Colorectal cancer is defined clinically as invasion of dysplastic cells into the submucosa. Lesions with submucosal invasion but without invasion into the muscularis propria are generally called malignant polyps. A stepwise approach produces optimal management of malignant polyps (including polypoid and flat/depressed lesions). The first step is to avoid endoscopic resection of non-pedunculated lesions with endoscopic features that predict deep submucosal invasion. Lesions without such features are candidates for endoscopic resection. The second step is to assess candidates for endoscopic resection for features that predict an increased risk of superficial submucosal invasion. Such lesions should be considered for en bloc endoscopic excision if feasible. The third step is giving patients with endoscopically resected malignant polyps good advice regarding whether to undergo adjuvant therapy, usually surgery. We review the endoscopic and histologic criteria that guide clinicians through these steps.
Bibliographical noteFunding Information:
Funding This work was funded in part by a gift to the Indiana University Foundation in the name of Douglas K. Rex from Scott Schurz of Bloomington, Indiana, and his children.
Conflicts of interest These authors declare the following: Douglas K. Rex: Aries/Cosmo, Boston Scientific, Olympus, Braintree-consultant; Boston Scientific, Sebela, Medtronic, EndoAid Ltd, Olympus, Paion, Braintree, Medivators-research support. Michael Wallace: Cosmo/Aries, Lumendi, GI Supply-consultant; ownership interest in EndoQuality Consulting; Olympus, FUJIFILM, Boston Scientific, Medtronic-research grants. The remaining author discloses no conflicts. Funding This work was funded in part by a gift to the Indiana University Foundation in the name of Douglas K. Rex from Scott Schurz of Bloomington, Indiana, and his children.
© 2019 AGA Institute
Copyright 2019 Elsevier B.V., All rights reserved.
- Colon Polyp
- Colorectal Cancer
- Malignant Polyps
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't