Colonic Polyps

Polyps are growths in the colon that may turn cancerous over time.

A colonoscopy allows for early detection and removal, reducing the risk of colorectal cancer to virtually zero.

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Colonic polyps are small growths that form on the inner lining of the large intestine.

What are Colonic Polyps?

Colonic polyps are abnormal growths that develop on the inner lining of the large intestine (colon). They may appear as small bumps, flat lesions, or mushroom-like growths attached by a stalk. The size of polyps can range from just a few millimetres to several centimetres.

Polyps themselves are not cancer, but some types carry the potential to turn into colorectal cancer over time. This process usually takes years, which is why finding and removing polyps early is one of the most effective ways to prevent colon cancer.

There are different types of colonic polyps:

Adenomatous polyps (adenomas) – the most common type and some may progress into cancer if they are left untreated.
Hyperplastic polyps – usually small and considered low risk.
Serrated polyps – certain subtypes can also develop into cancer, depending on their size and location.

Colonic polyps are quite common, especially in people over the age of 50 years old. In many cases, they cause no obvious symptoms and are only discovered during routine screening tests such as a colonoscopy.

What causes Colonic Polyps?

These polyps form when the normal cycle of cell growth and repair in the lining of the colon is disrupted. Normally, cells grow, perform their function, and are shed in a controlled way. When this process goes wrong, cells may grow too quickly or fail to die when they should, resulting in a clump of excess tissue.

Some of the main causes include:

Genetic mutations in colon cells – changes in certain genes can cause cells to keep dividing uncontrollably, creating abnormal growths. These mutations may occur spontaneously or be inherited.
Abnormal cell repair – the lining of the colon is constantly renewing itself. If damaged tissue is repaired in an irregular way, this can lead to the formation of polyps.
Inflammation in the colon – long-standing inflammation, such as that seen in chronic bowel conditions, can trigger abnormal healing responses that contribute to polyp growth.
Hormonal and chemical signals – imbalances in the chemical messengers that regulate cell turnover in the colon may encourage excessive growth of the mucosal lining, leading to polyp formation.

What are the symptoms of Colonic Polyps?

Many people with colonic polyps experience no symptoms. When present, it usually signifies cancerous change and the signs may include:

Blood in the stool, which may appear red or dark
Persistent changes in bowel habits, such as constipation, diarrhoea, or irregular stools
Abdominal bloating, cramping, or discomfort

Although rare, some people may experience anaemia due to chronic blood loss.

Abdominal cramps or discomfort can sometimes occur when colonic polyps disturb normal bowel function.

If you are experiencing the symptoms,

consult a medical professional immediately.

Schedule an appointment with Dr Aaron Poh.

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Who is at risk of developing Colonic Polyps?

While colonic polyps can develop in anyone, some people are more likely to develop them due to genetic, age-related, or lifestyle influences that affect how the colon lining behaves.

Some key risk factors include:

Age – as people get older, especially after 50 years old, the colon lining undergoes natural wear and tear. This increases the likelihood of abnormal cell growth and polyp formation.
Family history – individuals with close relatives who have had polyps or colorectal cancer are at higher risk, as inherited traits can make the colon cells more prone to abnormal growth.
Certain medical conditions – people with chronic illnesses such as type 2 diabetes, metabolic syndrome, or previous colorectal conditions have an increased tendency to develop polyps.
Diet low in fibre, high in fat or processed foods – poor dietary habits can alter how the colon processes waste, encouraging slower transit, irritation of the lining, and eventual development of polyps.
Sedentary lifestyle – lack of physical activity can slow bowel movements, prolonging the contact time between stool and the colon lining, which raises the chance of cellular changes.
Smoking and alcohol use – harmful chemicals from tobacco and alcohol can damage colon cells over time, making it easier for abnormal growths to develop.
Obesity – excess body weight alters hormonal and metabolic processes, creating an environment in the colon that favours polyp formation.

Can Colonic Polyps lead to cancer?

Not all colonic polyps turn into cancer. Many remain small and harmless throughout life. However, certain types of polyps, particularly adenomatous polyps (adenomas) and some serrated polyps, carry a higher risk of becoming malignant.

The process of transformation from a benign polyp into colorectal cancer typically occurs slowly, often over 5 to 10 years. During this time, genetic changes build up in the cells of the polyp, causing them to grow uncontrollably. The larger a polyp grows, the greater the likelihood that cancerous cells may appear.

This is why early detection and removal of polyps is so important. A colonoscopy not only identifies these growths but also removes them before they have the chance to develop into cancer, making it one of the most effective preventive tools in modern medicine.

How are Colonic Polyps diagnosed?

Colonoscopy allows doctors to examine the entire colon and remove polyps during the same procedure, making it both diagnostic and preventive.

