Diagnosis of colonic polyps: practical advice

The diagnosis of colorectal polyps sounds scary to many people, and often the fear is that we don't know exactly what it means and what will happen to us. If you or a loved one suspects or has already been diagnosed with polyps, it is important to get reassuring and clear answers. This post is designed to provide practical advice to help you navigate the diagnostic process, dispel misconceptions and reduce anxiety about the unknown.

Colon polyps are growths on the inner surface of the intestinal wall, starting from the mucous membrane and bulging towards the intestinal cavity. Although most of them are benign, some types can develop into malignant tumours, or colon cancer, over many years. This is why early detection and, if necessary, removal is crucial. Modern medicine, especially gastroenterology, now has highly effective and gentle tools to identify these lesions. Endomedix Gastroenterology Centre are committed to helping their patients on this journey with state-of-the-art methods and an empathetic approach.

In this article, we explain in detail what symptoms can indicate polyps, how the investigation is carried out step by step and what the different diagnostic procedures, especially colonoscopy, mean. Find out what to do after diagnosis and how polyps are removed and followed up. Our aim is to give you all the information you need to face the situation with more confidence and less fear.

What is colonic polyps?

In order to understand the diagnostic process, it is first important to clarify what is called colonic polyps. Polyps are a growth of mucosal tissue covering the inner surface of the colon. They can vary widely in size, shape and histological structure.

The most important consideration is the risk of malignant degeneration. In this respect, two main groups are distinguished:

• Polyps that are not cancerous (not neoplastic): Examples include hyperplastic or inflammatory polyps. These are not usually cancer risk, but it is important to distinguish them from the cancerous types.
• Tumorous (neoplastic) polyps: This includes adenomas and serrated lesions. These polyps are considered a cancer-preventing condition because they are the origin of the vast majority of colon cancers. The process of transformation, called the adenoma-carcinoma sequence, usually takes many years. This window of time allows for early detection and removal of polyps, which can prevent the cancer from developing.

Types of adenomas

Adenomas are the most common precancerous polyps. Based on their histological structure, three main types are distinguished:

• Tubular adenoma: The most common type (80-86% of cases), usually with a lower cancer risk.
• Villosus adenoma: Less common (3-16%) but higher chance of malignant transformation.
• Tubulovillous adenoma: A mixture of the two types above (8-16%).

The risk is also influenced by the size of the polyp and the degree of atypia (dysplasia) of the cells within it. Polyps larger than 10 mm, with a villous structure and severe (high-grade) dysplasia are at the highest risk of developing cancer.

When to suspect colonic polyps? The most common symptoms

Colon polyps can be completely asymptomatic for a long time and are often only detected during screening. If they do cause complaints, they are usually:

• Changes in stool habitus: Chronic diarrhoea or constipation, or alternations of these.
• Blood in the stool: Fresh, red blood (haematomas) or blackening of the stools (melena, which is more likely to indicate upper tract bleeding, but can occur).
• Hidden (occult) bleeding: Bleeding that is not visible to the eye and can only be detected by a special test (faecal blood test), which can lead to iron deficiency anaemia.
• Iron deficiency anaemia: Fatigue, paleness, weakness, shortness of breath, for which no other cause is found.
• Unclear abdominal pain: Cramping, discomfort in the abdomen.
• Unnecessary weight loss: Significant weight loss without dieting or exercising more.

These symptoms are not specific, meaning they can be caused by other diseases. Therefore, if you experience any of these symptoms, you should consult a doctor, preferably a gastroenterologist, to find out the exact cause of your symptoms. The website Endomedix Gastroenterology Centre trained specialists are ready to help you with your examination.

The key to diagnosis: colonoscopy (colonoscopy)

The gold standard, or most reliable method of diagnosing colonic polyps is colonoscopy, also known as colonoscopy. Although many people are afraid of this test, it is important to know that it is now a very safe and gentle procedure, which can be performed under general anaesthesia for the patient's complete comfort.

How is the test done?

During a colonoscopy, a thin, flexible instrument (colonoscope) with a camera and light source is passed through the entire section of the colon. The image transmitted by the camera is followed by the doctor on a monitor, allowing him or her to view the intestinal wall in detail.

Key benefits of the study:

• High sensitivity: It allows the detection of even the smallest polyps, down to a few millimetres.
• Histological sampling (biopsy): If the doctor finds a suspicious lesion, he or she can use tiny forceps to take a tissue sample and analyse it to determine the exact type of polyp.
• Immediate intervention (polypectomy): Most polyps can be removed immediately during the examination using a special loop. This procedure is usually completely painless and can prevent the development of cancer.

Preparing for colonoscopy

The key to a successful test is a thorough cleansing of the colon. If fecal residue remains in the intestine, it makes it difficult to navigate and the doctor can easily overlook minor lesions. Preparation usually consists of the following:

• Diet: A low-fibre diet should be followed in the days before the test.
• Laundry detergent solution: The day before the test, a special laxative solution mixed with a large amount of liquid is taken, which effectively cleans out the intestines.
• Medicines: Certain medications (e.g. iron supplements, anticoagulants) should be stopped or changed before the test, as directed by your doctor.

