Management of malignant polyps

Malignant polyps of the colon may be managed with endoscopic therapy or oncologic resection, with the appropriateness of each dependent on histologic features, polyp location, and patient preference. Lesions at increased risk for having nodal metastases should undergo oncologic resection. High-risk features include lymphovascular invasion, poor differentiation, and greater depth of submucosal invasion. However, while there are some clear indications for endoscopic or oncologic resection, many cases of malignant polyps fall into a gray zone where management is under debate.