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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.