Heterogeneity of colorectal adenomas, the serrated adenoma, and implications for screening and surveillance

Freeman, Hugh James; Yang, Vincent W.; Fichera, Alessandro
June 2008
World Journal of Gastroenterology;6/14/2008, Vol. 14 Issue 22, p3461
Academic Journal
Current algorithms for screening and surveillance for colon cancer are valuable, but may be limited by the underlying nature of the targeted neopplastic lesions. Although part of the success of adenoma removal relates to interruption of so-called "adenoma-carcinoma sequence", an alternate serrated pathway to colon cancer may oppose difficulties with the ultimate results achieved by traditional colonoscopic methods. The endpoint carcinoma in this unique may be derived from a dysplastic serrated adenoma. These tend to be located primarily in the right colon, especially in females, and are frequently associated with co-existent colon cancer. Unfortunately, however, there are few, if any, other identifiable risk factors, including age or family history of colon polyps or colon cancer. Moreover, this alternate serrated may itself also be quite biologically heterogeneous as reflected in sessile serrated adenomas (SSA) with virtually exclusive molecular signatures defined by the presence of either BRAF or KRAS mutations. Screening algorithms in the future may need to be modified and individualized, depending on new information that likely will emerge on the natural history of these biologically heterogeneous lesions that differs from traditional adenomatous polyps.


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