Being told that a polyp was found during your colonoscopy can feel alarming. Your mind may jump to the worst. But for most patients, finding and removing a polyp is actually good news — it is precisely what colonoscopy screening is designed to do, and it is one of the most effective ways to prevent bowel cancer before it even begins.
Understanding what type of polyp was found, what it means for your health, and how often you need follow-up is essential information that every patient deserves in clear, plain language.
This guide, written by Dr Devesh Kaushal — upper GI and general surgeon in Liverpool — explains everything you need to know about bowel polyps: what they are, which types matter, how they are removed, and what happens next.
Appointments available within 4–8 weeks depending on urgency Book online 24/7 at drdeveshkaushal.com.au | Call (02) 7906 8312 |
What Is a Bowel Polyp?
A bowel polyp is a small growth that develops on the inner lining of the colon (large intestine) or rectum. Polyps range in size from a few millimetres to several centimetres. Most polyps cause no symptoms — they are typically found incidentally during colonoscopy performed for another reason, such as a positive FOBT result, bowel symptoms, or family history screening.
Polyps are very common. Studies suggest that approximately 25–30% of adults over the age of 50 have at least one polyp in their colon, and the prevalence increases with age. The vast majority are benign — but certain types carry a risk of becoming cancerous if left untreated.
Key fact: Not all polyps are the same. The type of polyp — determined by pathology after removal — is what determines your level of risk and how often you need follow-up. Size alone is not the only factor. |
How Polyps Look: Shape and Appearance
Polyps come in several shapes, which also influences how they are removed:
Shape | Description | Removal Method |
Pedunculated | Polyp on a stalk — like a mushroom shape. The most straightforward to remove. | Snare polypectomy — wire loop around the stalk |
Sessile | Flat-based, attached directly to the bowel wall without a stalk. More variable in difficulty. | Snare or EMR depending on size |
Flat / Superficial | Barely raised above the lining — the most difficult to detect and the most clinically important. | Endoscopic mucosal resection (EMR) |
Depressed | Rare — slightly sunken below the lining. Higher malignant risk despite small size. | EMR or surgical referral in selected cases |
Types of Bowel Polyps: Which Ones Matter Most?
The most important thing about a polyp is not its size — it is its type. Type is determined by pathological examination under a microscope after removal. Here are the main types:
Tubular Adenoma | Risk: Low to Moderate |
The most common precancerous polyp. Small tubular adenomas (under 10mm) carry a relatively low risk of malignant transformation. They must be removed and monitored. The risk increases with size — a tubular adenoma over 20mm has substantially higher malignant potential. Surveillance: 5 years for 1–2 small adenomas. 3 years if 3–4 adenomas or any adenoma 10–19mm. |
Tubulovillous Adenoma | Risk: Moderate to High |
A mixed type adenoma with both tubular and villous features. Carries a higher malignant risk than pure tubular adenomas. More likely to recur. Closer surveillance is recommended. Surveillance: 3 years — or 1–2 years for large or incompletely removed lesions. |
Villous Adenoma | Risk: High |
A flat, carpet-like polyp with significant malignant potential. Villous adenomas are associated with the highest risk of malignant transformation among the adenoma subtypes. Thorough removal and close follow-up are essential. Surveillance: 1–3 years depending on size, completeness of removal, and degree of dysplasia. |
Sessile Serrated Adenoma (SSA) | Risk: Moderate to High |
Flat, pale, and difficult to detect — even by experienced endoscopists. SSAs are located predominantly in the right colon and are increasingly recognised as a significant cause of bowel cancer through a distinct molecular pathway. They can progress rapidly compared to conventional adenomas. Surveillance: 3 years for SSA under 10mm. 1–2 years for SSA 10mm or larger, or those with dysplasia. |
Hyperplastic Polyp | Risk: Generally Low |
The most common polyp type overall. Small hyperplastic polyps in the left colon (sigmoid and rectum) carry minimal malignant risk. However, large hyperplastic polyps (over 10mm) or those in the right colon require closer attention as they overlap with the serrated lesion pathway. Surveillance: 10 years for small left-sided hyperplastic polyps. 5 years for larger or right-sided lesions. |
Inflammatory / Pseudopolyp | Risk: Low (related to IBD, not cancer) |
Not a true polyp — these are areas of mucosa that appear raised due to surrounding inflammation in IBD (Crohn’s disease or ulcerative colitis). They do not carry direct malignant risk themselves, but their presence indicates IBD activity requiring management. Surveillance: Surveillance interval determined by IBD management protocol, not polyp type. |
How Are Bowel Polyps Removed? Polypectomy Explained
Polypectomy — the removal of a bowel polyp — is performed at the time of colonoscopy in the vast majority of cases. You do not need a separate procedure, additional sedation, or a return visit. The colonoscopy and polypectomy happen in one sitting.
