A colonoscopy examines the large intestine and rectum to screen for abnormalities within the bowel lining, with a strong focus on preventing colorectal cancer. While a negative result is the desired outcome, finding something is a relatively common occurrence that should not automatically cause alarm. Understanding that many findings are manageable and treatable helps to mitigate patient anxiety. This preventative approach allows physicians to intervene early, often stopping a problem before it can develop into a serious health concern.
Common Discoveries During Screening
The most frequent finding encountered during a screening colonoscopy is a polyp, an abnormal growth of tissue protruding from the inner lining of the colon. These growths are categorized by their microscopic appearance, which determines their potential to become cancerous. Hyperplastic polyps, typically small and located in the lower section of the colon, are generally considered non-threatening.
Adenomatous polyps, or adenomas, are the most common type of precancerous growth. A specific subtype known as a sessile serrated lesion also has malignant potential and is characterized by a flatter, harder-to-spot appearance on the colon wall. The gastroenterologist also looks for non-polyp conditions, such as diverticulosis (small pouches in the colon wall), or signs of inflammation known as colitis, which can indicate an underlying inflammatory bowel disease.
Immediate Interventions Performed by the Doctor
When an abnormal finding like a polyp is identified, the gastroenterologist typically takes immediate action to remove or sample the tissue during the procedure itself. The removal of a polyp, known as a polypectomy, is performed using specialized tools. For smaller polyps (under 10 millimeters), a cold snare polypectomy is often employed, using a wire loop to sever the polyp without electrical current.
Larger or flatter lesions may require a hot snare polypectomy, which uses electrocautery to cut the tissue while simultaneously sealing the blood vessels to prevent bleeding. Any tissue that is too large or complex for standard removal, or any area appearing inflamed or suspicious, will be sampled using biopsy forceps to obtain a small piece of tissue for laboratory analysis. All removed polyps and tissue samples are retrieved and sent to a pathology lab.
Interpreting Biopsy Results and Surveillance Schedules
The tissue analysis performed by a pathologist ultimately dictates the patient’s future surveillance schedule. A finding of low-risk adenomas, defined as one or two tubular adenomas smaller than 10 millimeters, typically places the patient on a 7-to-10-year follow-up schedule. This extended interval is based on the low probability of these polyps developing into advanced lesions quickly.
Patients are classified as higher risk if they have three or more adenomas, any adenoma 10 millimeters or larger, or any adenoma showing high-grade dysplasia or a villous component. These high-risk findings indicate a significantly faster growth potential or a more advanced stage of precancerous change. For these individuals, a repeat colonoscopy is generally recommended within three years. The presence of 3 to 4 small adenomas often warrants an intermediate follow-up interval of five years.
Specialized Care for Malignant Findings
The least common outcome is the pathology report confirming the presence of malignant cells. The patient is immediately referred to a specialized multidisciplinary team, typically including a surgeon, oncologist, and radiation oncologist. The first step involves confirmatory testing to stage the cancer and determine if it has spread beyond the colon wall.
This staging process usually involves imaging scans and blood work. The treatment plan is then customized based on the cancer’s stage, location, and the patient’s overall health. The coordinated care team works quickly to outline the surgical resection, chemotherapy, or radiation required to manage the disease.