The word “dysplasia” can be scary, especially when you hear it from your doctor after they perform a colonoscopy on you. But many
Technically, colon dysplasia can go away on its own, especially if it’s low-grade. But in clinical practice, this is very rare and doctors tend to err on the side of caution and recommend removal of the dysplastic tissue.
If all of that sounds like gibberish to you — don’t worry. In this blog post, we’ll break down colon dysplasia and what it means for you in complete detail.
What is dysplasia in the colon?
Dysplasia is a precancerous condition. It means that the cells lining the colon (or any other organ) look abnormal when viewed under a microscope.
There are different degrees of dysplasia: low grade to high grade dysplasia. Low grade dysplasia means the cells don’t look too abnormal under a microscope. On the other hand, high grade dysplasia means the majority of cells look abnormal, and the degree of abnormality is also high.
So what are these “abnormalities” that we’re talking about? Well, they can mean several things. For example, the cells may be larger than normal, or they might have abnormal nuclei (the part of the cell that contains its DNA). In some cases, the cells might be arranged in an abnormal way, forming an outgrowth known as a polyp.
Can colon dysplasia go away?
Yes, colon dysplasia may go away on its own if it’s not severe. However, it’s important to understand that it’s very rare for this to happen and dysplasia is considered irreversible for all practical purposes.
That’s why doctors generally recommend removing the dysplastic tissue, even if it’s not severe. This is a preventative measure to make sure that the dysplasia doesn’t turn into cancer.
Does dysplasia mean cancer in the colon?
No, dysplasia doesn’t mean cancer in the colon. But it’s important to understand that dysplasia can lead to cancer, if not treated early.
Think of it this way: imagine that your house is made of bricks. The bricks are like the cells in your body, and dysplasia is when some of those bricks are starting to crack.
If you do nothing, the cracks will get bigger and eventually the entire house will collapse. But if you catch the cracks early, you can repair them before they cause too much damage.
The same is true for dysplasia — the longer it’s left untreated, the more abnormal the cells become, ultimately turning into cancer.
What is the difference between dysplasia and cancer?
The main difference between dysplasia and cancer is that dysplasia doesn’t invade the basement membrane while cancer does.
The basement membrane is a layer of tissue that separates the lining of the colon from the underlying connective tissue. It acts as a barrier to prevent cancer cells from spreading.
In other words, dysplastic cells haven’t yet broken through this barrier. So while they have the potential to turn into cancer, they haven’t yet.
Cancer cells, on the other hand, have broken through the basement membrane. This means they can start to invade other tissues and organs, which can be very dangerous.
This is why it’s important to catch dysplasia early on and remove it if possible. Otherwise, it will turn into cancer, break through the basement membrane, and may spread throughout the body.
Why does colon dysplasia occur?
The main reason colon dysplasia occurs is because of inflammation. Inflammation in the colon can be caused by a number of things, including:
- Infections: for example, a bacterial infection like C. difficile
- Inflammatory bowel disease (IBD): this is a condition that causes prolonged inflammation in the digestive tract
- Dietary factors, such as low-fiber, high-fat diets
All of these things put stress on the cells lining your gut. As a result, they start to multiply more rapidly, which is called hyperplasia. Each time a cell multiplies, there’s room for more mistakes to be made during DNA replication.
Eventually, these mistakes —- called mutations — can accumulate to the point where the cells become dysplastic. If the stress on dysplastic cells continues and they keep on dividing, there is an even greater risk for replication errors. Ultimately, this can lead to cancer.
In addition, some mutations can also exist without inflammation and lead to the development of dysplasia. For example, a mutation in the APC gene is a well-known cause of familial adenomatous polyposis (FAP), which is an inherited condition that predisposes people to developing colon dysplasia and cancer.
How is colon dysplasia diagnosed?
Colon dysplasia can be diagnosed through a number of different tests, including:
- Colonoscopy: during this procedure, a doctor inserts a long, flexible tube with a camera into the rectum and colon. This allows them to directly visualize any dysplastic tissue.
- Biopsy: during a colonoscopy, a small sample of tissue can be taken for further analysis. This can confirm the diagnosis of dysplasia.
- Fecal occult blood test (FOBT): this test checks for the presence of blood in the stool, which can be an early sign of colon cancer.
- Imaging tests: such as CT or MRI, can be used to look for signs of cancer. However, they’re not as effective at detecting dysplasia.
If you have any symptoms of colon cancer, such as blood in your stool, abdominal pain, or weight loss, it’s important to see a doctor. They can order the appropriate tests to check for colon dysplasia or cancer.
How is colon dysplasia treated?
The treatment of colon dysplasia depends on the context from which it arose.
If you’re diagnosed with a dysplastic polyp — which is an abnormal, precancerous outgrowth of the colon lining — your healthcare provider may simply remove it during colonoscopy, send it for biopsy, and have you follow up with more frequent colonoscopies.
If your doctor finds out that your dysplasia has invaded the basement membrane — i.e. turned into a cancer — you may be advised to undergo a colectomy, where a part of your colon will be surgically removed.
Another important disease where colon dysplasia develops is IBD. IBD patients are advised to undergo regular colonoscopies, starting 8 years after they’re diagnosed with the condition. Until recently, doctors used to perform colectomy when they detected colon dysplasia in a patient with IBD.
However in 2021, The American Gastroenterological Association convened an expert panel to provide new recommendations on the treatment of dysplasia in IBD patients.
According to these new recommendations, not all IBD patients with dysplasia need to undergo a colectomy. If a healthcare provider thinks the dysplastic area is small and can be removed with the help of an endoscope, that’s the route they should take.
Patients should be sent for colectomy only if the doctor thinks the dysplastic area can’t be removed endoscopically.
Colon dysplasia can go away (but it usually doesn’t)
So as you can see, colon dysplasia is not irreversible like cancer. But for all practical purposes, it’s considered irreversible and doctors recommend removal. This removal can be done through an endoscope in some cases, while other patients will need to have their colons removed.
We understand that the world of cancer can be very confusing, especially when there are a lot of similar terms involved, such as metaplasia and dysplasia.
If you’ve been diagnosed with colon dysplasia and are still confused about what it means for you, feel free to reach out to us. We will be happy to answer your questions!