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Are colon polyps a cause for concern?

colon polyps

The diagnosis of colon polyps, also known as colorectal polyps, often strikes panic in patients. Colon polyps are abnormal growths that develop in the lining of your colon. These growths vary in size and shape and typically start as small, benign clumps of cells on the inner surface of the colon. 

colon polyps
Colon polyps are small lumps of cells that grow in the lining of the colon.

Frequently affiliated with cancer, colon polyps are usually detected during routine colonoscopy screening or when patients actively seek remedies for issues such as bloating, rectal bleeding, changes in bowel habits, and stool colour. In this article, we take a deep dive into colon polyps and whether the concern surrounding the subject is warranted. 

Myth 1: Colon Polyps = Colorectal Cancer  

The common misconception is that colon polyps will inevitably progress into colorectal cancer. Whilst 95% [1] of colon cancer begins with colon polyps, only an estimated 5% [2] will eventually progress into colorectal cancer [3]. Nonetheless,  given that colorectal cancer is the predominant cancer in Singapore [4], it is unsurprising that many Singaporeans are concerned about polyps.

Unbeknownst to many, the actual determinant of colon polyps becoming cancerous is the size of the polyps [5] during discovery. Below, we discuss the estimated prevalence of cancerous polyps out of 550,811 polyps studied.

Polyp size Percentage of cancer 

1–5 mm 0.6%

6–9 mm 2.1%

10 mm+ 13.4%

** It has been noted from prior studies [6] that polyps of size 30 mm or more have the highest risks of cancer progression. 

Colon polyp size
The size of a colon polyp determines the likelihood of the growth progressing into colon cancer.

Additionally, the type of polyps is another factor that significantly determines the likelihood of cancer progression. There are two primary categories of colon polyps: adenomatous [7] and hyperplastic [8]. 

Adenomatous polyps, specifically, tend to raise concern as they have a higher likelihood of cancer progression. These are further divided into three subtypes:

  • Tubular adenomas: tubular adenomas [9] are the most commonly occurring polyps and tend to have a lower risk of developing into cancer.
  • Villous adenomas: villous adenomas [10] are less common but more likely to become cancerous.
  • Tubulovillous adenomas: tubulovillous adenomas [11] are a mix of tubular and villous features with a moderate risk of malignancy. 

Hyperplastic polyps, on the other hand, are typically benign and rarely become cancerous. They often occur on the left side of your colon and do not raise concern. The most promising preventative care one can practice is to detect and remove polyps regardless of the type of polyp. This sentiment is echoed unanimously [12] by medical professionals in Singapore. 

Myth 2: Only symptomatic patients should be screened

This myth is not only inaccurate but rather dangerous. Most patients with colon polyps are asymptomatic, so if you are stalling screening because there are no concerning signs at sight yet, you may be missing the opportunity to introduce intervention at early stages. As mentioned, when polyps grow to a certain size, the risk of cancer progression increases concurrently. Thus, conducting health screening at the prescribed frequency is in your best interest. 

Colon polyp removal
Regular screening allows for detecting and removing colon polyps at early stages. 

Additionally, patients tend to consider their risk factors less. Where risk factors are present, the standard recommendations will no longer apply. It is recommended to discuss screening and surveillance with your doctor, depending on your risk factors.

Myth 3: Colon polyps are only prevalent among older men 

While colon polyps are more prevalent in men than women (66.2% vs 33.8%) [14] and are generally of higher concern in seniors [15], this statement is not necessarily true. Children, too, may be at risk of polyp growth, known as juvenile polyposis [16]. These are usually detected when children present symptoms such as rectal bleeding. 

In some Asian countries, the prevalence of colon polyps in younger age groups has been growing [17]. For instance, in India, one out of six people [18] over 40 has a polyp, increasing the risk of colorectal adenoma fivefold after age 40. A recent study [19] also projected an increased incidence rate for colon and rectal cancers by 90% and 124%, respectively, for patients between 20 and 34 years of age based on increased findings of colon polyps in younger adults. 

The verdict

So, should colon polyps be a cause for concern? The studies mentioned above indicate that more adults may have colon polyps. Additionally, even younger age groups adults are now vulnerable to colon polyp growth. Given the pervasiveness, we can safely deduce colon polyps growth is not an unusually unique health concern. 

Yes, colon polyps do increase the risk of cancer. However, patients are not doomed to have cancer in their lifetime invariably. The takeaway from the recent statistics about colon polyp growth signals an immediate need for change in lifestyle and proactiveness in health. Patients must take more accountability for their health where risk factors are present. 

Stay tuned for the next article, where we discuss lifestyles and behaviours that increase the risks of colon polyps and colorectal cancer, ways to prevent them, and how to retake autonomy of your health. 


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