Tubular Adenomas

Tubular adenomas are precancerous polyps in your colon or rectum. Healthcare providers often find them during routine colonoscopies to screen for colon cancer (colorectal cancer).

Even though fewer than 9 out of 100 tubular adenomas become cancer, having them might be a very early warning sign that you have a higher risk of developing colorectal cancer. That early warning could help you reduce your risk.

Symptoms of tubular adenomas

Tubular adenomas rarely cause symptoms. Most people don’t know they have them until a colonoscopy finds them. When they do cause symptoms, the most frequent sign is finding either bright red or dark red blood when you wipe yourself after pooping.

Tubular adenoma causes

These polyps form when cells lining your colon grow faster than usual. Experts don’t know what causes the abnormal growth in the first place.

Anyone can develop tubular adenomas, but you’re at higher risk if:

• You’re a male, age 50 or older
• You smoke or use tobacco products
• You drink a lot of alcohol
• You have obesity
• You eat a diet high in red or processed meat
• You spend most of your day sitting or lying down and not getting much physical activity (sedentary lifestyle)
• You have type 2 diabetes
• You have a family history of cancer (if your parents, siblings or children have colorectal cancer, you’re twice as likely to develop colorectal cancer as someone who doesn’t have that history)
• Your medical history includes inflammatory bowel disease, previous colorectal cancer or ovarian cancer
• You inherited certain gene changes that cause syndromes like familial adenomatous polyposis (FAP) or MUTYH-associated polyposis (MAP) (they often lead to colorectal cancer)

How to lower your risk

Some of these risk factors you can change, and some you can’t. Here are steps you can take to reduce your risk:

• Don’t smoke or use tobacco products (see your healthcare provider for help quitting if you do).
• Avoid alcohol or drink only in moderation.
• Maintain a weight that’s healthy for you.
• Eat red or processed meats only in moderation.
• Stay physically active.

How doctors diagnose this condition

Tubular adenomas are usually found during colonoscopies done to screen for colorectal cancer. During this procedure, healthcare providers use a scope with a camera to check your colon for growths. 

How is it treated?

The primary treatment is to remove the adenomas. This is called a polypectomy. It happens at the same time as your colonoscopy. Providers typically use a wire loop or forceps to pull the adenoma loose from your colon lining. Because you’re sedated during the procedure, you shouldn’t feel pain when it’s removed.

Once your provider removes it, they’ll send it to a lab for testing. A pathologist will examine it under a microscope for cancer cells.

If your provider has any concerns that they may not have removed all the tissue, you may need a repeat colonoscopy in about six months. Tissue left behind can regrow into a new tubular adenoma.

When should I see my healthcare provider?

Contact your healthcare provider if you notice changes in how often you poop or what it looks like. Reach out to them if you see blood, too.

Most importantly, be sure not to skip colorectal cancer screenings.

What can I expect if I have tubular adenomas?

If your healthcare provider finds tubular adenomas while performing your colonoscopy, you’ll probably need to have colonoscopies more frequently than someone who doesn’t have tubular adenomas. This is because tubular adenomas can recur. The risk is greater if you smoke.

People with average colorectal cancer risk usually need a colonoscopy every 10 years starting at age 45. If your provider finds a tubular adenoma, your screening timeline depends on how many you have and whether they’re small. “Small” means less than 10 millimeters, or less than half an inch.

Here are the recommendations from the US Multi-Society Task Force on Colorectal Cancer about how often you’ll need a follow-up colonoscopy based on how many adenomas you have:

• One to two small adenomas: Repeat colonoscopy in seven to 10 years
• Three to four small adenomas: Repeat colonoscopy in three to five years
• Five to 10 small adenomas or any large ones: Repeat colonoscopy in three years
• More than 10 adenomas: Repeat colonoscopy in a year

Keep in mind that your healthcare provider may adjust this timeline based on your overall health or colonoscopy quality.

Is there anything I can do to feel better?

You’re already taking steps to take care of yourself by having the colonoscopy that showed you have tubular adenomas. If you’re feeling anxious about your colonoscopy outcome, it might help to remember a few facts about tubular adenomas:

• Most tubular adenomas never turn into cancer, especially when they’re small.
• Those that do turn malignant take a long time to become cancer, usually about 10 years or more.
• Having colonoscopies on a regular basis means your provider can remove any new tubular adenomas, so they never have a chance to turn into cancer.

What is the difference between a polyp and a tubular adenoma?

A tubular adenoma is one type of polyp. It’s the most common one healthcare providers find and remove during colonoscopies. It can become colorectal cancer over time, but the chances in general are low.

Are tubular adenomas the same as villous adenomas?

No, but they’re related.

Seen under a microscope, both adenomas look like bumps in your colon lining or like tiny cauliflower heads clinging to a stalk. But tubular and villous adenomas have different growth patterns. Tubular adenomas have a regular growth pattern that looks like someone used your colon lining to create orderly rows of tiny test tubes. Villous adenomas look more like fronds from randomly placed ferns.

Understanding the different growth patterns helps healthcare providers assess whether your adenomas are likely to become cancerous. For example, villous adenomas tend to grow more quickly than tubular adenomas and are more likely to become cancerous.