Snapshot A 60-year-old healthy man undergoes a screening colonoscopy. He has been staying active, does not smoke, denies any bloody or dark stools, changes in stool, abdominal pain, or fatigue. His prior colonoscopy was normal. During today’s colonoscopy, his gastroenterologist notes a small pedunculated growth in the descending colon. Introduction Overview abnormal growth of tissue from the colonic mucosa login to view 2 more bullets can be part of a polyposis syndrome login to view 4 more bullets Genetics APC KRAS T53 BRAF microsatellite instability mismatch repair Epidemiology Incidence highly prevalent (30-50% of adults) 90% occur after 50 years of age can be hyperplastic and benign or adenomatous with malignant transformation login to view 1 more bullet most commonly in sigmoid and rectum Risk factors smoking obesity high-fat diet red meat ETIOLOGY Pathogenesis pathophysiology login to view 6 more bullets Presentation Symptoms most often asymptomatic common symptoms login to view 2 more bullets Physical exam inspection login to view 1 more bullet provocative tests login to view 3 more bullets Imaging Lower gastrointestinal radiograph series may detect larger polyps Virtual colonoscopy with computed tomography scan limited use outside of research may detect larger polyps poor sensitivity Studies Serum labs tumor markers login to view 3 more bullets Invasive studies stool occult blood test login to view 1 more bullet endoscopic evaluation login to view 3 more bullets Histology H&E of endoscopic biopsy samples is diagnostic login to view 3 more bullets Differential Inflammatory bowel disease key distinguishing factor login to view 1 more bullet Familial adenomatous polyposis key distinguishing factors login to view 2 more bullets Peutz-Jeghers syndrome key distinguishing factors login to view 2 more bullets Treatment Surgical endoscopic polypectomy login to view 2 more bullets colectomy login to view 6 more bullets Complications Gastrointestinal bleeding Adenocarcinoma of the colon risk factors login to view 1 more bullet treatment login to view 1 more bullet Prognosis Natural history malignant progression of adenomatous polyps can take years Good progosis with polypectomy