Colorectal polyps

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 14 Aug 2025

Last updated: 01 Nov 2024

Colorectal polyps (adenomas) are predominantly asymptomatic.

Adenomas are highly prevalent and incidence is related to older age, male sex, and family history (first-degree relatives with colorectal cancer).

Most colorectal cancers arise in an adenoma (adenoma-carcinoma sequence).

Colonoscopic polypectomy is diagnostic and therapeutic. Polypectomy reduces the incidence of colorectal cancer by up to 90%.

Surveillance after polypectomy is based upon polyp size, number, and histopathology.

Familial polyposis syndromes should be considered if many polyps are found, particularly in younger patients.

Definition

Colorectal polyps are projections arising from the mucosal surface of the colon and rectum. Polyps may be neoplastic or nonneoplastic; histopathology is required to confirm the nature of the polyp. The two main classes of precancerous colorectal polyps are conventional colorectal adenomas and serrated lesions.[1]

This topic covers diagnosis and treatment of sporadic colorectal polyps.

See Familial adenomatous polyposis syndromes and Peutz-Jeghers syndrome for the diagnosis and treatment of these hereditary conditions.

History and exam

Key diagnostic factors

family history

Full details

Other diagnostic factors

rectal bleeding
mucus discharge
weight loss
tenesmus
change in bowel habit
symptoms and signs of anemia

Full details

Risk factors

increasing age
family history of colorectal cancer or colorectal polyps
previous history of polyps
male sex
acromegaly

Full details

Diagnostic tests

1st tests to order

colonoscopy
CT colonography
chromoendoscopy
histology

Full details

Tests to consider

flexible sigmoidoscopy

Full details

Emerging tests

virtual chromoendoscopy techniques
artificial intelligence-assisted colonoscopy
capsule endoscopy

Treatment algorithm

ACUTE

suitable for endoscopic resection

unsuitable for endoscopic resection

Contributors

Authors

Edward T. Pring, FRCS, PhD

Post CCT Fellow

St Mark’s the National Bowel Hospital

London

Disclosures

ETP declares that he has no competing interests.

Jason Rai, MRCS, MMedEd

General Surgery Specialty Registrar

Oxford Deanery

Clinical Research Fellow

St Mark’s the National Bowel Hospital

London

Disclosures

JR declares that he has no competing interests.

Allison Wallace, MRCS, MSc

General Surgery Specialty Registrar

Oxford Deanery

Clinical Research Fellow

St Mark’s the National Bowel Hospital

London

Disclosures

AW declares that she has no competing interests.

Laura E. Gould, MRCS

General Surgery Specialty Registrar

North East and Central London Deanery

Clinical Research Fellow

St Mark’s the National Bowel Hospital

London

Disclosures

LG declares that she has no competing interests.

Dinh V. C. Mai, MRCS

General Surgery Specialty Registrar

Oxford Deanery

Clinical Research Fellow at St Mark’s the National Bowel Hospital

London

Disclosures

DM declares that she has no competing interests.

Ioanna Drami, MRCS, MSc, BSc

General Surgery Specialty Registrar

North East and Central London Deanery

Clinical Research Fellow at St Mark’s the National Bowel Hospital

London

Disclosures

ID declares that she has no competing interests.

John T. Jenkins, MD

Consultant Colorectal Surgeon

St Mark’s the National Bowel Hopital

London

Disclosures

JTJ declares that he has no competing interests.

Acknowledgements

Mr Edward T. Pring, Mr Jason Rai, Miss Alison Wallace, Miss Laura E. Gould, Mr Dinh V. C. Mai, Miss Ioanna Drami and Mr John T. Jenkins would like to gratefully acknowledge Mr Phil Tozer and Mr George Malietzis previous contributors to this topic.

Disclosures

PT and GM declares that they have no competing interests.

Peer reviewers

John Anderson, FRCS

Consultant Colorectal Surgeon

Glasgow Royal Infirmary

Glasgow

Disclosures

JA declares that he has no competing interests.

Sharon Stein, MD

Assistant Professor of Surgery

Division of Colon and Rectal Surgery

University Hospital Case Medical Center

Cleveland

Disclosures

SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force On Colorectal Cancer. Am J Gastroenterol. 2017 Jul;112(7):1016-30.Full text Abstract

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer [internet publication].Full text

Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep;143(3):844-57.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Colorectal cancer
- Hemorrhoids
- Anal fissure
More Differentials
Guidelines
- NCCN clinical practice guidelines in oncology: colorectal cancer screening
- ACR appropriateness criteria: colorectal cancer screening
More Guidelines
Patient information
Bowel cancer
Colonoscopy
More Patient information
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Colorectal polyps

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

suitable for endoscopic resection

unsuitable for endoscopic resection

Contributors

Authors

Edward T. Pring, FRCS, PhD

Disclosures

Jason Rai, MRCS, MMedEd

Disclosures

Allison Wallace, MRCS, MSc

Disclosures

Laura E. Gould, MRCS

Disclosures

Dinh V. C. Mai, MRCS

Disclosures

Ioanna Drami, MRCS, MSc, BSc

Disclosures

John T. Jenkins, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

John Anderson, FRCS

Disclosures

Sharon Stein, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice