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Risks of colon cancer after multiple polyp removals

Risks of colon cancer after multiple polyp removals

Question

Dear OncoLink "Ask The Experts,"
I am in my mid 30's and have had numerous colonoscopies over the last 10 years with polyps removed each time. I am now going every 3 years to get checked. Am I still at risk to get colon cancer even though I have the polyps removed?  

Answer

Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

There are several issues that should be discussed concerning your risk for colorectal cancer. You have had "numerous colonoscopies over the last 10 years with polyps removed each time" even though you are only in your 30's. I presume that these were adenomatous polyps. That is unusual and raises the question of whether you have an inherited cancer syndrome such as Familial Adenomatous Polyposis (FAP) or Hereditary Non-Polyposis Colon Cancer (HNPCC). Perhaps you know that and just didn't include it in your question. If you have FAP, you will continue to develop polyps and the recommendation is that you have your colon removed at some time to prevent the development of colon cancer. While colonoscopies and polypectomies may delay that surgery, it is nearly inevitable.

If you have HNPCC, it has been shown that polypectomies do decrease the risk for colon cancer, but not completely. In the US, the recommendation is that patients who have HNPCC have colonoscopies every 1 to 2 years. That is because those cancers can develop at a more rapid pace than sporadic cancers. If cancer is detected, you should have a total or subtotal colectomy. It would be unusual for you to have this many polyps without the possibility of one of these cancer syndromes but if so, colonoscopies every 3 years will decrease your risk for colon cancer. I would suggest you be evaluated by someone who is very familiar with colon cancer risk and the inherited colon cancer syndromes to try to better determine your risk. While no preventive procedure will completely reduce your risk, the goal should be for you to minimize it as much as possible.