Colon Polyps

Examinations and Tests

Unless colon polyps are large and cause bleeding or pain, the only way to know if you have polyps is to have one or more tests that explore the inside surface of your colon.

Several tests can be used to detect colon polyps. Two of these examinations, flexible sigmoidoscopy and colonoscopy, also can be used to collect tissue samples (called a biopsy) or to remove colon polyps. All the tests may be used to screen for colon polyps and colon cancer and as follow-up tests after colon polyps have been removed. These tests include:

• Fecal occult blood test (FOBT). A fecal occult blood test (FOBT) is done to look for microscopic amounts of blood in stool. FOBT is a simple screening tool for colon polyps or colon cancer. FOBT is used most often to screen for colon polyps in Canada. FOBT has been shown in studies to reduce the number of deaths from colon cancer.¹ By itself, an FOBT is not evidence of colon polyps or colon cancer, and a negative FOBT (no blood found) does not mean that you do not have colorectal cancer. If a fecal occult blood test is positive for blood in the stool, it is important to have a colonoscopy to help your doctor find the source of the blood and remove polyps if they are found.
• Flexible sigmoidoscopy.Flexible sigmoidoscopy allows the doctor to look at the lower third of the colon. During a sigmoidoscopy examination, samples of any growths can be collected (biopsied), and precancerous and cancerous growths can sometimes be removed. Although a sigmoidoscopy does not cover the entire colon, a study has found that when combined with an FOBT, it can detect about 76% of advanced colon polyps or cancers.²
• Colonoscopy. This screening method allows a doctor to inspect the entire colon for polyps and cancer. During a colonoscopy, samples of any growths can be collected (biopsied), and precancerous and cancerous growths sometimes can be removed. Expert groups recommend having the test every 10 years beginning at age 50 for people who are at average risk of colon cancer or whenever another screening test is positive for possible colon polyps or cancer. Screening may begin earlier and be more frequent in people at higher risk for colon polyps and colon cancer.³
• Double-contrast barium enema (DCBE). This examination, also known as a lower gastrointestinal (GI) examination, is an X-ray of the large intestine. A double-contrast barium enema can be used to screen for colon cancer because it can detect polyps in the entire colon. A DCBE can more accurately detect large polyps and cancer than a fecal occult blood test combined with flexible sigmoidoscopy. However, a DCBE is not as accurate as a colonoscopy. DCBE also may miss smaller polyps, may incorrectly identify stool as a polyp, and does not allow the doctor to obtain a biopsy or remove polyps.

Research is being done on other methods to detect colon cancer. One method is virtual colonoscopy, which is a non-invasive screening method that uses a CT scan to view the colon. Another method is genetic testing of stool samples, which is a test that checks for changes to the cells in the colon. Certain kinds of changes in cell DNA happen when you have cancer.

Screening for colon cancer

Screening for colon cancer with a single test or a combination of tests reduces your chance of having complications and dying from colon cancer. Expert groups recommend routine colon cancer screening for all people older than 50 who are at average risk for colon cancer. These are people who have no family history of colon polyps or colon cancer, have not had colon polyps or colon cancer, and are not having symptoms of colon cancer.

If you are older than 50, screening may lower your risk of developing colon cancer. Screening options include:^{4, 5}

• Test for blood in the stool (fecal occult blood test, or FOBT) every 1 to 2 years.
• Flexible sigmoidoscopy every 5 years.
• Fecal occult blood test every year and a flexible sigmoidoscopy every 5 years.
• Double-contrast barium enema (DCBE) every 5 years.
• Colonoscopy every 10 years.

The method of screening that you have depends on your personal preferences, your doctor’s preferences, what is recommended and available in your province or territory, and what the clinic or office you go to is able to do.

Should I have a sigmoidoscopy or a colonoscopy to screen for colorectal cancer?

If you are at increased risk of developing colon cancer, you may need to begin screening earlier or to be tested more often.

If you have a family history of colon cancer, you should begin having tests for the disease either at age 40 or when you are 10 years younger than the age of the youngest case in your immediate family.

If you have a family history of familial adenomatous polyposis (FAP), you should begin screening examinations beginning at age 10 or 12.^{4, 5, 3}

If you have a family history of hereditary non-polyposis colon cancer (HNP), you should have a colonoscopy every 1 to 2 years starting at age 20 to 25, or 10 years younger than the age at which the youngest family member who has colorectal cancer was diagnosed, whichever comes first.^{4, 5, 3}

The decisions about when to start and stop screening for colon cancer should be made with your doctor. These decisions will depend on how old you are, your family history, any health problems you may have, and the benefits you can expect from regular screening. Which screening tests are available and the recommendations may differ by province and territory. If you are not sure how often you need screenings, talk with your doctor.

Follow-up testing

If a biopsy of polyps obtained during screening reveals only hyperplastic polyps of any size, routine follow-up screening is all that is needed. These polyps do not become cancerous.

Most doctors agree that if you have had one or more adenomatous polyps removed, you probably need regular follow-up colonoscopy examinations every few years.³ This type of polyp is more likely to turn into cancer, but that risk is still very low. How often you need a colonoscopy may depend on the number and size of the polyps, your age, your health, and other risk factors that you may have for polyps. Talk with your doctor about the follow-up testing schedule that is right for you.

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Author:	Carrie Henley Monica Rhodes	Last Updated: July 23, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Peter J. Kahrilas, MD - Gastroenterology Andrew Swan, MD, CCFP, FCFP - Family Medicine
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