Abstract
Colorectal cancer (CRC) is the third most frequently diagnosed cancer in the world. For a long time, only one pathway of colorectal carcinogenesis was known. In recent years, a new “alternative” pathway through serrated adenoma was described. Recent meta-analysis estimated these cancers as about 10% to 30% of all CRCs. Serrated polyps are the second most popular groups of polyps (after conventional adenomas) found during colonoscopy. Serrated polyps of the colon are clinically and molecularly diverse changes that have common feature as crypt luminal morphology characterized by glandular serration. Evidence suggests that subtypes of serrated polyps, particularly TSA and SSA/P, can lead to adenocarcinoma through the serrated pathway. Moreover, the data indicate that the SSA/P are the precursors of colorectal carcinoma by MSI and may be subject to rapid progression to malignancy. An important step to reduce the incidence of CRC initiated by the serrated pathway is to improve the detection of serrated polyps and to ensure their complete removal during endoscopy. Understanding of the so-called serrated carcinogenesis pathway is an important step forward in expanding possibilities in the prevention of CRC.
Highlights
Colorectal cancer (CRC) is the third most frequently diagnosed cancer in the world
This review presents the current knowledge of serrated polyps and their pathways leading to CRC
Evidence suggests that subtypes of serrated polyps, traditional serrated adenoma (TSA) and sessile serrated adenoma/polyp (SSA/P), can lead to adenocarcinoma through the serrated pathway
Summary
Colorectal cancer (CRC) is the third most frequently diagnosed cancer in the world. Each year about 600,000 people die from it [1]. A new “alternative” pathway through serrated adenoma was described. Adenocarcinomas developed from serrated lesions were first described by Jass and Smith [4]. They estimated these cancers as about 10% to 30% of all CRCs. Serrated polyps are the second most popular groups of polyps (after conventional adenomas) found during colonoscopy [5]. It has been challenged that HP was considered as benign lesion, but numerous studies have shown the malignant nature of this lesion In this regard, nature of HP is clinically important. Serrated pathway leading to the development of colon cancer is not homogeneous. Serrated polyps are interdisciplinary problem among gastroenterologists, pathologists, and oncologists
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