From Endomedix Gastroenterology Centre staff provide detailed written information and personal advice to help patients prepare properly.

Modern technologies for even more accurate diagnosis

The accuracy of colonoscopy is now enhanced by a number of innovative technologies, commonly known as chromoendoscopy. These techniques help to examine the surface and vascular structure of polyps in more detail, making it easier to distinguish between benign and malignant lesions.

• Virtual chromoendoscopy: One example is Narrow Band Imaging (NBI), which uses special light filters to highlight the veins and fine patterns of the mucosa. This makes suspicious areas more visible.
• Painting processes: By injecting contrast agents (e.g. indigo carmine) into the intestine, the unevenness of the mucosa, such as flat adenomas, is better highlighted.

These modern techniques increase the polyp detection rate (adenoma detection rate - ADR), which is one of the most important indicators of the quality of colorectal cancer screening.

Other diagnostic methods

Although colonoscopy is the most accurate method, there are other methods of examination that are used mainly for screening or as an additional test.

• Fecal blood test: This is the simplest screening test that can be done at home. There are two main types: the guaiac-based test (gFOBT) and the more modern, more specific immunochemical test (FIT). FIT detects even very small amounts of human blood in stool. It is important to know that a positive test result does not automatically mean cancer (it can be caused by haemorrhoids, inflammation or even a large polyp), but it is a good reason to have a colonoscopy to find the exact cause.
• CT colonography („virtual colonoscopy”): A special CT scan that takes a three-dimensional image of the colon. It has the advantage of being non-invasive, but the disadvantages of being radiation-sensitive, making it harder to detect small and flat polyps, and if a polyp is found, there is no possibility of histological sampling or removal - this would still require a conventional colonoscopy.

What does the diagnosis mean? Interpretation of the histological findings

Polyps removed during colonoscopy and tissue samples taken are always examined under the microscope by a pathologist. The histological findings contain the most important information that will determine the next steps to be taken.

The most frequently used terms in the find:

• Polip type: E.g. tubular adenoma, hyperplastic polyp.
• Size: Size of the octopus in millimetres.
• Degree of dysplasia: The degree of abnormal transformation of cells. It can be mild (low-grade) or severe (high-grade). High-grade dysplasia is considered a precancerous condition, but not yet invasive cancer.
• Invasive carcinoma: When cancer cells break through the base of the mucosa (muscularis mucosae) and enter the deeper, submucosal layer.
• Resection wind: The pathologist will check whether the polyp in the intact tissue has been removed. A „negative” or „intact” resection margin means that the excision was complete.

The results of the histological findings are always evaluated by the treating physician, gastroenterologist, and on this basis, he or she makes a recommendation for further action.

After diagnosis: treatment and follow-up

The treatment of colonic polyps is their removal. In most cases this is done during diagnostic colonoscopy (endoscopic polypectomy).

Endoscopic removal techniques:

• Traditional polypectomy: For smaller polyps, a special electric loop is used to cut the polyp.
• Endoscopic mucosaresection (EMR): A technique used for larger, flat polyps, where fluid is injected under the polyp to elevate it, making it easier and safer to remove.
• Endoscopic submucosal dissection (ESD): It is a highly specialised procedure for very extensive or scarring lesions.

If the polyp has been successfully removed in one piece and completely, and the histology shows no deep invasion, the treatment is complete. Surgical intervention is only rarely required for very large polyps that cannot be removed endoscopically, or in certain cases of histologically proven invasive cancer.

The importance of control tests

The most important thing after polyp removal is regular check-ups. Polyps tend to recur. How often you need a repeat colonoscopy depends on several factors:

• the number of polyps removed,
• size,
• histological type (risk classification).

General guidelines:

• A low-risk case: For 1-2 tubular adenomas smaller than 10 mm, a check-up is usually recommended after 5-10 years.
• High risk case: For 3 or more adenomas, adenomas larger than 10 mm, villous polyps or polyps with high-grade dysplasia, follow-up is usually recommended within 3 years.

The exact schedule is always determined by the treating doctor, based on international professional guidelines and tailored to the individual. From Endomedix Gastroenterology Centre ensure long-term follow-up of your patients and notify them in good time of any check-ups that are due.

The next step is in your hands

A diagnosis of colorectal polyps is no longer a verdict, but an opportunity to prevent colorectal cancer. The modern gastroenterology toolbox allows early, safe and effective detection and removal of polyps. The most important step is to take your symptoms seriously, attend screening tests and, once diagnosed, follow your doctor's instructions.

Don't let fear or insecurity hold you back! A timely, professional colonoscopy can save your life. Visit Endomedix Gastroenterology Centre experienced professionals and a modern, patient-friendly environment all help to make the diagnostic process as stress-free as possible for you. Take action for your health and make an appointment for a consultation today!