Colon Polyp Found on Colonoscopy: What Happens Next?

A colon polyp found on colonoscopy is a small growth on the lining of the large bowel or rectum. Most polyps are not cancer, and they are usually removed during the same test and sent to a laboratory. The lab result, often called the histology or pathology report, tells your team what type of polyp it was and helps decide whether you need another colonoscopy and when.

This guide is for adults whose polyp has already been seen or removed. It explains common report wording and how guidelines group findings. It cannot interpret your own report or set your follow-up date. If the colonoscopy was done after a positive stool test, the guide on a positive FIT result covers that earlier step.

Follow the written instructions your endoscopy unit gave you after the procedure, including who to call if you have pain or bleeding. If you were not given any, ask the unit for them.

Heavy bleeding from the bottom needs emergency care; the NHS advises calling emergency services or going to an emergency department. The NHS also suggests seeing a GP if you have blood or slime (mucus) in your poo for 3 weeks or more. Do not wait for a surveillance date if you notice new bleeding or other symptoms that worry you.

Polyps are very common. The NHS says around 1 in 4 people over 50 will have at least one. Cleveland Clinic notes they become more common with age and that most cause no symptoms, so many are found only at screening.

NIDDK states that most polyps are not cancerous, but some may develop into cancer over time, and that removing polyps can help prevent colorectal cancer. The NHS explains that a removed polyp is sent to a lab to check whether it was fully removed, whether it might grow back and whether there are any cancerous changes.

Cleveland Clinic divides polyps into neoplastic types, which can grow into cancer, and non-neoplastic types, which cannot. The main groups you may see on a report are:

• Adenoma (adenomatous polyp): neoplastic. Subtypes are tubular, tubulovillous and villous.
• Sessile serrated lesion, also written as sessile serrated polyp or adenoma: neoplastic, part of the serrated group.
• Hyperplastic polyp: non-neoplastic according to Cleveland Clinic. Small ones in the lower bowel are treated by the US guideline as no different from a normal colonoscopy, but large ones may still lead to earlier follow-up.
• Inflammatory polyp or pseudopolyp: linked to long-term inflammation, usually inflammatory bowel disease, and not a true polyp.

Cleveland Clinic says results usually take a week or two. Words you may see include the polyp type, the subtype (tubular or villous), the size in millimetres, how many polyps were removed, and the grade of dysplasia. Dysplasia describes abnormal-looking cells; reports often say low-grade or high-grade. Guidelines treat high-grade dysplasia as a higher-risk feature.

The report may also say whether the polyp was removed in one piece or in several pieces (piecemeal), and whether removal looked complete. These details affect follow-up. If the report mentions cancer cells or invasion, ask for a dedicated appointment to discuss it; that situation is outside the scope of this guide.

Follow-up depends on the number, size and type of polyps, and on whether the colonoscopy was complete with good bowel preparation. Guidelines differ between countries. The examples below are quoted from two published guidelines and are not a personal schedule.

The 2020 US Multi-Society Task Force update states these intervals, and assumes a high-quality examination, complete to the caecum, with adequate bowel preparation and complete polyp removal:

• 1 to 2 tubular adenomas smaller than 10 mm: 7 to 10 years.
• 3 to 4 adenomas smaller than 10 mm: 3 to 5 years.
• 5 to 10 adenomas smaller than 10 mm, any adenoma 10 mm or larger, or an adenoma with villous features or high-grade dysplasia: 3 years.
• More than 10 adenomas: 1 year.
• Hyperplastic polyps smaller than 10 mm in the rectum or sigmoid: repeat screening in 10 years, the same as a normal colonoscopy. A hyperplastic polyp 10 mm or larger: 3 to 5 years.
• Sessile serrated polyps: 5 to 10 years for 1 to 2 under 10 mm, 3 to 5 years for 3 to 4 under 10 mm, and 3 years for 5 to 10, one 10 mm or larger, or one with dysplasia.

The 2020 BSG/ACPGBI/PHE guideline from the UK uses a different approach. It defines high-risk findings as either 2 or more premalignant polyps including at least one advanced polyp, or 5 or more premalignant polyps. An advanced polyp is a serrated polyp at least 10 mm or with any dysplasia, or an adenoma at least 10 mm or with high-grade dysplasia. This high-risk group should have a one-off surveillance colonoscopy at 3 years.

Because the US and UK approaches differ, two people with similar polyps in different countries may be given different dates. Ask which guideline your service follows and how it applies to your report.

Ask for a copy of both the colonoscopy report and the histology report. These questions can help you understand them.

• How many polyps were removed, how big were they and what type was each one?
• Was there any dysplasia, and if so, what grade?
• Were all polyps removed completely, and were any removed in pieces?
• Was the bowel preparation adequate and did the test reach the whole colon?
• Which guideline are you using, and when exactly is my next colonoscopy or screening test due?
• Does my family history change the plan, and who will send me the reminder?

On SameCase, patients and verified doctors share de-identified cases. Seeing how others described a polyp report, and which questions helped them understand their follow-up plan, can help you prepare for your own appointment.

Other people's cases cannot tell you what your histology means or set your surveillance interval. We suggest using them only to sharpen your questions, and relying on your own care team for decisions.