ABSTRACT
The presence of carcinoma in a polyp challenges the clinician to determine whether to observe the patient or perform resection. Managing this peculiar condition is based on an understanding of colorectal carcinoma, colonic anatomy, and endoscopy. Specific principles of polyp evaluation include complete endoscopic excision, proper histologic orientation of the polyp, identification of invasive malignant cells, assessment of tumor grade, and margin of excision. Endoscopic features, histologic features, and depth of invasion are among a variety of criteria that have been used to predict outcome. All such studies are limited by retrospective design and differing definitions of malignancy and outcome. Modern studies of tumor biology suggest that the behavior of carcinoma lies beyond histology and awaits clinical application of this knowledge. Until this happens, given the low risk of elective colon resection, the authors recommend resection for any polyp with poor prognostic features.
KEYWORD
Polyp - carcinoma - endoscopy