Techniques used:
- Cold biopsy forceps: For very small polyps (under 3mm). A small grasping tool removes the polyp directly. Quick, safe, no bleeding risk.
- Cold snare polypectomy: For polyps 3–10mm. A wire snare is looped around the polyp base and tightened to cut it off without electrocautery. Preferred technique for this size range due to low complication rate.
- Hot snare polypectomy: For polyps 10–20mm. Snare with electrocautery applied to seal blood vessels and prevent bleeding.
- Endoscopic Mucosal Resection (EMR): For large or flat polyps over 20mm. Fluid is injected beneath the polyp to lift it from the bowel wall before snare removal. May be performed in multiple pieces (piecemeal) for very large lesions.
- Endoscopic Submucosal Dissection (ESD): A more advanced technique for very large or difficult flat lesions, allowing en-bloc removal of larger areas. Performed in specialist centres.
All removed polyps are sent to pathology. The pathology result — not just the visual appearance — determines the polyp type, whether it was completely removed, whether dysplasia is present, and what your surveillance interval should be. Results are typically available within 5 to 7 business days. |
After Polypectomy: What to Expect
Normal after-effects:
- Mild abdominal cramping — settles within hours
- Small amounts of blood in the stool for 1 to 3 days — normal after polypectomy
- Bloating from air used during the colonoscopy — resolves quickly
- Fatigue from sedation — rest for the remainder of the day
For 7–14 days after polypectomy (especially for larger polyps):
- Avoid heavy lifting and strenuous physical activity
- Avoid NSAIDs such as ibuprofen and naproxen — these increase bleeding risk
- Avoid long-distance travel — particularly long-haul flights
- Do not restart blood-thinning medications until specifically instructed by Dr Kaushal
- Avoid alcohol for at least 24 hours after the procedure
Seek urgent care if you experience: • Heavy or persistent rectal bleeding — soaking a pad or passing clots • Severe abdominal pain that is worsening rather than settling • Fever above 38.5 degrees Celsius • Feeling faint, dizzy, or very unwell
These are rare but important warning signs after polypectomy. Present to your nearest emergency department immediately. Do not wait. |
Surveillance Colonoscopy: When Do You Need Another One?
Your pathology result and the number, size, and type of polyps removed determine how soon you need your next colonoscopy. Dr Kaushal follows Australian and international evidence-based guidelines for surveillance intervals. Here is a summary:
Colonoscopy Finding | Recommended Next Colonoscopy |
Normal colonoscopy / no adenoma | 10 years — or return to NBCSP/iFOBT |
1–2 tubular adenomas < 10mm, no HGD/villous | 10 years |
3–4 tubular adenomas < 10mm, no HGD/villous | 5 years |
Any adenoma ≥ 10mm OR HGD/villous features | 3 years |
5–9 adenomas | 3 years if all low-risk; 1 year if any advanced feature |
≥ 10 adenomas | 1 year + consider familial cancer / genetics referral |
1–2 sessile serrated lesions < 10mm, no dysplasia | 5 years |
Serrated lesion ≥ 10mm, dysplasia, or TSA | 3 years |
3–4 serrated lesions < 10mm, no dysplasia | 3 years |
≥ 5 serrated lesions | 1 year |
Large sessile / laterally spreading lesion — en-bloc removal | ~12 months |
Large lesion removed piecemeal | ~6 months (check removal site) |
IBD surveillance — interval based on risk category | Determined by extent, activity, dysplasia history, PSC, family history & inflammatory burden — as per GESA guidelines |
Surveillance intervals are based on Cancer Council Australia / GESA-endorsed Australian surveillance colonoscopy guidance. Intervals may be modified according to bowel preparation quality, completeness of excision, family history, IBD risk factors, and pathology. Your individual interval will be determined by Dr Kaushal based on your complete pathology report and clinical circumstances. |
Polyps and Bowel Cancer: Understanding the Connection
The relationship between polyps and bowel cancer is well established — and it is also the reason colonoscopy screening saves lives. Here is what the science tells us:
Most bowel cancers develop from adenomatous polyps — particularly tubular, tubulovillous, villous, and sessile serrated adenomas. This process typically takes 10 to 15 years from a normal cell to a cancer. |
The risk of malignant transformation increases with polyp size. A polyp under 5mm has a very low risk. A polyp over 20mm may have a 10–50% risk of containing cancerous cells. |
Removing a polyp at colonoscopy breaks the adenoma-to-cancer sequence entirely. This is why colonoscopy surveillance dramatically reduces bowel cancer incidence and mortality. |
If a polyp is found to contain cancer limited to the polyp itself (polyp cancer or T1 cancer), complete endoscopic removal may be curative — no surgery required. This is only possible when the cancer is found early. |
The presence of multiple adenomas, a strong family history, or specific genetic conditions (such as Lynch syndrome or FAP) significantly increases the risk of future adenomas and bowel cancer — which is why adherence to surveillance intervals is so important. |
Frequently Asked Questions — Bowel Polyps Liverpool
Should I be worried that a polyp was found?
