27 - sessile serrated polyp

[mymaria]

Your GI doctor didn't think you should be tested for Lynch? You are only 27 and have had the flat polyps, which tend to be indicative of Lynch, plus your father was diagnosed at a relatively young age. Is there any other colon, uterine or gastric cancers on that side of the family? Please meet with a genetic counselor if you meet the Amsterdam criteria. It is so much better to know if you have it so you can start getting your screenings. I know it's scary to think about, but as someone who has known for almost five years she has Lynch, I'd much rather know than not know! I have half my colon removed four and a year years ago for a right-sided cancer. My last colonoscopy in December the doctor for a flat polyp that was precancerous, but because I know I have Lynch, I go every year and it was taken out before it could become dangerous. Do a little digging into your family tree and if you meet the criteria-get tested.

[Jac835]

Hi Maria,

he didn't mention anything about lynch syndrome when I had the colonoscopy, he just said he really wanted to see what happened in 12 months. If they find more polyps in my next scan I will definitely ask, if they don't say anything first. He said he would be a lot more concerned if they do find another polyp again 12 months later, but he also said that some people just get a lot of polyps (all of mine were hyperplastic except for that sessile serrated one) and that can just be the same as how some people are prone to moles etc. I do have a family history obviously of bowel cancer on my dad's side and skin cancer on my mum's side. My grandfather had prostate cancer but not until he was 75 so not sure if that counts. My mum has had a number of pre-cancerous growths removed but we haven't been nearly as sun smart as we should have been and my mum's side are Austrian/Italian so very fair skinned.

I am increasingly worried though that I may be prone to developing cancers. I recently had an ultrasound of my uterus and ovaries and they found that my ovaries have become multi-follicular. I don't have any of the symptoms for polycystic ovarian syndrome and again multi-follicular ovaries aren't always something you have to worry about but it's now something else I have to get checked all the time. In addition, I also had a skin cancer check and one of my moles that I've had all my life was found to have become dysplastic so that will be getting removed.

I can't help but wonder that there might be something wrong with my DNA that's getting increasingly worse as I get older because lots of 'little' things are starting to change. Other than these things, I'm a fit, thin 27 year old female, I don't remember the last time I had a cold and I've never really been sick and my cuts and wounds heal faster than anyone else I know (my bf jokes that I'm Wolverine lol) so I'm really hoping that maybe I'm just someone who will have moles and extra growths but no cancers. Don't know if that's possible but I will keep everyone posted if you're interested. And at the moment, I don't actually have that many moles either, maybe 5-10 on my whole body.

I read somewhere that moles can be associated with long telomeres (bits on the end of chromosomes that stop your DNA from getting damaged when they replicate and prevent you from aging as quickly - and I guess I don't really look old) so I was hoping maybe my polyps and extra follicles could maybe all be associated with that?

[-Sophie-]

I am lynch positive and I had 3 sessile serrated popyls removed at my first colonoscopy post surgery (16 months post first colonoscopy that was my diagnosis).

I am discovering that there are a few cases in my family history of lynch cancers but I didn't know they were there until really talking to my dad. Getting tested for lynch syndrome is very important. I would ask for the test and get annual colonoscopies for the time being.

Sessile serrated popyls are nasty because it's harder to get clear margins so they can reappear quickly.

The best thing about finding it a the stage you have is that now you can be extra vigilant and if anything happens it will be caught early.

[Amarti0234]

I’m glad I found this thread. I need help please. I’m a 25 YO female who had a colonoscopy last year due to my father having CRC. They found a Traditional Serrated Adenoma 5mm. They removed it but I have to have annual coloscopies from here on out. I can’t find much information on these types of polyps via Dr.Google. Can anyone help me out?
Ashleigh

[O Stoma Mia]

I’m glad I found this thread. I need help please. I’m a 25 YO female who had a colonoscopy last year due to my father having CRC. They found a Traditional Serrated Adenoma 5mm. They removed it but I have to have annual coloscopies from here on out. I can’t find much information on these types of polyps via Dr.Google. Can anyone help me out?
Ashleigh

Here is a link to an article that might help:
.
https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-pathology-report/colon-pathology/colon-polyps-sessile-or-traditional-serrated-adenomas.html?ssDomainNum=5c38e88&print=t

Have you been tested for Lynch Syndrome? HNPCC? What other tests did they do on your removed polyp? Do you have a copy of your colonoscopy report or the biopsy report?

[Amarti0234]

I do have a letter, it won’t let me attach an image here...

[Diane E]

I took a Colagard
test and it came back positive. I believe this test saved my life for now. I had the colonoscopy done and they found (2) 7 mm pre-cancerous one tubular the other sessile serrated adenoma.

