The malignant adenoma: when to operate and when to watch.
BACKGROUND
Adenomas are the precursors to colorectal cancer. Malignant adenomas represent an early form of colorectal cancer, in which cancer has invaded by direct continuity through the muscularis mucosa into the submucosa. The management of these malignant adenomas depends upon their histological risk factors and the patient's general condition.


METHODS
A literature review of publications regarding the malignant adenoma/polyp using Medline was performed.


RESULTS
The three main histological characteristics associated with an increased risk of residual disease and the potential for metastases are completeness and margin of excision, degree of differentiation and Haggitt level of invasion.


CONCLUSIONS
The dilemma as to which course of action is in the best interest of the patient with high-risk adenoma, be it either therapeutic polypectomy alone or surgical resection, is best resolved by a multidisciplinary team involving the surgeon, pathologist and endoscopist, taking the patient's condition and wishes into account.
Mitchell
Peter J
PJ
Department of Surgery, Wythenshawe Hospital, South Manchester University Hospitals Trust, Southmoor Road, Wythenshawe, Manchester, UK. peter.mitchell40@btopenworld.com
Haboubi
Najib Y
NY
D000236:Adenoma / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual / Q000601:surgery*; D012307:Risk Factors