From the Guidelines
Hyperplastic polyps on colon biopsy are generally considered benign growths with no malignant potential, but certain subtypes may be associated with an increased risk of colorectal cancer. These polyps are the most common type found during colonoscopy, accounting for about 30-50% of all colon polyps, and typically appear as small, pale, sessile lesions, usually less than 5mm in size 1. Under the microscope, hyperplastic polyps show elongated crypts with a serrated or saw-tooth appearance and mature epithelial cells without dysplasia or abnormal cell growth patterns. While traditionally considered to have no malignant potential, current understanding suggests that certain subtypes, particularly larger hyperplastic polyps located in the right colon, may be part of the serrated polyp pathway to colorectal cancer 1. Some key points to consider include:
- Most hyperplastic polyps, especially small ones in the left colon or rectum, are considered clinically insignificant and do not require specific treatment beyond removal during colonoscopy 1.
- Follow-up recommendations depend on the size, number, and location of the polyps, but generally, routine screening intervals are appropriate for patients with only small, distal hyperplastic polyps 1.
- Patients with hyperplastic polyposis syndrome, characterized by multiple hyperplastic polyps, are at increased risk for adenomas and colorectal cancer and require more intensive follow-up evaluation 1. It is essential to note that the management of patients with hyperplastic polyps only was omitted from prior guidelines, but current guidelines state that there is no evidence that patients with small distally located hyperplastic polyps have an increased risk for colorectal cancer, and they should therefore be rescreened as appropriate for average-risk patients 1.
From the Research
Definition and Characteristics of Hyperplastic Polyps
- Hyperplastic polyps are typically considered to be benign lesions with little to no potential to progress to colorectal cancer 2.
- However, some studies suggest that certain hyperplastic polyps may be morphologically and genetically distinct and could lead to microsatellite unstable colorectal cancers 2.
- Hyperplastic polyps are often found in the colon and rectum, and their presence can be associated with an increased risk of colorectal cancer, particularly in individuals with multiple or large polyps 2, 3.
Risk Factors for Hyperplastic Polyps
- Risk factors for hyperplastic polyps include a history of smoking, moderate to heavy alcohol use, and low intake of cereal fiber and vitamin D 4.
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with a reduced risk of hyperplastic polyps, as well as adenomatous polyps and colorectal cancer 5, 6, 4.
- Other potential risk factors for hyperplastic polyps include physical inactivity, low daily multivitamin use, and high intake of fat derived from red meat 4.
Relationship Between Hyperplastic Polyps and Colorectal Cancer
- Some studies have found that individuals with hyperplastic polyposis, a condition characterized by the presence of multiple hyperplastic polyps, are at increased risk of developing colorectal cancer 2, 3.
- The risk of colorectal cancer associated with hyperplastic polyps may be higher in certain subgroups, such as individuals with a family history of colorectal cancer or those with large or numerous polyps 2, 3.
- Further research is needed to fully understand the relationship between hyperplastic polyps and colorectal cancer, as well as to identify effective strategies for preventing and treating these lesions 5, 2, 6, 3, 4.