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Colonoscopy result can be difficult to understand. Where is the rectosigmoid junction? Where is the hepatic flexure? What is an adenoma polyp? What is a hyperplastic polyp? This article is a guide to understanding your colonoscopy and pathology results.
Colonoscopy Result: Parts of the colon
Picture from teachmeanatomy.info
These are the parts of the lower gastrointestinal tract seen during colonoscopy:
- Ileum: This is part of the small intestine. It is the most distal part of the small intestine.
- Ileo-cecal valve: This valve connects the small intestine (ileum) with the colon (cecum).
- Cecum: This is the first part of the colon. The colon starts here.
- Ascending colon: This is the part of the colon between the cecum and the transverse colon.
- Hepatic flexure: This is the sharp bend between the ascending colon and the transverse colon. It is close to the liver, hence the name. It is also called the right colic flexure.
- Transverse colon: This is the part of colon between the hepatic flexure and the splenic flexure.
- Splenic flexure: This is the sharp bend between the transverse colon and the descending colon. It is close to the spleen, hence the name. It is also called the left colic flexure.
- Descending colon: This is the part of the colon between the splenic flexure and the sigmoid colon.
- Sigmoid colon: This is the curved, S-shaped part of the colon between the descending colon and the rectum.
- Recto-sigmoid junction: This is the junction between the sigmoid colon and the rectum.
- Rectum: This is part of the large intestine between the sigmoid colon and the anus.
- Anus: The opening between the rectum and outside. Anal sphincters prevent involuntary loss of stool.
Colonoscopy Result: Colonoscopy Findings
These are the things that may be found in your colon:
- Polyp: A colon polyp is a growth on the inner lining of the colon.
- Diverticulosis: The presence of a diverticulum or diverticula in the colon is called diverticulosis. A diverticulum is a pouch within the wall of the colon. Inflammation of the pouch is called diverticulitis.
- Angiodysplasia (also called angioectasia): These are abnormal blood vessels on the wall of the colon. They may bleed.
- Mass: A mass is a large abnormal growth. It can also be called a tumor. They can be benign, pre-cancerous or cancerous.
- Cancer: Abnormal cells that can spread or invade other parts of the body. A cancer is a malignant tumor.
- Ulcer: An ulcer is like a wound in the wall of the colon.
- Erosion: An erosion is like an abrasion in the wall of the colon. It looks like a shallower ulcer.
- Erythema: This is redness on the wall of the colon.
- Inflammation: An inflammation is how the body responds to injury. An inflammation in the colon may appear as erythema, erosion, ulcer, congestion, pus.
- Colitis: Inflammation of the colon.
- Condyloma: These are warts in the anus or rectum. They are caused by the human papillomavirus.
- Hemorrhoids: These are swollen veins around the anus or rectum.
- Fistula: This is an abnormal hole or connection between different parts of the body.
- Anal Fissure: This is a tear in the lining of the anus.
Colonoscopy Result: Appearance of the Polyp
Sessile: polyp with the same diameter at the base and top of the polyp.
Pedunculated: polyp with a stalk between the polyp and the colon wall. The base is narrow.
Flat: polyp that has a height that is less than one half the diameter of the polyp.
Depressed: polyp that has a thickness that is less than that of the surrounding colon wall.
Diminutive: Polyp that is 5mm or less in diameter.
Small: polyp 6mm-9mm in diameter.
Medium: polyp greater than or equal to 10mm but less than 20mm
Large: polyp 20mm or more in diameter.
Colonoscopy Result: Pathology Results
These are the findings or diagnosis that may be mentioned on your colonoscopy pathology result.
- Hyperplastic polyp: Usually found in the rectum and sigmoid colon. Typically, benign polyp with no risk of malignancy.
- Sessile serrated adenoma or sessile serrated polyp (SSA/SSP): Usually found in the cecum, ascending colon or transverse colon. It may be covered by mucus. It is usually flat or sessile. It has malignant potential so surveillance is recommended. Individuals with SSA/SSP less than 10mm in size with no dysplasia should have surveillance colonoscopy in 5 years. Those with SSA/SSP greater than 10mm in size or SSA/SSP of any size with dysplasia should have surveillance colonoscopy in 3 years.
