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Colon Cancer

Colonoscopy concerns

03/30/2011

Question:

I just had a colonoscopy. The doctor told me that the found some polyps. I have a few concerns: There was no biopsy taken. When I questioned the doctor, she said that because I’m only 50 and don’t have a family history of colon cancer, it wasn’t necessary. I’m worried that there was no biopsy done and that the polyps were just left there. Aren’t some polyps pre-cancerous? How is this determined (I thought it was a biopsy). Am I being overly concerned if I get a second opinion? I’m worried because my insurance won’t pay for another colonoscopy for 10 years.

Answer:

Some polyps are not felt to carry any risk for turning into cancer, whereas others (called adenomas) are a type that it is believed may potentially turn into cancer over a period of years. Although the appearance of a polyp can suggest that it is an adenoma, the only way at the present time to determine whether a polyp is an adenoma is to remove it and send it to be examined under the microscope by pathology.

There are various ways to remove polyps during colonoscopy depending on their size and shape -- for small polyps, biopsies are done in which the tissue is torn off using forceps; for larger polyps, a wire loop called a snare is often used to snip off the polyp. You may want to obtain a copy of the actual procedure report and have it reviewed by your primary care provider to confirm that no samples at all were sent to pathology. If such is the case, it would be reasonable to get an opinion from a gastroenterologist.

In general, we do try to remove polyps when we find them because we cannot typically tell just by looking whether they are adenomas or not, but rarely there are extenuating circumstances under which polyps are not removed. In response to the comment that you are only 50 with no family history, the reason we start screening for colon cancer with colonoscopy at age 50 in people without a family history is because age is a risk factor for colorectal cancer.

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Response by:

Linda Cheng Cummings, MD, MS Linda Cheng Cummings, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University