Polyp pT1 colorectal cancer

With the introduction of NHS Bowel Cancer Screening Programme, coupled with advances made in endoscopic equipment and techniques, there is a higher detection rate for early pT1 polyp colorectal cancers (CRC). The current clinical trend is towards a conservative approach without surgical resection, if felt that there is successful endoscopic excision and without unfavourable histology parameters. Nonetheless, the further management of malignant polyps, observation or resection, remains controversial.For the practising pathologists, these endoscopically removed malignant polyp specimens can present unique diagnostic dilemma. In addition, the pathological criteria used lacks adequate evidence base and are not met with good inter-observer agreement that can be applied for pathological substaging of these malignant polyps into high and low risk categories.