Treatments and drugsBy Mayo Clinic staff
Although some types of colon polyps are far more likely to become malignant than are others, a pathologist usually must examine polyp tissue under a microscope to determine whether it's potentially cancerous. For that reason, your doctor is likely to remove all polyps discovered during a bowel examination.
The great majority of polyps can be removed during colonoscopy or sigmoidoscopy by snaring them with a wire loop that simultaneously cuts the stalk of the polyp and cauterizes it to prevent bleeding. Some small polyps may be cauterized or burned with an electrical current. Risks of polyp removal (polypectomy) include bleeding and perforation of the colon.
Polyps that are too large to snare or that can't be reached safely are usually surgically removed — often using laparoscopic techniques. This means your surgeon performs the operation through several small incisions in your abdominal wall, using instruments with attached cameras that display your colon on a video monitor. Laparoscopic surgery may result in a faster and less painful recovery than does traditional surgery using a single large incision. Once the section of your colon that contains the polyp is removed, the polyp can't recur, but you have a moderate chance of developing new polyps in other areas of your colon in the future. For that reason, follow-up care is extremely important.
Endoscopic mucosal resection
Some specialized medical centers perform endoscopic mucosal resection (EMR) to remove larger polyps with a colonoscope. For this newer technique a liquid, such as saline, is injected under the polyp to elevate and isolate the polyp from surrounding tissue. This makes it easier to remove a larger polyp. With this procedure, you can avoid surgery, but it's not yet clear how the complication rates may compare.
Colon and rectum removal
In cases of rare, inherited syndromes, such as familial adenomatous polyposis (FAP), your surgeon may perform an operation to remove your entire colon and rectum (total proctocolectomy). Then, in a procedure known as ileal pouch-anal anastomosis, a pouch is constructed from the end of your small intestine (ileum) that attaches directly to your anus. This allows you to expel waste normally, although you may have watery and more frequent bowel movements.
- Polyps of the colon and rectum. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec02/ch021/ch021g.html#sec02-ch021-ch021e-1467. Accessed May 23, 2011.
- What I need to know about colon polyps. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/colonpolyps_ez/. Accessed May 23, 2011.
- Colorectal cancer prevention and treatment. American Gastroenterological Association. http://www.gastro.org/patient-center/digestive-conditions/AGAPatientBrochure_ColorectalCancer.pdf. Accessed May 23, 2011.
- Ahnen DJ, et al. Approach to the patient with colonic polyps. http://www.uptodate.com/home/index.html. Accessed May 23, 2011.
- Detailed guide: Colorectal cancer. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf. Accessed May 23, 2011.
- Torpy JM, et al. Colon polyps. Journal of the American Medical Association. 2008;300:1480.
- Itkowitz SH, et al. Colonic polyps and polyposis syndromes. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed May 25, 2011.
- Ahnen DJ, et al. Colorectal cancer: Epidemiology, risk factors, and protective factors. http://www.uptodate.com/home/index.html. Accessed May 23, 2011.
- Tolliver KA, et al. Colonoscopic polypectomy. Gastroenterology Clinics of North America. 2008;37:229.