- Traditional serrated adenoma (TSA): Usually found in the recto-sigmoid junction. It may be sessile or pedunculated. It has malignant potential so surveillance is recommended. Individuals with TSA should have surveillance colonoscopy in 3 years.
- Serrated polyposis syndrome: This is also called hyperplastic polyposis syndrome. According to the World Health Organization (WHO), the syndrome should be considered if an individual has any of the following:
- At least 5 serrated polyps proximal to the sigmoid colon, of which two or more are 10mm in size or more.
- Any number of serrated polyp proximal to the sigmoid colon in an individual who has a first degree relative with serrated polyposis syndrome.
- Greater than 20 serrated polyps of any size, throughout the colon.
A person with serrated polyposis syndrome is at high risk for malignancy therefore surveillance colonoscopy is recommended every 1-3 years. A person with a first degree relative with serrated polyposis syndrome should start screening colonoscopy at age 40 years ( or 10 years earlier than the earliest age of the affected family member) and colonoscopy every 5 years if no polyps are found.
- Tubular adenoma polyp: A polyp with tubular component. It has malignant potential therefore surveillance colonoscopy is recommended. Individuals with tubular adenoma polyp equal or greater than 10mm or 3-9 tubular adenomas of any size should have surveillance colonoscopy in 3 years. Individuals with 10 or more adenomas should have surveillance colonoscopy in 1 year. Individuals with 1-2 tubular adenoma polyps less than 10mm in size should have surveillance colonoscopy in 5 years.
- Villous adenoma polyp: A polyp with villous component. It has malignant potential therefore surveillance colonoscopy is recommended. Individuals with villous adenoma should have surveillance colonoscopy in 3 years.
- Tubulo-villous adenoma polyp: A polyp with both tubular and villous components. It has malignant potential therefore surveillance colonoscopy is recommended. Individuals with villous adenoma should have surveillance colonoscopy in 3 years.
Neoplasm (precancerous and cancerous)
- Metaplasia: Abnormal cells in the lining of the colon. It may reverse back to normal or progress to dysplasia.
- Dysplasia: Abnormal cells in the lining of the colon. It may reverse back to normal or metaplasia or progress to cancer.
- Low grade dysplasia: A form of dysplasia with less abnormality.
- High grade dysplasia: A form of dysplasia with high abnormality. This cells are close to being cancer.
- Carcinoma-in-situ: Abnormal cancerous cells that are just of the surface. They have not spread or invaded any other parts of the body. It is sometimes called stage 0 cancer.
- Adenocarcinoma: A type of cancer that starts in the glands of the lining of the colon.
- Squamous cell carcinoma: A type of cancer that starts from squamous cells. In the gastrointestinal tract, squamous cells are found in the anus and skin around the anus.
- Ileitis: inflammation of the ileum
- Colitis: inflammation of the colon
- Proctitis: inflammation of the rectum
Colonoscopy Result: Next Steps
- Discuss your colonoscopy result with your physician.
- Follow any follow up recommendations.
I AM SO GLAD I HAD A COLONASCOPY
I’m glad you did.
I had a colonoscopy ten years ago that was clear.
I just had my second colonoscopy at Cleveland Clinic on 8/10/18 and a 4 MM Polyp was removed from the cecum and sent to the pathologist.
The result was a serrated polyp.
The MD who performed the colonoscopy never called me with the results, to explain the results, or when to be retested.
I only found out by researching my account on the Cleveland Clinic website.
What is your advice.
Contact the physician or his office. I’m sure the result will be explained as well as when to repeat your colonoscopy. Good luck!
I just had a colonoscopy at age 48 and they found 2 polyps. They just sent me the results onlilne that said tubular Adenoma and said to come back for colonoscopy in 3 years. From my understanding they are precancerous. Any other information you can tell me would be great. Thanks
Keep up with your surveillance colonoscopy. Avoid tobacco. Limit alcohol intake. Limit Red meat intake. Eat more fiber. Exercise.
