**1. Introduction**

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140 Colonoscopy and Colorectal Cancer Screening - Future Directions

Endoscopic resection of colorectal polyps is a well-recognised therapy for the prevention of colorectal carcinoma. Roughly 10% of resected polyps contain foci of carcinoma and are of‐ ten termed malignant polyps or polyp cancers. Their incidence is increasing in line with the increasing use of colonoscopy.[1] A proportion of these will have progressed to nodal dis‐ ease before presentation and a further oncological resection should be considered for high risk patients.[2]

The risk of nodal disease at presentation can be stratified by histology but definitive staging information can currently only be obtained by oncological resection, a procedure which can cause significant morbidity and mortality, especially in the elderly. This is of particular rele‐ vance as the majority of patients do not have nodal disease, even for the most dangerous categories of polyp.[3] There is a real risk of causing excess morbidity by over treating the majority in order to adequately treat the minority.
