Endoscopic treatment of early colorectal cancer.

Abstract

Early colorectal neoplasia is a localized precancerous lesion of the large intestine associated with negligible risk of lymphatic or systemic dissemination. Early neoplasia consists of adenoma with low- and high-grade dysplasia, intramucosal carcinoma and superficially invasive cancer without other high-risk features. In the majority of cases, early neoplastic lesions are detected by colonoscopy and treated by means of endoscopy resection replacing surgical treatment. Risk of invasive cancer should be stratified during diagnostic colonoscopy using morphological classifications and then, appropriate resection technique (endoscopic polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection or full-thickness resection) is used. Success of endoscopic resection is assessed by histological examination of the resected specimen and in some cases, additional surgical resection with lymphadenectomy should be performed. Colonoscopic surveillance is needed due to the risk of local recurrence and metachronous lesions.