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World J Gastroenterol. Nov 21, 2014; 20(43): 16178-16183
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16178
Management of malignant colon polyps: Current status and controversies
Cary B Aarons, Skandan Shanmugan, Joshua IS Bleier
Cary B Aarons, Skandan Shanmugan, Joshua IS Bleier, Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
Author contributions: Aarons CB performed the literature review, wrote and edited the review; Shanmugan S helped with the editing of the review; Bleier JIS designed the manuscript and critically analyzed and edited the review.
Correspondence to: Joshua IS Bleier, MD, FACS, FASCRS, Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania Health System, 800 Walnut Street, Floor 20, Philadelphia, PA 19104, United States. joshua.bleier@uphs.upenn.edu
Telephone: +1-215-8295333 Fax: +1-215-8295350
Received: February 28, 2014
Revised: July 14, 2014
Accepted: August 13, 2014
Published online: November 21, 2014
Abstract

Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women. It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps. This stepwise progression of normal epithelium to carcinoma, often with intervening dysplasia, occurs as a result of multiple sequential, genetic mutations-some are inherited while others are acquired. Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa (T1). They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario. Emphasis should be initially focused on the endoscopic assessment of these lesions. Suitable polyps should be resected en-bloc, if possible, to facilitate thorough evaluation by pathology. In these cases, proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes. If resection is not feasible endoscopically, then these patients should be referred for surgical resection. This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile. Additionally, we will discuss effective strategies for their overall management.

Keywords: Malignant polyp, Endoscopic mucosal resection, Submucosal invasion, Early colon cancer, Lymphovascular invasion, Tumor budding

Core tip: This article discusses the important prognostic features of malignant polyps that will ultimately inform the overall management. Emphasis should be placed on the risks of residual disease in the colon wall and/or in the surrounding lymph nodes.