Colonoscopy Results Explained
Learn what your colonoscopy findings mean, understand different polyp types, and know what to expect for your next screening.
When You'll Get Results
You'll typically receive results at two different times:
- Immediately after the procedure: The doctor will share visual findings with you before you leave — what they saw during the exam, whether any polyps were found and removed, and their general impression.
- 1-2 weeks later: If biopsies were taken or polyps were removed, the tissue is sent to a pathology lab for microscopic analysis. These results take time and determine the exact type of polyp and whether any further action is needed.
Possible Findings
✅ Normal (No Polyps)
Your colon looks healthy with no polyps, masses, or other abnormalities. This is the most common result.
Next steps: For average-risk individuals, repeat colonoscopy in 10 years. Continue healthy lifestyle habits.
🔵 Hyperplastic Polyps
Small, benign polyps that have very low cancer risk. These are common, especially in the lower part of the colon (rectum and sigmoid).
Next steps: Usually no change to screening interval. Repeat colonoscopy in 10 years for most patients.
🟡 Tubular Adenomas
The most common type of precancerous polyp. These can develop into cancer over many years if not removed. Removing them during colonoscopy prevents cancer.
Next steps: Depends on number and size. Small tubular adenomas: repeat in 7-10 years. Multiple or larger adenomas: repeat in 3-5 years.
🟠 Villous or Tubulovillous Adenomas
Adenomas with villous features have higher cancer risk than tubular adenomas. They require closer surveillance.
Next steps: Typically repeat colonoscopy in 3 years.
🔴 High-Grade Dysplasia
Severely abnormal cells that are close to becoming cancer but haven't invaded deeper tissue. Complete removal is critical.
Next steps: If completely removed, repeat colonoscopy in 3 years. May need additional evaluation if removal was incomplete.
⚠️ Colorectal Cancer
Cancer cells have been found. Early-stage cancers found during screening are often highly treatable.
Next steps: Additional testing (CT scan, staging) and referral to oncology and/or surgery. Treatment depends on stage and location.
Understanding Polyp Types
Polyps are classified by their microscopic appearance. Here's what the pathology report may include:
| Polyp Type | Cancer Risk | Description |
|---|---|---|
| Hyperplastic | Very low | Benign growths with minimal cancer potential. Common in rectum/sigmoid. |
| Sessile serrated | Moderate | Flat polyps that can be hard to see. Higher risk if in right colon or larger than 1cm. |
| Tubular adenoma | Low-Moderate | Most common adenoma type. Risk increases with size. |
| Tubulovillous adenoma | Moderate-High | Mixed features. Higher risk than tubular adenomas. |
| Villous adenoma | High | Finger-like projections. Highest adenoma cancer risk. |
| Traditional serrated adenoma | Moderate-High | Rare type with serrated appearance. Needs close follow-up. |
Follow-Up Intervals
Your doctor will recommend when to have your next colonoscopy based on what was found. These are general guidelines from the U.S. Multi-Society Task Force:
| Finding | Recommended Follow-Up |
|---|---|
| Normal (no polyps) | 10 years |
| 1-2 small (<10mm) tubular adenomas | 7-10 years |
| 3-4 small tubular adenomas | 3-5 years |
| 5-10 adenomas | 3 years |
| >10 adenomas | 1 year (and genetic counseling) |
| Adenoma ≥10mm | 3 years |
| Adenoma with villous features | 3 years |
| Adenoma with high-grade dysplasia | 3 years |
| Sessile serrated polyp <10mm without dysplasia | 5-10 years |
| Sessile serrated polyp ≥10mm or with dysplasia | 3 years |
| Piecemeal removal of large polyp | 6 months (to check for complete removal) |
💡 Why Different Intervals?
The follow-up interval is based on your risk of developing more polyps or cancer. More polyps, larger polyps, and certain polyp types indicate higher risk, so closer surveillance is needed. Your doctor may adjust recommendations based on your individual situation, family history, and prep quality.
Understanding Your Pathology Report
The pathology report may include terms like:
- Adenomatous — contains adenoma cells (precancerous)
- Dysplasia — abnormal cell growth; "low-grade" is less concerning than "high-grade"
- Sessile — flat or broad-based polyp
- Pedunculated — polyp on a stalk (easier to remove completely)
- Margins negative — the entire polyp was removed
- Margins positive/involved — polyp may not be completely removed
Questions to Ask Your Doctor
- What type of polyps were found?
- Were they completely removed?
- Do I need any additional treatment?
- When should I have my next colonoscopy?
- Should my family members be screened earlier?
If Cancer is Found
Finding colorectal cancer during a screening colonoscopy is uncommon but not rare. The good news: cancers found during screening are often early-stage and highly treatable.
What Happens Next
- Staging tests — CT scans, possibly PET scan, and blood tests to determine if cancer has spread
- Specialist referrals — You'll likely see a colorectal surgeon and/or oncologist
- Treatment planning — Options may include surgery, chemotherapy, radiation, or combinations depending on stage
- Genetic counseling — May be recommended, especially for younger patients or those with family history
🎯 Early Detection Saves Lives
The 5-year survival rate for localized colorectal cancer (cancer that hasn't spread beyond the colon) is over 90%. This is why screening colonoscopy is so valuable — it catches cancer at its most treatable stage.
Incomplete or Inadequate Exam
Sometimes a colonoscopy doesn't provide complete information:
- Inadequate prep — If the colon wasn't clean enough, the doctor may not be able to see everything. You may need to repeat the colonoscopy with better preparation.
- Incomplete exam — Technical difficulties, anatomy, or patient discomfort may prevent the doctor from reaching the beginning of the colon (cecum). Alternative imaging may be recommended.
If your exam was incomplete, your doctor will discuss next steps, which may include a repeat colonoscopy or alternative testing like CT colonography.