Tubular Adenomas

Having tubular adenomas is a sign you might be at increased risk for colorectal cancer. There are many risk factors linked to colorectal cancer. Some of these you can change, and some you can’t. Here are steps you can take to reduce your risk:

Understanding Your Pathology Report: Colon Polyps (Sessile or Traditional Serrated Adenomas)

When your colon was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. This report helps manage your care. The questions and answers that follow are meant to help you understand the medical language used in the pathology report you received for your biopsy.

What if my report mentions the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum?

These are all parts of the large intestine. The cecum is the beginning of the colon, where the small intestine empties into the large intestine. The ascending colon, transverse colon, descending colon, and sigmoid colon are other parts of the colon after the cecum. The colon ends at the rectum, where waste is stored until it exits through the anus.

What is a polyp in the colon?

A polyp is a projection (growth) of tissue from the inner lining of the colon into the lumen (hollow center) of the colon. Different types of polyps look different under the microscope. Polyps are benign (non-cancerous) growths, but cancer can start in some types of polyps. These polyps can be thought of as pre-cancers, which is why it is important to have them removed.

What is an adenoma (adenomatous polyp)?

An adenoma is a polyp made up of tissue that looks much like the normal lining of your colon, although it is different in several important ways when it is looked at under the microscope. In some cases, a cancer can start in the adenoma.

What are tubular adenomas, tubulovillous adenomas, and villous adenomas?

Adenomas can have several different growth patterns that can be seen under the microscope by the pathologist. There are 2 major growth patterns: tubular and villous. Many adenomas have a mixture of both growth patterns, and are called tubulovillous adenomas. Most adenomas that are small (less than ½ inch) have a tubular growth pattern. Larger adenomas may have a villous growth pattern. Larger adenomas more often have cancers developing in them. Adenomas with a villous growth pattern are also more likely to have cancers develop in them.

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The most important thing is that your polyp has been completely removed and does not show cancer. The growth pattern is only important because it helps determine when you will need your next colonoscopy to make sure you don’t develop colon cancer in the future.

What if my report uses the term sessile?

Polyps that tend to grow as slightly flattened, broad-based polyps are referred to as sessile.

What if my report uses the term serrated?

Serrated polyps (serrated adenomas) have a saw-tooth appearance under the microscope. There are 2 types, which look a little different under the microscope:

• Sessile serrated adenomas (also called sessile serrated polyps)
• Traditional serrated adenomas

Both types need to be removed from your colon.

What does it mean if I have an adenoma (adenomatous polyp), such as a sessile serrated adenoma or traditional serrated adenoma?

These types of polyps are not cancer, but they are pre-cancerous (meaning that they can turn into cancers). Someone who has had one of these types of polyps has an increased risk of later developing cancer of the colon. Most patients with these polyps, however, never develop colon cancer.

What if my report mentions dysplasia?

Dysplasia is a term that describes how much your polyp looks like cancer under the microscope:

• Polyps that are only mildly abnormal (don’t look much like cancer) are said to have low-grade (mild or moderate) dysplasia.
• Polyps that are more abnormal and look more like cancer are said to have high-grade (severe) dysplasia.

The most important thing is that your polyp has been completely removed and does not show cancer. If high-grade dysplasia is found in your polyp, it might mean you need to have a repeat (follow-up) colonoscopy sooner than if high-grade dysplasia wasn’t found, but otherwise you do not need to worry about dysplasia in your polyp.

How does having an adenoma affect my future follow-up care?

Since you had an adenoma, you will need to have another colonoscopy to make sure that you don’t develop any more adenomas. When your next colonoscopy should be scheduled depends on a number of things, like how many adenomas were found, if any were villous, and if any had high-grade dysplasia. The timing of your next colonoscopy should be discussed with your treating doctor who knows the details of your specific case.

What if my adenoma was not completely removed?

If your adenoma was biopsied but not completely removed, you will need to talk to your doctor about what other treatment you’ll need. Most of the time, adenomas are removed during a colonoscopy. Sometimes, though, the adenoma may be too large to remove during colonoscopy. In such cases you may need surgery to have the adenoma removed.

What if my report also mentions hyperplastic polyps?

Hyperplastic polyps are typically benign (they aren’t pre-cancers or cancers) and are not a cause for concern.

Tubular Adenomas

Tubular adenomas are precancerous polyps in your colon typically found during colonoscopies. These polyps are your body’s early warning system for colorectal (colon) cancer. While about 50% of the population develops tubular adenomas, less than 10% of tubular adenomas become cancerous.

Overview

What are tubular adenomas?

Tubular adenomas are precancerous polyps in your colon. They’re often found during routine colonoscopies done to screen for colorectal cancer. Even though fewer than 9% of tubular adenomas become cancer, learning you have them might be like getting a very early warning you have a higher risk of developing colorectal cancer. That early warning could help you reduce your risk.

Are tubular adenomas the same as villous adenomas?