My husband just had a colonoscopy and they found a 21mm polyp that they said was 50/50 cancerous but now he has to wait two weeks for the results of the biopsy. Why do results take so long and is this indicative of a low degree of concern? Meaning, if it is cancer then it is likely slow-moving/early stage?
A 21mm polyp is a large polyp. Was it removed? Completely or partially? If not removed then was it biopsied? Perhaps what the doctor means by 50/50 is that he does not know if it is cancerous or not. Biopsy results are usually back within 1 week but may vary if done in-house or transported somewhere else. If the polyp was not completely removed, it will need to be removed.
I had a colonoscopy 12/28/18 and they found and removed 2mm, 3mm, 5mm polyps and a very large 2-3cm in my proximal ascending colon that couldn’t be removed, Dr. was able to snare a 6mm and a 10mm piece from the 2-3 cm polyp, I had to call for my results on 1/2/19 the APRN said they look benign, what does that even mean, I have an appointment with a surgeon for consultation to have the large polyp removed, after the colonoscopy the Dr. told me they might have to remove a portion of my colon, hopefully the surgeon will have more concrete assurance that everything is benign, ever since I had the colonoscopy, above my right hip has pain.
You should be able to get your pathology report. We have 3 types of polyps- benign (can never grow into cancer; most hyperplastic polyps), pre-cancerous (can grow into cancer-these are tubular adenoma, villous adenoma, tubulovillous adenoma, sessile serrated adenoma), and cancerous polyps. Depending on the location and other circumstances, if a polyp is not cancerous, special procedures by a trained gastroenterologist can be done. These procedures include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Good luck!
I just had a coloscopy yesterday and was told I had a tortuous colon (this was not reported in prior colonoscopies) and a thickening in the ascending colon which is being biopsied. I have no symptoms, am a plant-based vegan but have immediate family members who had colon cancer. I’m freaking out. Is this likely cancer?
It is difficult for me to say if this is cancer. Most colon cancer appear as a mass or polyp. Be optimistic. Your biopsy results should be back soon. Good luck!
My brother had a colonoscopy at 12.03.2019. The result : there is erotion at transverse colon, till now, we have not receive the biopsy report but the hospital make a call and ask him as soon as possible to take another test to make sure. The erotion is sign of cancer?
I was told that I had a Sessile polyp of the ileo-cecal valve at my last colonoscopy. The Colonoscopy I had a year and a half before they found nothing. My concern is that I have had cancer already (melanoma stage 2), should I so concerned. Biopsies were done but due to a scheduling mess up on their end I know have to wait 2 more weeks for results.
What was the size of the polyp? Most likely it is non-cancerous. The sessile polyp may be benign/hyperplastic, tubular adenoma or serrated adenoma. Good luck! Read https://bowelprepguide.com/what-makes-colon-polyp-grow/
I had a Colonoscopy and a polyp was removed but after this was done I bleed a lot every time I tried to get the gas out ….like to know the seriously of this. Pleas e help.
Please, contact your doctor immediately.
31.1.2019 had colonoscopy. Three Paris iia polyps found. Six months ago three sessile polyps found. What’s the difference of these types of polyps?
Sessile polyps are Is paris polyps. The lesion is polypoid but has no stalk. Paris iia polyps are non-polypoid but slightly elevated. The paris classification is more technical but confusing. Both are classifications based on appearance. The pathology reports may be more important. Good luck!
I recently had a colonoscopy and congested mucosa at the splenic flexure – biopsied. Is this something I should be concerned about?
It depends. What was the reason for the colonoscopy? The pathology result will give you more information. Follow up with your doctor. Good luck!
6 months ago I had a colonoscopy and they found a 33 mm sessile polyp in descending colon.It was removed.
Went for another colonoscopy today and they found 8 mm sessile polyp again in descending colon plus found at 22 mm in the hepatic flexture. After 1 hour couldn’t remove it . Going back in 4 mo the for another colonoscopy to try to remove it . If not bowel surgery.
