**Author details**

Shigeki Tomita, Kazuhito Ichikawa and Takahiro Fujimori

\*Address all correspondence to: sstomita@dokkyomed.ac.jp

Department of Surgical and Molecular Pathology, DOKKYO Medical University School of Medicine, Tochigi, Japan

[9] Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal car‐ cinomas arising in adenomas: implications for lesions removed by endoscopic poly‐

Desmoplastic Reaction in Biopsy Specimens of T1 Stage Colorectal Cancer Plays a Critical Role in Defining the Level...

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175

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**Chapter 8**

**In vivo Optical Diagnosis of Polyp Histology: Can We**

**Omit Pathological Examination of Diminutive Polyps?**

In the United States colorectal cancer (CRC) is the third more commonly diagnosed cancer in both sexes and it is also the third leading cause of cancer death among men and women [1]. In Europe CRC is the second leading cause of cancer death in both sexes [2]. These figures mean a heavy economic burden for any health system. The national cost of a year of CRC care in the United States has been estimated to be between \$4.5 and \$9.6 billion [3]. In Spain €180.6

Adenomatous polyps are the precursors of CRC in most of the cases. Through a progressive accumulation of mutations and following some of the described carcinogenetic pathways [5], a benign adenomatous polyp develops into an advanced adenoma with high-grade dys‐ plasia (HGD) and then progresses to invasive cancer (Figure 1). Invasive cancers confined to the wall of the colon (TNM stages I and II) are curable by surgery while more advanced can‐

Detecting cancer at an early stage or, even better, diagnosing and resecting adenomas before a carcinoma has developed improves outcomes. This was first confirmed in the initial report of the National Polyp Study [6] which showed a reduction in the incidence of colorectal can‐ cer of around 76% in patients in which a polypectomy had been performed. Recently, the same group has described in the same cohort of patients a reduction in mortality of 53% in the long term [7]. This is the rationale for population-based screening programs, designed to detect advanced adenomas and CRC at an early and curable stage. For instance, recently the results of a nationwide screening colonoscopy program in Germany have been reported of a nationwide screening colonoscopy program in Germany, showing that 69.6% of diagnosed CRC were stages I and II [8]. Therefore, screening for CRC with removal of adenomas and surveillance colonoscopy of patients who have been treated for adenomas or CCR is recom‐

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

© 2013 Bustamante-Balén; 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,

million of annual loses in work productivity because of CRC have been reported [4].

cers are treated by a combination of surgery and chemotherapy.

Marco Bustamante-Balén

http://dx.doi.org/10.5772/53205

**1. Introduction**

Additional information is available at the end of the chapter


**Chapter 8**
