Latest / The Gastro Truth with Dr. Mel Ona / Your Colon Polyp Was Removed. What Happens Next Matters Even More

Transcript

Your Colon Polyp Was Removed. What Happens Next Matters Even More · The Gastro Truth with Dr. Mel Ona

• 0:00
  SPEAKER_00: Your doctor removed a colon polyp and told you it wasn't cancer.
• 0:03
  SPEAKER_00: Great news, right?
• 0:05
  SPEAKER_00: Absolutely.
• 0:06
  SPEAKER_00: But here's something many patients don't realize.
• 0:09
  SPEAKER_00: Some polyps are precancerous.
• 0:12
  SPEAKER_00: And just because your doctor removed one doesn't necessarily mean you're done with colonoscopies.
• 0:17
  SPEAKER_00: In fact, there's one question I wish every patient would ask after having a polyp removed.
• 0:22
  SPEAKER_00: When do I need my next colonoscopy?
• 0:25
  SPEAKER_00: Because getting that answer right can make a real difference in preventing colorectal cancer.
• 0:29
  SPEAKER_00: I'm Dr.
• 0:30
  SPEAKER_00: Mel Ona, a board-certified gastroenterologist in Hawaii, and I've cared for more than 10,000 patients.
• 0:35
  SPEAKER_00: Today I'm going to explain what happens after a polyp is removed, what the pathology report actually tells us, and how we decide when you need to come back.
• 0:43
  SPEAKER_00: And believe me, that last part matters more than most people realize.
• 0:47
  SPEAKER_00: Removing the polyp is only the first step.
• 0:49
  SPEAKER_00: Now here's something remarkable about colonoscopy.
• 0:52
  SPEAKER_00: We're not just looking for cancer, we're looking for certain polyps that could eventually become cancer.
• 1:00
  SPEAKER_00: Most colorectal cancers develop over time, often through changes that begin in precancerous growths in the colon.
• 1:06
  SPEAKER_00: So when I find and completely remove one of these polyps, I've potentially interrupted that process.
• 1:13
  SPEAKER_00: That's a big deal.
• 1:14
  SPEAKER_00: But there's something I can't always tell just by looking at a polyp during the procedure.
• 1:19
  SPEAKER_00: What kind of polyp is it?
• 1:20
  SPEAKER_00: That's where the pathology report comes in.
• 1:23
  SPEAKER_00: After we remove a polyp, we generally send the tissue to a pathology laboratory where a pathologist examines the cells under a microscope.
• 1:30
  SPEAKER_00: And that report tells us several important things.
• 1:33
  SPEAKER_00: Was it a hyperplastic polyp, which is often low risk, particularly when small and located in the lower colon?
• 1:39
  SPEAKER_00: Was it an adenoma, one of the common types of precancerous polyps?
• 1:43
  SPEAKER_00: Or was it a serrated lesion, another type that can sometimes develop into colorectal cancer?
• 1:49
  SPEAKER_00: And were there abnormal cellular changes called dysplasia?
• 1:52
  SPEAKER_00: These details matter because not all polyps carry the same future risk, but pathology is only part of the picture.
• 1:59
  SPEAKER_00: I also want to know how many polyps we found and how large they were, whether we removed them completely, and how well your colon was cleaned out.
• 2:08
  SPEAKER_00: Because if your bowel preparation wasn't adequate, stool and debris can hide abnormalities that we might otherwise detect.
• 2:14
  SPEAKER_00: Put all these pieces together, and now we have something much more valuable than simply hearing your polyp was benign.
• 2:20
  SPEAKER_00: We have information that helps determine your future risk.
• 2:23
  SPEAKER_00: So when should your next colonoscopy be?
• 2:25
  SPEAKER_00: Now here's where patients are often surprised.
• 2:27
  SPEAKER_00: There isn't one follow-up interval that applies to everybody.
• 2:31
  SPEAKER_00: Let's say your colonoscopy was completely normal.
• 2:34
  SPEAKER_00: You're at average risk and the examination was high quality or adequate.
• 2:38
  SPEAKER_00: You may not need another screening colonoscopy for 10 years.
• 2:41
  SPEAKER_00: Now let's say we removed one or two small low-risk tubular adenomas.
• 2:46
  SPEAKER_00: Under US surveillance guidelines, your next colonoscopy may be recommended in seven to ten years.
• 2:52
  SPEAKER_00: Now that's right, finding a polyp doesn't automatically mean coming back in three years.
• 2:56
  SPEAKER_00: But the recommendation changes when the findings change.
• 2:59
  SPEAKER_00: If we find several adenomas, a larger polyp, or certain higher risk features under the microscope, the interval may be three years, sometimes sooner.
• 3:07
  SPEAKER_00: If a large polyp, typically 20 millimeters or larger, had to be removed in pieces, we may need to re-examine that area in approximately six months to make sure no tissue remains or has grown back.
• 3:18
  SPEAKER_00: And if more than 10 adenomas are found, follow-up may be recommended in about one year, along with consideration of whether a hereditary condition could be involved.
• 3:27
  SPEAKER_00: Now these are examples, not rules you should apply to yourself without reviewing your report.
• 3:32
  SPEAKER_00: Your family history, previous findings, bowel prep quality, completeness of removal, and other medical conditions can change the plan.
• 3:38
  SPEAKER_00: So here's the point.
• 3:39
