Endoscopic management of polypoid early colon cancer

Endoscopic management of polypoid early colonic cancer (malignant polyps an d polypoid carcinomas) is no longer controversial. When the endoscopist is satisfied that excision is complete and histology is "favorable" (a resecti on margin of 2 mm and well or moderately well differentiated tumor), surger y is unnecessary. When histology shows "unfavorable" characteristics (which a few histologists still take to include invasion into lymphatics), surgic al or laparoscopic resection may be indicated, providing the patient is con sidered at suitable risk Surgery kills some patients without finding residu al cancer and cannot save others with metastases, so it should be recommend ed only with due clinical consideration. Sessile or broad-based polyps, esp ecially those in the rectum, are more likely to be "high risk" and merit sp ecialist management if local removal is to be attempted and to allow proper histologic assessment. Endoscopic approaches such as saline injection poly pectomy, india-ink tattooing, and use of the argon beam coagulator are appl icable in some cases. New approaches that still require trials include ultr asonographic probes, which occasionally clarify the degree of invasion, and prototype stapling devices to allow full-thickness histologic specimens to be obtained.