From the Guidelines
Both hyperplastic colonic polyps and tubular adenomas are considered benign growths in the colon, with hyperplastic polyps having essentially no malignant potential and tubular adenomas having a low risk of progressing to colorectal cancer if left in place for many years. Hyperplastic polyps are non-neoplastic lesions that are typically small, pale, and sessile, and are found incidentally during colonoscopy 1. Tubular adenomas, on the other hand, are neoplastic lesions that can potentially progress to colorectal cancer, but are still classified as benign 1. The risk of malignant transformation in tubular adenomas depends on their size, with larger adenomas carrying higher risk 1.
Key Characteristics of Hyperplastic Polyps and Tubular Adenomas
- Hyperplastic polyps:
- Non-neoplastic lesions
- Essentially no malignant potential
- Typically small, pale, and sessile
- Tubular adenomas:
- Neoplastic lesions
- Low risk of progressing to colorectal cancer
- Risk of malignant transformation depends on size
Surveillance Recommendations
- Patients with small colorectal hyperplastic polyps: next follow-up colonoscopy in 10 years 1
- Patients with one or two small tubular adenomas: next follow-up colonoscopy in five to 10 years 1
- Patients with three to 10 adenomas, any adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia: next follow-up colonoscopy in three years 1
Importance of Regular Colonoscopy Screening
Regular colonoscopy screening is recommended for adults to detect and remove these benign growths before they have a chance to potentially transform into cancer 1. This is especially important for patients with a family history of colorectal cancer or those who have had previous adenomas or colorectal cancer 1.
From the Research
Hyperplastic Colonic Polyps and Tubular Adenomas
- Hyperplastic polyps are generally considered to be benign with little or no potential to progress to colorectal cancer 2, 3
- However, some studies suggest that hyperplastic polyps may be associated with an increased risk of colorectal cancer, particularly in patients with multiple hyperplastic polyps or those with a family history of colon cancer 2, 4, 5, 6
- Tubular adenomas are also considered to be benign, but they have a higher potential for malignant transformation compared to hyperplastic polyps 3
Association with Colorectal Cancer
- Patients with hyperplastic polyposis, characterized by the presence of multiple hyperplastic polyps, are at high risk for colorectal cancer 2
- The presence of a hyperplastic polyp in the left colon may serve as a marker for synchronous adenomatous polyps in the proximal colon 4, 5
- Some studies suggest that hyperplastic polyps may have neoplastic potential, particularly in patients with a history of smoking or other risk factors for colorectal cancer 6
Clinical Implications
- The finding of hyperplastic polyps in the rectosigmoid may justify full colonoscopy to rule out proximal adenomas 5
- Patients with hyperplastic polyps should be monitored closely for the development of colorectal cancer, particularly if they have a family history of colon cancer or other risk factors 2, 6