How to understand the results of your colonoscopy.

A colonoscopy is a medical test that lets your doctor examine the inside of your colon or large intestine. It’s the most effective way to screen for colon cancer and check the health of your colon.

After your test, you might feel worried about your colonoscopy results and what they mean. Here’s what you should know and what your doctor might recommend for follow-up after a colonoscopy.

What Happens During a Colonoscopy

During a colonoscopy, your gastroenterologist inserts a colonoscope — a thin, flexible tube with a lighted camera — into your rectum. As they advance the tube throughout your colon, your doctor looks for polyps, which are abnormal growths in your colon or rectum. They also check to ensure your intestinal lining looks smooth and healthy.

Doctors can usually remove any polyps they find during the exam. They can also collect tissue samples if they see anything suspicious in your colon. Your health care team will biopsy any polyps or tissue removed and check for cancer or abnormalities.

Nearly everyone is nervous and anxious when they have a colonoscopy, but the procedure itself is surprisingly easy. The entire exam usually takes about 30 to 60 minutes.

Once you’re awake, your health care provider will tell you if you had a negative or positive exam. You’ll also get a written report, along with any follow-up instructions you may need.

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Understanding Your Colonoscopy Results

A negative exam report means that the inside of your colon looks normal, with no polyps, abnormal tissue, or signs of cancer. Future screenings are still important, though, because things can change as you age.

After a negative exam, doctors usually recommend having another colonoscopy in 10 years. But if you have a family history of polyps or colon cancer, you might need one sooner, usually in five years.

A positive colonoscopy result means that your doctor found one or more polyps or something abnormal, including cancer, in your colon. Hearing that your exam was positive is worrisome. But a positive colonoscopy can mean any number of things, including the presence of:

  • Diverticular disease. This causes small bulges or pouches to form in weak spots in your colon wall. It’s common in people over 60 and usually doesn’t cause symptoms unless the pouches become infected.
  • Hemorrhoids. These are clumps of swollen veins in your anus or near the surface lining of your rectum. Hemorrhoids can cause pain, itching, or bleeding, but they’re rarely serious and easily treated.
  • Intestinal sores or ulcers. These can develop in your colon for various reasons, including long-term use of certain medications, inflammatory bowel disease, or cancer.
  • Polyps. Most of these abnormal tissue growths aren’t malignant (cancer), but some may become cancer over time. Doctors remove polyps in your colon so they can prevent cancer.
  • A tumor or other blockage. Some tumors are cancer, but others are not. Blockages (obstructions) can happen from fibrous tissue or a hernia. Your exam report will note if you have cancer or need further testing to rule it out.

What Are Colon Polyps?

Colon polyps are small growths that vary in size from a few millimeters to several centimeters. They grow on the inner lining of your large intestine and rarely cause symptoms. But they’re concerning because most colon cancers start as polyps.

It’s normal to worry if you learn you have polyps in your colon, but they are more common than you might think. As many as 40% of adults have polyps, and the chance you’ll develop them increases with age. You might have a higher risk of developing polyps if you:

  • Are over 45.
  • Are significantly overweight.
  • Eat a high-fat, low-fiber diet.
  • Have a family history of colon cancer or polyps.
  • Have an inflammatory bowel disease like Crohn’s or colitis.
  • Smoke cigarettes.

If you have polyps, it’s important to know that most are not cancerous. Still, some have the potential to turn into cancer, so removing them significantly reduces your subsequent cancer risk.

Types of Polyps

After your gastroenterologist removes polyps, a pathologist will examine them to determine if they have precancerous or cancerous cells. The pathologist will determine what kind of polyp it is and if it could potentially become cancerous.

Those that do not turn into cancer include:

  • Hamartomatous polyps
  • Hyperplastic polyps
  • Inflammatory polyps

Polyps classified as adenomas are precancerous. They might turn into cancer (called adenocarcinoma), and some might even contain cancer cells.

The likelihood of an adenoma becoming cancer depends on its size and growth pattern. Larger adenomas are more likely to become cancer, so removing them while they’re small is essential.

It’s vital to follow your health care provider’s recommendations for future colonoscopies if your doctor finds any polyps.

Following Up After a Colonoscopy

Your doctor will tell you if you need any follow-up and when. If you have an average colon cancer risk and have had a negative or normal colonoscopy, they may recommend 10 years. But even with a negative exam, if you have a family history or develop any unusual symptoms, you may need earlier testing.

Symptoms that need attention include:

  • Blood in your stool.
  • A change in your bowel habits, like ongoing constipation or diarrhea.
  • Severe abdominal pain.
  • Unintentional weight loss.

A positive colonoscopy with polyps might also require more frequent screening, but this depends on:

  • The size and number of polyps.
  • The type of polyps you had.

If your exam shows your polyps are adenomas (or your doctor found cancer), your doctor will recommend more frequent surveillance colonoscopies.

If your bowel prep isn’t thorough, your doctor can’t examine your entire colon with certainty. A suboptimal prep may require a repeat colonoscopy in just a few months, hence achieving a good bowel preparation is a priority.

For most people, the prep is the most difficult part of a colonoscopy. Preparing as instructed is crucial. If you don’t, you run the risk of having to redo your colonoscopy, and that’s a pain in the you-know-what.

American College of Gastroenterology. Colon Polyps Overview. LINK

National Institute of Diabetes and Digestive and Kidney Diseases. Colon Polyps. LINK

Harvard Health Publishing. Understanding the Results of Your Colonoscopy. LINK

American Cancer Society. Your Colon or Rectal Pathology Report: Polyps (Including Serrated Adenomas). LINK

About UPMC

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