How Does the Serrated Polyp Pathway Alter CRC Screening and Surveillance?

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13 Scopus citations

Abstract

Screening and surveillance for colorectal cancer (CRC) reduces mortality through the detection of early-stage adenocarcinoma, and more importantly the detection and removal of premalignant polyps. While adenomas have historically been considered the most common and screening-relevant precursor lesions, there is accumulating evidence showing that the serrated pathway is an important contributor to CRC, and a disproportionate contributor to interval or postcolonoscopy CRC, particularly in the proximal colon. The serrated pathway is characterized by mutations in the BRAF gene, high levels of methylation of promoter CpG islands (CIMP-high), and the sessile serrated adenoma/polyp (SSA/P) is the most important precursor lesion. The study of serrated polyps has been complicated by evolving nomenclature, substantial variation among pathologists in the identification of SSA/Ps, high variability in endoscopic detection rates, and uncertainty regarding the relation to synchronous and metachronous colonic neoplasia. This paper presents an overview of the serrated polyp pathway and discusses its clinical implications including its impact on CRC screening.

Original languageEnglish (US)
Pages (from-to)773-780
Number of pages8
JournalDigestive diseases and sciences
Volume60
Issue number3
DOIs
StatePublished - Mar 1 2015

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Keywords

  • Colon cancer
  • Colorectal neoplasms
  • Screening
  • Serrated polyps

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology
  • Medicine(all)

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