Seen under a microscope, both adenomas look like bumps in your colon lining or like tiny cauliflower heads clinging to a stalk. But tubular and villous adenomas have different growth patterns. Tubular adenomas have a regular growth pattern that looks like someone used your colon lining to create orderly rows of tiny test tubes. Villous adenomas look more like fronds from randomly placed ferns.

Understanding the different growth patterns helps healthcare providers to assess whether your adenomas are likely to become cancerous. For example, villous adenomas tend to grow more quickly than tubular adenomas and are more likely to become cancerous.

Symptoms and Causes

What causes tubular adenomas?

Anyone can develop tubular adenomas, but you’re at higher risk if:

• You smoke or use tobacco products.
• You have obesity.
• You are age 50 or older.
• You’re a man.
• You have a family history of cancer. If your parents, siblings or children have colorectal cancer, you’re twice as likely to develop colorectal cancer as someone who doesn’t have that history.
• Your medical history includes inflammatory bowel disease, previous colorectal cancer or ovarian cancer.
• You inherited certain gene changes. You’re more likely to develop rare forms of colorectal cancer such as familial adenomatous polyposis (FAP) or MUTYH-associated polyposis (MAP).

What are tubular adenoma symptoms?

Tubular adenomas rarely have symptoms. When they do, the most frequent symptom is finding painless bright red or dark red blood when you wipe yourself after pooping. Other symptoms are:

• Constipation or diarrhea.
• Unintentional weight loss.
• Loss of appetite.
• Stomach pain.

Diagnosis and Tests

How do healthcare providers diagnose tubular adenomas?

Your healthcare provider might find a tubular adenoma while examining your rectum as part of a physical examination. But most tubular adenomas are found during colonoscopies done to screen for colorectal cancer.

Management and Treatment

What is the treatment for tubular adenomas?

The primary treatment is to remove your adenomas. This usually happens during the colonoscopy where healthcare providers discovered your adenomas. Providers typically use a wire loop or forceps to pull the adenoma loose from your colon lining. You might feel some pressure or pulling, but no pain. Your provider retrieves the adenoma so they can examine it under a microscope for cancer cells.

Care at Cleveland Clinic

• Colorectal Cancer Treatment
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Prevention

How can I reduce my risk of developing tubular adenomas?

Having tubular adenomas is a sign you might be at increased risk for colorectal cancer. There are many risk factors linked to colorectal cancer. Some of these you can change, and some you can’t. Here are steps you can take to reduce your risk:

• Cut back on the amount of alcohol that you drink.
• Stop smoking and using tobacco products.
• Attain a weight that’s healthy for you.

Outlook / Prognosis

What can I expect if I have tubular adenomas?

Tubular adenomas are precancerous polyps in your colon and rectum. They’re usually found during colonoscopies done to screen for colorectal cancer. If your healthcare provider finds tubular adenomas while performing your colonoscopy, you’ll probably need to have colonoscopies more frequently than someone who does not have tubular adenomas.

Will I always have tubular adenomas?

Tubular adenomas can recur, particularly if you smoke.

Living With

How do I take care of myself if I have tubular adenomas?

You’re already taking steps to care of yourself by having the colonoscopy that showed you have tubular adenomas. If you’re feeling anxious about your colonoscopy outcome, it might help to remember a few facts about tubular adenomas:

• Healthcare providers performing colonoscopies typically remove your tubular adenomas as part of the colonoscopy process.
• Approximately 90% of tubular adenomas don’t become cancerous.
• Having colonoscopies on a regular basis means you’ll know if you have new tubular adenomas providers can remove before the new adenomas can become cancerous.

When should I see my healthcare provider?

You should contact your healthcare provider any time you notice changes in your body that might be signs of new tubular adenomas or other problems that might be signs of colorectal cancer. Tubular adenomas rarely have symptoms. When they do, the most frequent symptom is finding painless bright red or dark red blood when you wipe yourself after pooping.

When should I go to the emergency room?

You should go to the emergency room if you have the following problems after your colonoscopy:

• Severe pain or cramping in your belly.
• A hard belly.
• Trouble passing gas or pooping.
• Fever.
• Dizziness.
• Vomiting.
• Frequent or severely bloody bowel movements.
• Rectal bleeding that won’t stop or bleeding more than a couple of tablespoons.

What questions should I ask my doctor about tubular adenoma?

When your regular colonoscopy shows you have tubular adenomas, you might want to ask your healthcare provider the following questions:

• What is a tubular adenoma?
• Does this mean I have colorectal cancer or that I will have colorectal cancer?
• What is the treatment for tubular adenomas?
• Does this mean I have a genetic predisposition to colorectal cancer?
• How often should I have colonoscopies?
• What can I do to limit my risk of developing colorectal cancer?

A note from Cleveland Clinic

Tubular adenomas are a very early warning you’re at risk for colorectal cancer. Tubular adenomas aren’t cancerous and they aren’t likely to become cancer. But they are a sign you should consider learning what you can do to limit your risk of developing colorectal cancer. Ask your healthcare provider about steps you can take to limit your risk. They’ll be able to recommend helpful programs and services, whether that’s helping you stop smoking or to attain a healthy weight.