What does surgery involve ?
Why are they so big ?
You need a gastroenterologist with expertise in endoscopic mucosal resection or endoscopic submucosal dissection to remove large polyps (>20mm). It is unlikely that new large polyps grew in 6 months. Most likely they were missed. Important to have adequate bowel prep. Polyps occur due to genetic and environmental factors. Read https://bowelprepguide.com/what-makes-colon-polyp-grow/
The 33mm polyp was injected with Gelofusine and methylene blue mix and lifted well.
En bloc EMR was performed.
I was told I had a genetic disposition.
Going back on the 21 October for a second attempt to remove the 22 mm hepatic flexure polyp.
SPOT marked downstream.
Very sore internal today from colonoscopy yesterday
Do polyps grow to 8 mm in 6 months ?
If they can’t get it next time what surgery is required ?
Rapid growth of colon polyps have been reported in the literature including one by Dr. Rex.
Genetic disorders may accelerate growth. For instance it takes 10 years on average for small colon polyps to grow into cancer but for patients with Lynch syndrome, it takes about 1-3 years.
In general, if a polyp cannot be removed endoscopically then a partial colon resection may be necessary.
My mother had colon cancer and I have been having screenings beginning for the last 20 years (I’m F 61. yrs). My gastroenterologist found pre cancerous polyps in each of my colonoscopy’s, with the exception of my last one and let me go 5 years between screenings instead od the 3 years I had before. I only had 1 sessile 6 mm polyp in the hepatic flexure this time. My concern is I had squamous cell carcinoma near my rectum removed 2 years ago, and didn’t realize I should have let him know about this. I also just found out I have the serious kind of HPV, courtesy of my husband of 34 years. Do I need to let my Dr know this information ? I’m embarrassed to admit my husband gave me HPV, and wonder if the squamous cell in my rectum area could be related to any of my issues? Thank you.
Yes, let your gastroenterologist know these things. It will help him/her take better care of you. Good luck!
hello. my name is, billy. today, [07.09.2019], i had a colonoscopy. my gastro doctor found two polyps. he told me there was no cancer found, however because of the way i was breathing while sedated, [even though i was never diagnosed, i believe i have sleep apnea] he didn’t feel comfy with trying to take out the second polyp.
i had the colonoscopy procedure done at a clinic as supposed to a hosp. so, my gastro feels it would suit me better to have my second polyp removed there, but he did say two to three times there was no cancer. so, here’s where things get confusing. when the nurse called me later that day, she told me that when a polyp is found it has to be taken for a biopsy to determine if there’s cancer as well as when to have the next colonoscopy. the nurse went on to say a gastro can sometimes look at a polyp and if it looks a certain way he may be able to tell right off if it’s cancer, but until the results come back, we won’t know for sure. here are the findings:
*Preparation of the colon was fair.
*One 20mm polyp at the hepatic flexure removed with a hot snare. Resected and retrieved. Clip was placed.
*One 25mm polyp at the hepatic flexure. No specimens collected.
* Non bleedig internal hemorrhoids.
We are waiting for pathology results. Your gastro has recommended a repeat colonoscopy that will need to be done in the hosp. and bowel preparation was suboptimal.
It looks like the 25mm polyp at the hepatic flexure was not removed or biopsied. You also had suboptimal bowel prep. Repeat your colonoscopy and aim for excellent bowel prep. Use a split dose regimen. Read https://bowelprepguide.com/prep-for-colonoscopy/ and https://bowelprepguide.com/faq/
Hi I had a colonoscopy 2.5 days ago. Apparently no polyps removed however many biopsies taken. First 2 bowel movements bloody diarrhea then no visible blood since but diarrhea. Originally my stomach cramps woke me up with the sweats at night but no fever and today the cramping has stopped but I’m so bloated I look 7 months pregnant and my skin is stretching so bad I’m afraid I’m going to get stretch marks. At what point is the amount of bloating unreasonable? I hate to go to the Dr for nothing. I’m passing gas regularly too. Should I be concerned?
Talk to your doctor.