  SPEAKER_00: Your next colonoscopy should be based on what we actually found, not a guess.
• 3:44
  SPEAKER_00: Too early and you may undergo an unnecessary procedure.
• 3:47
  SPEAKER_00: Too late and we may miss an opportunity to detect a new or recurring lesion before it becomes dangerous.
• 3:53
  SPEAKER_00: Now, if you've ever left a medical appointment wondering what your test results actually meant, subscribe to Gastro Truth.
• 3:59
  SPEAKER_00: Every week, I explain the things I wish more patients knew about their digestive health without the hype or unnecessary medical jargon.
• 4:07
  SPEAKER_00: Now here's the question I hear all the time.
• 4:09
  SPEAKER_00: If the polyp is gone, why am I still at risk?
• 4:12
  SPEAKER_00: Doctor, you removed it, so why do I have to come back?
• 4:15
  SPEAKER_00: Fair question.
• 4:16
  SPEAKER_00: If we completely remove a precancerous polyp, that particular lesion can no longer progress into cancer.
• 4:22
  SPEAKER_00: But removing one polyp doesn't mean your colon can never develop another.
• 4:26
  SPEAKER_00: Some patients are more likely than others to form additional adenomas or serrated lesions.
• 4:31
  SPEAKER_00: And occasionally, depending on how a lesion was removed, we need to check that no residual tissue remains.
• 4:37
  SPEAKER_00: Think of your colonoscopy as giving us information about the road ahead.
• 4:41
  SPEAKER_00: A completely normal examination tells us one thing.
• 4:44
  SPEAKER_00: Finding several advanced precancerous lesions tells us something different.
• 4:48
  SPEAKER_00: We shouldn't treat those two patients as though their future risks are identical.
• 4:52
  SPEAKER_00: That's why surveillance matters.
• 4:54
  SPEAKER_00: And unfortunately, this is also where some patients fall through the cracks.
• 4:58
  SPEAKER_00: So the follow-up that gets forgotten.
• 5:00
  SPEAKER_00: Now here's a situation I've seen many times.
• 5:02
  SPEAKER_00: A patient undergoes a colonoscopy.
• 5:04
  SPEAKER_00: We remove a polyp.
• 5:06
  SPEAKER_00: A few days later, the pathology report comes back.
• 5:09
  SPEAKER_00: The patient hears the word benign.
• 5:12
  SPEAKER_00: And that's the word they remember.
• 5:14
  SPEAKER_00: Life gets busy, they change jobs, move, or switch doctors.
• 5:18
  SPEAKER_00: Five years go by.
• 5:20
  SPEAKER_00: Then someone asks, When was your last colonoscopy?
• 5:23
  SPEAKER_00: And when are you due again?
• 5:24
  SPEAKER_00: And all they can remember is they removed a polyp, but it wasn't cancer.
• 5:29
  SPEAKER_00: But here's the problem.
• 5:31
  SPEAKER_00: Not cancer does not automatically mean no follow-up needed.
• 5:35
  SPEAKER_00: Some benign polyps are still precancerous, and colorectal cancer can develop without obvious warning symptoms.
• 5:42
  SPEAKER_00: You may feel perfectly fine, no pain, no visible bleeding, no major change in bowel habits.
• 5:48
  SPEAKER_00: And that's why I want you to remember this.
• 5:50
  SPEAKER_00: Symptoms are not a reliable calendar for your next colonoscopy.
• 5:54
  SPEAKER_00: Your surveillance recommendation is.
• 5:56
  SPEAKER_00: So the three questions to ask.
• 5:58
  SPEAKER_00: Now, if you had a polyp removed, I want you to know the answers to three questions.
• 6:03
  SPEAKER_00: Number one, what did the pathology show?
• 6:06
  SPEAKER_00: Was it an adenoma, a serrated lesion, or another type of polyp?
• 6:10
  SPEAKER_00: Number two, how many polyps were removed?
• 6:13
  SPEAKER_00: How large were they?
• 6:14
  SPEAKER_00: And was the examination complete and adequately prepared?
• 6:17
  SPEAKER_00: Now those details help determine your risk.
• 6:20
  SPEAKER_00: And number three, and this is the big one, exactly when do I need my next colonoscopy?
• 6:25
  SPEAKER_00: Not sometime in a few years.
• 6:28
  SPEAKER_00: Ask for a specific recommended interval and make sure it's documented.
• 6:31
  SPEAKER_00: If the pathology is still pending, ask when the final recommendation will be available.
• 6:36
  SPEAKER_00: And if you don't understand the report, ask your gastroenterologist to explain it.
• 6:41
  SPEAKER_00: That's not being difficult, that's being informed.
• 6:44
  SPEAKER_00: Here's what I want you to take away.
• 6:46
  SPEAKER_00: Finding and removing a precancerous polyp can prevent cancer.
• 6:51
  SPEAKER_00: That's one of the most powerful things we do in gastroenterology.
• 6:55
  SPEAKER_00: But prevention doesn't always end when the procedure ends.
• 6:59
  SPEAKER_00: Removing the polyp protects you today.
• 7:01
  SPEAKER_00: Following the right surveillance plan helps protect you for years to come.
• 7:05
  SPEAKER_00: And if you're worried about your next colonoscopy because you remember how difficult the preparation was, watch my video on seven ways to make colonoscopy prep easier.
• 7:14
  SPEAKER_00: Because the best colonoscopy is the one you actually complete with a good preparation and the right follow up.
• 7:19
  SPEAKER_00: I'm Dr.
• 7:20
  SPEAKER_00: Melona.
• 7:21
  SPEAKER_00: Evidence over hype.
• 7:22
  SPEAKER_00: Your gut deserves the truth.
• 7:24
  SPEAKER_00: I'll see you in the next one.