The go-to standard for detecting polyps is colonoscopy. It is a procedure where a thin, flexible tube with a camera is inserted into the colon. Colonoscopy allows the doctor to examine the entire large intestine in real time. If polyps are found, they can often be removed immediately and sent to a laboratory for analysis.

Other methods of diagnosis include:

Faecal occult blood test (FOBT) – a non-invasive test that checks for microscopic traces of blood in stool, which can be a sign of bleeding polyps or cancer. Detection rate is however on the low side.

CT colonography (virtual colonoscopy) – a specialised CT scan that produces detailed images of the colon. While it can detect larger polyps, it cannot remove them. As such, a follow-up colonoscopy is usually required if abnormalities are seen.

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How are Colonic Polyps treated?

Treatment for colonic polyps focuses on complete removal, as this eliminates the risk of the polyp becoming cancerous. The approach depends on the size, type, and location of the polyp.

Endoscopic removal (polypectomy)

Performed during colonoscopy using specialised tools such as snares or forceps.
Suitable for most small and medium-sized polyps.
Usually painless as the procedure is done under sedation.

Advanced endoscopic techniques

For larger or flat polyps, methods such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) may be used.
These techniques allow removal of more complex polyps without surgery.

Surgery

Rarely required, but may be necessary if the polyp is too large, located in a difficult area, or has features suspicious for cancer.
May involve laparoscopic (keyhole) or open surgery to remove the affected segment of colon.

After removal, all polyps are sent for laboratory testing to check if they are benign or precancerous. The results guide future follow-up and the need for repeat colonoscopies.

Summary

A healthy colon has a smooth inner lining without abnormal growths such as polyps.

Colonic polyps are common, especially in older adults, and most cause no symptoms. However, some types have the potential to become cancerous if left untreated. Regular screening is therefore essential, as it allows early detection and removal before cancer develops.

If you are over 50 years old or have a family history of colorectal cancer or polyps, it is advisable to discuss screening options with a colorectal surgeon. Early intervention not only protects against cancer but also provides peace of mind. Book an appointment with Dr Aaron Poh today for a detailed diagnosis and personalised treatment plan.

Frequently Asked Questions (FAQs)

Are all polyps cancerous?

No. Most polyps remain harmless, but certain types, such as adenomas and some serrated polyps, can progress to colorectal cancer if not removed.

How often should I go for screening?

For people at average risk, screening is recommended from the age of 50 years old. If you have a family history of colorectal cancer or polyps, your doctor may suggest starting earlier or undergoing colonoscopy more frequently. A 4-5 year interval for colonoscopies is sufficient for average risk individuals

Is colonoscopy safe?

Yes. Colonoscopy is generally very safe. Complications such as bleeding or perforation are rare, especially when performed by an experienced colorectal surgeon.

Is polyp removal painful?

No. Polyp removal during colonoscopy is usually painless because the procedure is done under sedation. Most patients do not remember the procedure and recover quickly.

How long does it take to recover after a colonoscopy and polyp removal?

Most people recover quickly after a colonoscopy. You may feel bloated or have mild cramping for a few hours, but you can usually return to normal activities by the next day.

Do polyps come back after removal?

Polyps that are removed do not grow back. However, new polyps can develop elsewhere in the colon over time, which is why follow-up colonoscopies may be recommended.

What happens if a polyp is cancerous?

If a polyp is found to contain cancerous cells, further treatment may be needed depending on how advanced it is. This could include surgery to remove part of the colon and, in some cases, additional therapies.

Are there symptoms I should watch out for between screenings?

Yes. If you notice blood in your stool, unexplained changes in bowel habits, or persistent abdominal pain, you should seek medical attention even if your last colonoscopy was normal.

Can lifestyle changes reduce my risk?

Yes. Maintaining a balanced diet rich in fibre, exercising regularly, avoiding smoking, limiting alcohol, and keeping a healthy weight can all help reduce your risk of developing polyps.

Meet Our Doctor

DR AARON POH

Dr Aaron Poh is a fully accredited General Surgeon with dual subspecialties in Colorectal Surgery and Trauma Surgery, recognised by Singapore’s Specialist Accreditation Board and Ministry of Health. He is the Medical Director of Alpine Surgical Practice, with clinics located at Mount Elizabeth Hospital, Parkway East Hospital, and Farrer Park Hospitals.

Dr Aaron Poh has extensive experience, having performed over 5,000 endoscopic procedures. He is a strong advocate for early detection through colonoscopy, particularly for individuals at risk of colorectal cancer. His expertise includes advanced endoscopic techniques such as Endoscopic Mucosal Resection (EMR) for complex polyps and colonic stenting for obstructed cancers, which help patients avoid major emergency surgery.

When surgery is required, he specialises in minimally invasive laparoscopic colorectal cancer surgery, offering patients faster recovery with less pain and scarring. In addition to cancer care, he manages a wide range of anal conditions including haemorrhoids, fistulas, fissures, and abscesses, providing comprehensive colorectal treatment.