In most cases, no. Finding and removing a polyp is exactly what a colonoscopy is designed to do. It means a potential problem has been identified and dealt with before it could cause harm. The polyp type — confirmed by pathology — tells you and Dr Kaushal how closely it needs to be monitored going forward.
Do polyps always come back?
The polyp that was removed does not grow back. However, new polyps can develop elsewhere in the colon over time. This is why surveillance colonoscopy at the recommended interval is so important. Adherence to your surveillance schedule is the single most effective thing you can do to prevent bowel cancer.
My polyp was described as ‘completely removed’ — do I still need follow-up?
Yes. Even when a polyp is completely removed, the fact that you formed it means you have an increased propensity to develop new polyps in the future. The surveillance interval is based on your individual risk profile — not just whether the polyp was fully removed.
What if my polyp could not be completely removed?
Occasionally — particularly with large, flat, or complex polyps — complete removal at the first attempt may not be possible. Dr Kaushal will arrange a follow-up colonoscopy at a shorter interval, typically 3 to 6 months, to check the removal site and treat any residual tissue. This is a standard, planned approach and not a cause for alarm.
I have been told I have a ‘serrated lesion’ — is this serious?
Sessile serrated adenomas (also called serrated lesions or SSLs) are increasingly recognised as an important cancer precursor — particularly in the right colon. They are flat, pale, and difficult to detect, which is why they require close attention and adherence to the recommended surveillance interval. If you have been told you have a serrated lesion, take the follow-up advice seriously.
What is adenoma surveillance and why does it matter?
Adenoma surveillance is the program of regular colonoscopies recommended after adenomatous polyps are found and removed. The interval between colonoscopies is determined by the type, number, and size of polyps previously found. Surveillance colonoscopy has been shown to significantly reduce bowel cancer incidence and mortality in people with a history of adenomas.
How soon can I get a colonoscopy or surveillance appointment in Liverpool?
Appointments with Dr Kaushal are available within 4 to 8 weeks depending on clinical urgency. Urgent referrals — such as suspected cancer, large polyps, or significant symptoms — are prioritised for earlier appointments. Book online at drdeveshkaushal.com.au or call (02) 7906 8312.
Book Your Colonoscopy or Surveillance Appointment in Liverpool
Whether you need your first colonoscopy, a follow-up surveillance appointment after polyp removal, or have received a pathology result you would like to discuss — Dr Devesh Kaushal provides expert, evidence-based bowel care right here in Liverpool and South Western Sydney.
Finding a polyp early and removing it is one of the most effective cancer-prevention steps available. Do not delay your surveillance appointment.
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Contact Dr Devesh Kaushal Liverpool Consulting Rooms Phone: (02) 7906 8312 Email: [email protected] Book Online: drdeveshkaushal.com.au Office Hours: Monday – Friday, 9:00 AM – 5:00 PM Operating at: Sydney Southwest Private Hospital Liverpool | Campbelltown Public Hospital | Campbelltown Private Hospital | The George Hospital Appointments available within 4–8 weeks depending on urgency | Book online 24/7 | Medicare & Private Health Insurance Accepted |
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