A colonoscopy is a medical procedure that involves examining the inner lining of the colon and rectum. A long, flexible tube with a camera, called a colonoscope, is guided through the colon. This procedure screens for and detects abnormalities, such as polyps or inflamed tissues, which could indicate various colon health conditions. Finding something during a colonoscopy is common and usually does not signify a serious problem.
Common Discoveries During a Colonoscopy
During a colonoscopy, healthcare providers may find several types of growths or conditions. Polyps are small tissue growths that can form on the lining of the colon, occurring in approximately 25% of individuals aged 45 and older. These polyps can be categorized into nonneoplastic, which are benign, and neoplastic, which have the potential to become cancerous.
Among neoplastic polyps, adenomatous polyps are the most frequently encountered. These are further classified by their growth patterns: tubular adenomas are the most common, small and pedunculated (attached by a stalk), while villous adenomas are flatter and carry a higher risk of becoming cancerous. Tubulovillous adenomas represent a mix of these two patterns. Serrated polyps, another neoplastic type, can also be precancerous and are harder to detect due to their flat appearance.
Beyond polyps, other findings include diverticulosis, which are small pouches that bulge outward from the colon wall. These are harmless unless they become inflamed. Signs of inflammation, indicative of conditions like colitis (e.g., ulcerative colitis or Crohn’s disease), are also observed. Hemorrhoids, though not the primary target of a colonoscopy, are noted during the examination.
Immediate Actions Taken During the Procedure
If an abnormal growth or suspicious area is identified, the gastroenterologist takes immediate action. For polyps, a procedure called a polypectomy is performed to remove them during the same colonoscopy. This is a minimally invasive procedure where the doctor inserts small instruments through the colonoscope to remove the polyp.
Small polyps less than 5 millimeters in diameter can be removed using biopsy forceps. For larger polyps, up to 2 centimeters, a wire snare is used, which loops around the polyp’s base and uses heat to cut it off. Any remaining tissue or stalk is then cauterized to prevent bleeding. For very large or flat polyps, techniques like endoscopic mucosal resection (EMR) are employed, where a fluid is injected under the polyp to lift it before removal, sometimes in pieces.
A biopsy is taken if a suspicious area, inflammation, or a lesion too large for immediate removal is found. This involves taking a small tissue sample for further examination. Some findings, such as small, clearly benign diverticula, do not require immediate intervention during the procedure.
Interpreting the Pathology Report
After a polypectomy or biopsy, the removed tissue samples are sent to a pathologist for examination under a microscope. The pathologist prepares a report that classifies the findings, which is then sent to your doctor. This report helps understand the nature of any abnormalities found.
The pathology report classifies the findings as benign, pre-cancerous, or cancerous. Benign findings indicate non-cancerous tissue, such as hyperplastic polyps, that do not become cancerous. Pre-cancerous findings, like adenomas with dysplasia, mean the cells are abnormal but not yet cancerous; however, they have the potential to become malignant. Dysplasia can be low-grade (mildly abnormal cells) or high-grade (more abnormal, resembling cancer cells).
A cancerous diagnosis indicates the presence of malignant cells. The report provides additional details about the cancer, such as its type, location, and how aggressive it appears. Your doctor reviews these results with you, explaining the medical terminology and what the findings mean for your health.
Subsequent Steps and Monitoring
The actions taken after receiving a pathology report depend on the findings. If benign polyps were removed, routine screening is recommended every 5 to 10 years for average-risk individuals. For pre-cancerous polyps, follow-up colonoscopies are recommended more frequently to monitor for new growths or ensure complete removal. If low-risk adenomas are found, a follow-up colonoscopy is suggested in 5 years; high-risk adenomas necessitate a repeat procedure in 3 years.
If cancer is detected, additional treatment options are discussed, including surgical removal of the cancerous tissue, chemotherapy, or radiation therapy. The specific approach depends on the stage and type of cancer. For inflammatory conditions, medication or lifestyle changes are recommended to manage symptoms and prevent complications.
Regardless of the findings, maintaining open communication with your healthcare provider is important. They explain the results, outline the personalized surveillance schedule, and discuss any necessary lifestyle adjustments, such as dietary modifications or increased physical activity, that can support colon health. Regular follow-up appointments are important for managing colon health after a colonoscopy.