What Your Pathology Results Mean
You had a precancerous polyp removed that requires surveillance colonoscopy in 3 years. 1, 2, 3
Understanding Your Polyp
Your pathology report describes three key features:
- Adenomatous polyp: This is a precancerous growth that can develop into colorectal cancer over time if not removed. 1
- Tubulovillous type: This refers to the architectural pattern under the microscope—your polyp has both tubular (tube-like) and villous (finger-like) components. 1, 4
- Low-grade dysplasia: This means the cells show mild abnormal changes but are not severely abnormal or cancerous. 1
Why This Matters
The tubulovillous architecture places you in a higher-risk category regardless of polyp size or the low-grade dysplasia. 1, 3 Even though your dysplasia is low-grade, the presence of any villous features (even minor villous changes) is associated with increased molecular markers of malignant potential and qualifies as an "advanced adenoma." 1, 4
The good news is that this polyp was found and removed before it could progress to cancer. 1
What You Need to Do Next
You need a surveillance colonoscopy in 3 years. 1, 2, 3, 5 This recommendation is based on:
- The tubulovillous histology, which is an independent risk factor for future advanced neoplasia 1
- Strong evidence showing this interval balances cancer prevention with avoiding excessive procedures 1
Important Exception
If your polyp was removed in pieces (piecemeal resection) and was ≥20 mm in size, you need a shorter follow-up at 6 months to verify complete removal. 1 After confirming complete removal, you would then follow the standard 3-year surveillance schedule. 1, 5
What Happens at Your 3-Year Colonoscopy
The surveillance interval may change based on what is found:
- If normal or only 1-2 small tubular adenomas with low-grade dysplasia: Your next colonoscopy can be extended to 5 years later 1, 2, 5
- If high-risk features return (more adenomas, large size, or villous features): Continue 3-year intervals 1, 3, 5
- If more than 10 adenomas are found: You need 1-year follow-up and consideration for genetic testing 3
Critical Quality Requirements
These surveillance recommendations assume your colonoscopy was high-quality, meaning: 1, 2, 3
- Complete examination to the cecum (end of colon)
- Adequate bowel preparation to see polyps >5 mm
- Minimum 6-minute withdrawal time
- Complete polyp removal
If any of these quality metrics were not met, discuss with your gastroenterologist whether you need an earlier repeat examination. 3
Additional Considerations
Your entire colon should have been carefully examined during the polypectomy procedure, as patients with tubulovillous adenomas have up to a 30% risk of having synchronous (simultaneous) neoplasia elsewhere in the colon. 1 If your colonoscopy report indicates incomplete examination or poor preparation, you may need a sooner repeat examination. 1, 3
The British guidelines note that tubulovillous histology has poor inter-observer agreement among pathologists, but U.S. guidelines still use it as a surveillance criterion because it correlates with increased cancer risk. 1, 4
Bottom Line
Your polyp was precancerous but not cancer. The tubulovillous features mean you need closer monitoring than someone with a simple tubular adenoma. Mark your calendar for a colonoscopy in 3 years (or 6 months if it was a large piecemeal resection), and do not delay this surveillance—it is your best protection against developing colorectal cancer. 1, 2, 3