Contents

### **Preface XI**


Chapter 6 **The Malignant Polyp: Polypectomy or Surgical Resection? 141** Josef M. Taylor and Kenneth B. Hosie


Preface

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‐

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

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

> > Valencia, Spain

formation provided by the number and histology of the detected adenomas.

colonoscopy and CRC screening.

