Aim of the leaflet

The aim of this leaflet is to provide further information and advice about colonic polyps.

You will have been given this leaflet because you have had polyps removed from the colon as part of the NHS National Bowel Cancer Screening Programme.

One of the Specialist Screening Practitioners (Bowel Screening Nurses) or endoscopy nurses will have arranged with you the arrangements for receiving your results.

If you have any concerns about the effects following the procedure, you should contact the Bowel Screening Office on the following telephone number for advice:  01522 597548.

What can I expect after the polypectomy?

You may experience some cramp-like discomfort or tenderness and/or bloating in the abdomen (tummy) or slight spotting of blood on the toilet paper – this is normal.

After removal of large polyps (bigger than 1cm) there is a risk of bleeding and/or a hole forming in the bowel wall while the area heals. The healing process can take up to two weeks. You do not need to alter your general activity during this time, however, in some situations you may have been advised by the clinical team to avoid all heavy lifting and strenuous exercise for two weeks after your procedure (this includes work, sport and heavy housework). This is to reduce your chance of complications and bleeding post procedure.

It is important that you read the following information, which explains what to look out for and what to do if you are worried.

If you experience any of the following symptoms, you should ring the Bowel Screening Office on: 01522 597548 between the hours of 7.30am and 5pm. Outside of these hours, ring your local Out of Hours service or, in an emergency, dial 999 or attend the Accident & Emergency Department – ideally at the hospital you were scoped at. If this is not possible, please go to the hospital nearest to you.

If you pass fresh blood or clots from your back passage – more than a few tablespoonfuls.

• If you have severe pains in the abdomen that persist and do not improve.
• If you have severe swelling of the abdomen.
• If you feel generally unwell, with a fever or flu like symptoms.

If you need to attend hospital, please take the coloured copy of your procedure report with you and inform the Bowel Screening Office as soon as possible. You may leave a message on the answerphone. Your call will be returned.

What is a polyp?

A polyp is an overgrowth of the cells that line the inside of the bowel wall. Some people develop a single polyp while others may have two or more. About one in four people over the age of fifty will develop at least one colonic polyp.

Why do polyps develop?

It is not really known why polyps develop. The lining of the bowel constantly renews itself – millions of tiny cells grow, serve their purpose and die as new cells replace them.  Each cell contains genes that determine the behaviour and function of the cell.  If a gene becomes faulty, it can cause the cells to grow more quickly and bunch up on the side of the bowel wall forming a polyp.

You may have a greater chance of developing polyps if:

• You are 50 years of age or older
• You have had polyps before
• Someone in your family has had polyps or cancer of the large bowel
• You eat a lot of fatty foods
• You smoke
• You drink alcohol
• You don’t take regular exercise
• You are overweight

What sorts of polyps are there?

There are two main types of polyps:

Hyperplastic polyps

These are very common and are usually small – less than half a centimetre in diameter. They are generally regarded as harmless and rarely develop into cancer.

Adenomas

These are also common.  Most are less than one centimetre in diameter but may grow to be quite large (3cm to 4cm).  Most adenomas are benign (non-cancerous) but if left, about one in 10 will change and become malignant (cancerous). This process generally takes place over several years.

There are different types of adenomas.  Some types are more prone to changing into cancer than others. Most bowel cancers develop from a polyp that has been present for five to 15 years.

Polyps may be raised on a stalk (pedunculated) or flat (sessile).

What are the symptoms of polyps?

Most people with polyps do not have any symptoms at all.  However, sometimes polyps bleed and that is why the screening test kit you used is designed to look for blood in bowel motions.

Polyps may also produce excess mucus (slime) that may be noticeable on the motions. If polyps are large, they may cause diarrhoea or constipation. Very occasionally a polyp may grow so big it causes a partial or total blockage of the bowel and this may give rise to abdominal pains and/or bloating.

Now I have had polyps removed what happens next?

The polyps that have been removed from your bowel will be sent to the laboratory to be examined under a microscope. This will show the type of polyp and if any of the cells within it have started to change into cancer cells.

Most polyps are benign, but very occasionally a polyp may contain cancer cells. The results from the laboratory will usually say if the polyp (and the cancer, if present) has been completely removed. If it is felt that all the polyp or cancer has been removed you may not need to have any further treatment.

Will I get an appointment to discuss my results?

One of the Bowel Screening Nurses will ring you when the results are available (approximately seven to 10 days after polyp removal).

You will be offered an appointment to receive these results at the hospital where you had your procedure, however, some people  prefer to receive their results over the telephone as this saves a trip to the hospital. This will be discussed with you after your procedure.

Will I need to have further checks?

There are national guidelines that recommend whether you will need to have further colonoscopies to check for more polyps. This depends on the size and number of polyps found in your bowel.

When you are given the laboratory results of your polyps the screening practitioner will explain if you need to have another camera test (surveillance). This usually takes place three years after the original procedure.  If you had only one or two small polyps you will go back into the screening programme.

If you are 55 to 60 years old and do not need surveillance, you will be sent a test kit around your 60th birthday as part of the Bowel Cancer Screening Programme.

If you are already 60 to 74 years old you will either be entered on a surveillance programme or be sent this test kit in two years time. This will be explained to you when you are given your results.

Contact details

If you have any questions about any of the information contained in this leaflet please contact the Bowel Screening Office on the telephone number below (this office covers all the hospitals at United Lincolnshire Hospitals NHS Trust (Lincoln County Hospital, Pilgrim Hospital in Boston, Grantham and District Hospital, County Hospital Louth).

Lincolnshire Screening Centre Direct Dial 01522 597548

NHS Friends and Family Test

We value your feedback and want to make our services as good as possible for you. That is why we will be asking you the following simple question:

“How likely are you to recommend our services to friends and family if they needed similar care or treatment?”

This will be sent to you either by text or as an automated telephone survey within 48 hours of leaving our services which will ask you to rate your experience. We will use your feedback to assess the quality of our service so your response would be very much appreciated. However if you do not wish to take part you can simply reply STOP when you receive the message. Responses to the survey are FREE.

For more information on the Friends and Family Test, please visit www.nhs.uk/friendsandfamily, email patient.experience@ulh.nhs.uk or speak to a member of staff.

Care Opinion

‘Care Opinion’ is an independent feedback service that aims to promote honest and meaningful conversations between patients and health services. It believes that telling your story can help make health services better.

Stories relating to United Lincolnshire Hospitals NHS Trust can be found at—www.careopinion.org.uk/services/rwd

We would like to know more about your experience so we know how we are doing. Your experience counts.

References

Sources of information used in the preparation of this leaflet:

British Society of Gastroenterologists (2020) BSG/ACPGBI/PHE Post polypectomy and post colorectal cancer resection surveillance guidelines

https://www.bsg.org.uk/resource/bsg-acpgbi-phe-post-polypectomy-and-post-colorectal-cancer-resection-surveillance-guidelines.html

NHS Choices (2020)

Bowel Polyps

https://www.nhs.uk/conditions/bowel-polyps/

Core Charity (2010) Polyps in the bowel

http://corecharity.org.uk/wp-content/uploads/2016/06/CORE-PATIENT-INFORMATION-POLYPS-IN-THE-BOWEL.pdf

Other sources of information for patients

www.patient.co.uk – website providing medical information and support

www.netdoctor.co.uk – as above

Bowel charities including Bowel Cancer UK and Cancer Research UK

NHS Bowel Cancer Screening Programme

Lincolnshire Screening Centre