**Author details**

\* Biopsy margin ≤ 1 mm, piecemeal removal, poorly differentiated tumour, lymphatic or vascular invasion

**Figure 7.** Therapeutic algorithm of pedunculated (0-Ip) polyps.

134 Colonoscopy and Colorectal Cancer Screening - Future Directions

Luis Bujanda Fernández de Piérola1 , Joaquin Cubiella Fernández2 , Fernando Múgica Aguinaga1 , Lander Hijona Muruamendiaraz1 and Carol Julyssa Cobián Malaver1

1 Department of Gastroenterology, Donostia Hospital, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Basque Country (UPV/EHU), San Sebastian, Gipuzcoa, Spain

2 Department of Gastroenterology, Complexo Hospitalario de Ourense, Ourense, Spain

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**Chapter 6**

**The Malignant Polyp:**

http://dx.doi.org/10.5772/52865

**1. Introduction**

risk patients.[2]

**2. Malignant polyps**

Josef M. Taylor and Kenneth B. Hosie

Additional information is available at the end of the chapter

majority in order to adequately treat the minority.

high grade mucosal neoplasm is now preferred. [4]

nomas will be discovered with foci of malignancy within them.

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

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

Not all polyps are created equal. The adenoma carcinoma sequence has long been recog‐ nised as the natural history of colorectal carcinoma and it is therefore logical that some ade‐

For those confined to the mucosa, polyps showing foci of potentially malignant cells are of‐ ten termed *carcinoma in situ*. The lack of lymphatics in the mucosa prevents distant spread and, as these lesions are neither regarded as malignant or treated as malignancies, the term

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

© 2013 Taylor and Hosie; 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,

**Polypectomy or Surgical Resection?**

