Making Sense of Your Colonoscopy Results

When you wake up from a colonoscopy, what you want to hear is that your doctor found nothing whatsoever. As for next best — it gets a little more complicated!

Polyps come in a variety of shapes and sizes, and those are only two of the many variables your doctor will weigh in determining the medical significance of your results. How many were found and where? Did they look like mushrooms or pancakes or something altogether different? This information holds important clues about your future health and risk for colon cancer. The research on this subject is intense and ongoing, so I called Dr. Gottumukkala Raju, a professor at The University of Texas MD Anderson Cancer Center, Houston, and a leading expert on colon cancer, to find out exactly what we all should know about our colonoscopy results.


Dr. Raju told me that there are many different types of polyps, each with different risks. Among the most commonly found sizes and shapes…

  • Pedunculated polyps, which resemble mushrooms.
  • Sessile polyps that look like stemless mushrooms.
  • Nonpolypoid lesions, also called flat lesions. These growths look like small pancakes on the wall of the colon.

Not surprisingly, the larger a polyp is, the more dangerous — with the greatest risk associated with those more than a centimeter wide.

Lab Tests Reveal Yet More…

Upon removal, a polyp is sent to a pathologist for diagnosis, where it is looked at for different cell structures that signal more about cancer risk.

You may see one of the following terms in your pathology report…

  • Hyperplastic polyps… these are not considered precancerous unless they are found up high in the colon. These polyps look like pale white scabs and usually measure less than 5 millimeters in width.
  • Adenomatous polyps… are precancerous. But even among these, there are some important distinctions relating primarily to the “architecture” of the polyp, or how its cells are arranged, Dr. Raju said.
  • Tubular adenomas. Small (less than a centimeter in width) polyps with tubular structures and cells, these usually aren’t cancerous, but cancer is increasingly likely as they grow. If the doctor finds more than three or four or any that are wider than one centimeter, you may be advised to get more frequent colonoscopies.
  • Villous adenomas. These have fingerlike projections and are less common than tubular adenomas but pose a higher risk of becoming cancerous as they grow.
  • Tubulovillous adenomas. These precancerous polyps, which have a combination of both tubular and villous type of architecture, are more common than the villous variety but less common than the tubular type. The risk level also lies somewhere between those two.

Another level of classification describes the appearance of the cells. Cells that look immature are called “low grade,” while mature-looking ones are “high grade.” High-grade dysplasia describes cells that look like cancer (and are close to becoming cancerous) but are still contained and have not breached the inner lining of the colon.

What’s Next?

Dr. Raju said that gastroenterologists usually snip out all polyps during a colonoscopy. A second surgery may be necessary to remove larger polyps and/or if the colonoscopy shows that cancer is present.

A colonoscopy takes about 20 to 30 minutes, but you’re likely to feel groggy for several hours afterward. As soon as you’re reasonably alert, the doctor tells you the basic results of the test. But since you may not be completely clear-headed then, it’s usually smarter to follow up in a few days or after you get results of the biopsy… at which time you can also discuss what the findings mean, whether any follow-up is required — and when you’ll need to get your next colonoscopy.