 resection). This means that there are no tumour cells at the edge of the excision.

Based on the histopathology results, the doctor will decide what to do next and when the next check-up should be.

What happens after polyp removal?

Polypectomy is generally a safe procedure, but like all medical procedures, it can have complications, although these are rare.

Bleeding: After the procedure, there may be a slight bleeding. Major bleeding is rare and may occur up to 7-10 days after the polypectomy. In such cases, you should seek medical advice immediately. The risk of bleeding is usually manageable with endoscopic surgery.

Intestinal wall perforation (perforation): This is a very rare but serious complication that requires immediate hospitalisation, often surgery.

Post-polypectomy syndrome: The heat caused by the electric current can also irritate the deeper layers of the intestinal wall, which can cause abdominal pain and fever after the procedure, even without perforation. It usually requires hospital observation and treatment with antibiotics.

After the procedure, it is important to follow the doctor's instructions, which usually mean a few days of a sparing diet and limiting physical activity.

The importance of control tests

Depending on the histological result, the doctor will recommend the next colonoscopy.

Low risk: If 1 to 4 adenomas smaller than 10 mm with mild dysplasia have been removed, the next check-up is usually due in 5 to 10 years.

High risk: If the number of polyps is 5 or more, their size exceeds 10 mm, or they show severe dysplasia or villousness, a follow-up is recommended within 3 years.

After removal in several pieces: If a large polyp has been removed in several pieces („piecemeal”), an early follow-up within 3-6 months is necessary to check that no polyp tissue remains.

Regular check-ups aim to detect and remove any new polyps in time.

Summary

Polypectomy and subsequent histological examination is the most effective means of preventing colorectal cancer. Modern endoscopic techniques allow safe and effective removal of polyps, often during screening. Fear of the procedure should not be a barrier because mirror examinations can be requested without or with anaesthesia, the latter guarantees complete painlessness, although involve higher costs.

From Endomedix highly qualified professionals and modern equipment ensure that the examination and intervention are carried out to the highest professional standards and in the safest possible way. Don't delay your screening! Colon cancer is preventable and your health is the most important thing. Do it today!