title: Serrated polyps - a concealed but prevalent precursor of colorectal cancer.
abstract: Serrated polyps have long been considered to lack malignant potential but accumulating data suggest that these lesions may cause up to one-third of all sporadic colorectal cancer. Serrated polyps are classified into three subtypes, including sessile serrated adenomas/polyps (SSA/Ps), traditional serrated adenomas (TSAs), and hyperplastic polyps (HPs). SSA/P and TSA harbour malignant potential but TSA represents only 1-2%, wheras SSA/P constitute up to 20% of all serrated lesions. HPs are most common (80%) of all serrated polyps but are considered to have a low potential of developing colorectal cancer. Due to their subtle appearence, detection and removal of serrated polyps pose a major challenge to endoscopists. Considering that precancerous serrated polyps are predominately located in the right colon could explain why interval cancers most frequently appear in the proximal colon and why colonoscopy is less protective against colon cancer in the proximal compared to the distal colon. Despite the significant impact on colorectal cancer incidence, the aetiology, incidence, prevalence, and natural history of serrated polyps is incompletely known. To effectively detect, remove, and follow-up serrated polyps, endoscopists and pathologists should be well-informed about serrated polyps. This review highlights colorectal serrated polyps in terms of biology, types, diagnosis, therapy, and follow-up.
authors.affiliation: a Department of Clinical Sciences, Section, of Surgery , Skåne University Hospital, Lund University , Malmö , Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Thorlacius
authors.affiliation: b Department of Gastrointestinal Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.affiliation: b Department of Gastrointestinal Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanesaka
authors.affiliation: c Department of Clinical Sciences, Section, of Gastroenterology , Skåne University Hospital, Lund University , Malmö , Sweden.
authors.forename: Otto
authors.initials: O
authors.lastname: Ljungberg
authors.affiliation: b Department of Gastrointestinal Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan.
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.affiliation: d Department of Clinical Sciences, Section, of Pathology , Skåne University Hospital, Lund University , Malmö , Sweden.
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D003106:Colon / Q000473:pathology; D003111:Colonic Polyps / Q000145:classification / Q000473:pathology*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D018450:Disease Progression; D006801:Humans; D006965:Hyperplasia; D011230:Precancerous Conditions / Q000473:pathology*
keywords: Colorectal cancer; colonoscopy; hyperplastic; malignant; polyps