Preface

Chapter 7 **Desmoplastic Reaction in Biopsy Specimens of T1 Stage**

Chapter 8 **In vivo Optical Diagnosis of Polyp Histology: Can We Omit**

**Section 3 Complications of Colonoscopy: Minimizing the Risks of a**

Chapter 9 **The Major Complications of Colonoscopy: Sedation-Related,**

Muhammed Sherid, Salih Samo and Samian Sulaiman

**Section 4 Colonoscopy Is Not the End of the Way: Other Screening**

Robert J. Richards and Jerome Zhengrong Liang

**Hemorrhage Associated with Polypectomy and Colonic**

**Sub-Mucosal Invasion 161**

**VI** Contents

Marco Bustamante-Balén

**Screening Tool 195**

**Perforation 197** Paul Miskovitz

Chapter 10 **Complications of Colonoscopy 215**

**Technologies 241**

Chapter 12 **Virtual Colonoscopy 253**

Chapter 11 **Colon Capsule Endoscopy: Quo Vadis? 243** Samuel N. Adler and Cesare Hassan

**Colorectal Cancer Plays a Critical Role in Defining the Level of**

Shigeki Tomita, Kazuhito Ichikawa and Takahiro Fujimori

**Pathological Examination of Diminutive Polyps? 177**

Colorectal cancer (CRC) is the third more commonly diagnosed cancer in both sexes and it is also the third leading cause of cancer-related death among men and women in the United States.It represents a global public health problem and a heavy burdenfor any healthcare system. Fortu‐ nately, most CRCs originate from an adenoma, a precursor lesion that is easily accessible and re‐ movable. This is the rationale for CRC screening programs, which are aimed to diagnose CRC at an early stage or even better, to detect and resect the advanced adenoma before CRC has devel‐ oped. Recent evidence suggests that colonoscopy with polypectomy is efficient in reducing the in‐ cidence of and mortality from CRC. Moreover, the CRC resection rates have recently been shown to be reduced after the implementation of colonoscopy-based screening programs. As a conse‐ quence, CRC screening programs, either directly with colonoscopy or based on fecal occult blood test, are being implemented in most countries. The physicians who are devoted to endoscopy or who are involved in CRC screening programs face several challenges. They are requested to par‐ ticipate in the organization of population-based CRC screening programs; screening colonoscop‐ ies have to be performed accomplishing quality standards; difficult endoscopic resections are expected because performing colonoscopy in asymptomatic individuals makes possible an early diagnosis of advanced adenomas; and finally clinical decisions have to be made based on the in‐ formation provided by the number and histology of the detected adenomas.

In this background, this book providesaccurate and updated information on several topics to be faced when implementing a CRC screening program.It is divided in four sections, the first one dealing with the epidemiology of CRC and the rationale and challenges of implementing such a program both from a European and American point of view. The second section tackles the issue of managing the findings of a screening colonoscopy, commenting on the use of endoscopic sub‐ mucosal dissection to resect difficult polyps, the significance and management of the malignant polyp and the possibility of using image enhancing technologies to make a presumptive histologi‐ cal diagnosis of diminutive polyps reducing costs without losing efficacy. The third section sum‐ marizes the main risks of diagnostic and therapeutic colonoscopy and how to manage them. And finally the last section comments on virtual colonoscopy and colon capsule endoscopy, technolo‐ gies that are being developed and soon will become part of our screening armamentarium.

The relevance of the topics covered in it and the updated evidence included by the authors turns this book into a very useful tool to introduce the reader in the amazing and evolving field of colonoscopy and CRC screening.

> **Marco Bustamante, MD, PhD** University Hospital La Fe Valencia, Spain

**Section 1**

**Overview of Colorectal Cancer. Implementation**

**of Colorectal Cancer Screening Programs**

**Overview of Colorectal Cancer. Implementation of Colorectal Cancer Screening Programs**

**Chapter 1**

**Colorectal Cancer**

http://dx.doi.org/10.5772/53524

**1. Introduction**

Kouklakis S. Georgios and Asimenia D. Bampali

Additional information is available at the end of the chapter

**1.1. Epidemiology – Clinical presentation-screening**

its development will be discussed here.

common in developed than developing countries.

Colorectal cancer (CRC) is a common and lethal disease. The risk of developing CRC is influenced by both environmental and genetic factors. Colorectal cancer is the third most common cancer worldwide. Clinical symptoms develop late in the course of the disease, and precursor lesions (adenomas) can be easily detected and removed. The disease is a candidate for early detection and prevention by screening. The epidemiology of CRC and risk factors for

**Epidemiology** — CRC incidence and mortality rates vary markedly around the world [1]. Globally, CRC is the third most commonly diagnosed cancer in males and the second in females, with over 1.2 million new cases and 608,700 deaths estimated to have occurred in 2008.Incidence and mortality rates are substantially higher in males than in females [2]. It is the fourth most common cause of cancer death after lung, stomach, and liver cancer. It is more

In the United States, both the incidence and mortality have been slowly but steadily decreasing. Annually approximately 143,460 new cases of large bowel cancer are diagnosed, of which 103,170 are colon and the remainder rectal cancers. Annually, approximately 51,690 Americans

**Incidence** — There is significant geographical variation in age-standardized and cumulative, 0-74 year incidence and mortality rates. Globally, the incidence of CRC varies over 10-fold. The highest incidence rates are in Australia and New Zealand, Europe and North America, and the lowest rates are found in Africa and South-Central Asia [5]. The highest incidence rate of CRC is estimated in the Czech Republic [39-42]. These geographic differences appear to be

and reproduction in any medium, provided the original work is properly cited.

© 2013 Georgios and Bampali; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

die of CRC, accounting for approximately 9 percent of all cancer deaths [6].