My understanding there are two major concerns with this polyp (1) location-ascending colon, (2) was the polyp completely removed. If polyp was completely removed you are safe for now.
According to my research the problem is these polyps are hard to detect and remove completely. If not removed completely, they grow back fast, and may turn into cancer. According to my research this may happen before the next scheduled colonoscopy. How can we be sure it is removed completely. Doesn't seem to be a definitive answer out there. Does anyone know? My gastro doctor said he removes the entire polyp in one piece, but there are serrated edges so I can see how cells can be left behind. Can the pathologist tell? I don't see anything in the report that states "completely removed". This is flipping me out to wait (3) years seems too long.

[O Stoma Mia]

I took a Cologuard® test and it came back positive. I believe this test saved my life for now. I had the colonoscopy done and they found (2) 7 mm pre-cancerous one tubular the other sessile serrated adenoma.

My understanding there are two major concerns with this polyp (1) location-ascending colon, (2) was the polyp completely removed. If polyp was completely removed you are safe for now.

According to my research the problem is these polyps are hard to detect and remove completely. If not removed completely, they grow back fast, and may turn into cancer. According to my research this may happen before the next scheduled colonoscopy.

How can we be sure it is removed completely. Doesn't seem to be a definitive answer out there. Does anyone know? My gastro doctor said he removes the entire polyp in one piece, but there are serrated edges so I can see how cells can be left behind.

This is flipping me out to wait (3) years seems too long.

Diane E-
Welcome to the Forum, and I'm sorry to hear that you still have some unanswered questions after receiving your colonoscopy report.

I don't have the answers myself, but there are some resources available that may help you clarify the situation and get better answers from your doctors.

For now, what seem to missing are some of the critical details pertaining to aggressiveness and risk that should have been included in the pathology report of your polypectomy procedure.

In the U.S., the College of American Pathologists issues standards that are supposed to be followed by the pathologists whenever they are reporting on the outome of polypectomies. Some of the data fields are required while others are optional. Required fields, such as Histological Type and Grade of the pre-cancer, etc., can tell how aggressive and serious the pre-cancerous polyp might be.

What I would suggest is for you to download the 16-page document below and check which of the required data fields are actually given in your colonoscopy report.

Protocol for the Examination of Excisional Biopsy or Polypectomy Specimens
Version 4.3.0.0, December 2023, 16 pages.

https://documents.cap.org/protocols/ColoRectal.Bx_4.3.0.0.REL_CAPCP.pdf

I may have some additional comments later on, but for now the important issue is how the pathologist evaluated the specimens.
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If the pathology report does confirm a pre-cancerous sessile serrated polyp, then please read the following article:

What happens if they find serrated polyps during my colonoscopy?

Hyperplastic polyps are common and aren’t a cause for concern. But if your provider suspects a precancerous type of serrated polyp, they’ll need to remove it. This is necessary both to confirm what type it is and to make sure it doesn’t progress to cancer.

If it does turn out to be precancerous, your provider will want to schedule your next colonoscopy relatively soon, to make sure they don’t miss any new ones."

Reference: https://my.clevelandclinic.org/health/diseases/17462-serrated-polyps

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Additional comment:

... Can the pathologist tell? I don't see anything in the report that states "completely removed"...

Yes, theoretically. the pathologist can include data iems in his report that can give this type of information. The main relevant data item is the one pertaining to "Resection Margin", which tells how many mm of tissue on the edge of the specimen are completely free of cancerous or pre-cancerous cells. But this type of assessment depends on how well the doctor cut the polyp out and whether he made sure that the cut in all directions and underneath the polyp was made far enough away from the visible polyp to allow some normal, non-polyp tissue to be included in the excised specimen. In other words, the specimen must be excised in such a way that the polyp is enclosed or surrounded by at least several millimiters of normal tissue in all directions. I'm not sure that there is any way to verify this from the pathologist's report. ***

The other important thing about the pathologist's report is whether the report actually gave any evidence that the polyp was in fact pre-cancerous. The key term that should be in the report is "dysplasia" since this is the histological attribute that identifies the polyp as being pre-cancerous. It is important to note that not all serrated polyps have "dysplasia'. Many serrated polyps have the attribute "hyperplasia', which means that they are not precancerous.

Do you have a copy of the pathologist's report? Can you look through it to see what it says about the histological grade of the polyp? Note: I think that the doctor cannot make a definitive assessment visually during the colonoscopy procedure; I think it requires a pathologist's electron microscope to assess the histological detail.
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***
Note: Here is an article that explains in great detail how to remove flat polyps correctly. The technology does exist for doing this, but it is not clear if gastroenterologists have the kind of colonoscopes that will allow all of the steps to be taken to excise the flat polyps with this type of precision.

Endoscopic Removal of Polyps in the Gastrointestinal Tract (2017)
https://www.gastroenterologyandhepatology.net/archives/june-2017/endoscopic-removal-of-polyps-in-the-gastrointestinal-tract/