Shinji Tanaka - Endoscopic Management of Colorectal T1(SM) Carcinoma
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- Book:Endoscopic Management of Colorectal T1(SM) Carcinoma
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This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
At present, many T1 (SM) colorectal carcinomas have been diagnosed and treated by endoscopy or surgery. Also, it has been clarified that even for T1b (SM deep invasive) cancer, if there are no other lymph node metastatic risk factors such as unfavorable histologic components, vessel involvement, and a high budding grade, the estimated lymph node metastatic risk is 1.21.4%. On the other hand, recent progress in endoscopy such as endoscopic submucosal dissection (ESD) has made it possible to resect Tis/T1 colorectal cancer endoscopically en bloc regardless of its size. Endoscopic treatment is gradually becoming more commonly used to achieve excisional biopsy even for cT1b colorectal carcinoma like this.
Nevertheless, in order to generalize this practice, we must solve several issues. First, precise invasion depth diagnosis prior to endoscopic resection of the lesion in order to achieve complete en bloc resection is important. En bloc resection is essential to determine the precise histologic diagnosis for deciding curability. Second, generalization of the endoscopic resection technique (polypectomy, endoscopic mucosal resection (EMR), ESD) for en bloc resection is important. Third, adequate handling of the endoscopically resected specimen and precise histologic diagnosis are essential to determine curability. For endoscopic treatment of T1 (SM) colorectal carcinoma, generalization and quality control of these three points are not only important but essential.
Accordingly, the publication of this educational text has been planned to address the above-mentioned issues. We hope that this book will assist in daily clinical practice for treatment of T1 (SM) colorectal carcinoma.
The original version of this book was revised. An erratum to this book can be found at
With recent advances in endoscopic diagnostic and therapeutic technology, the preoperative endoscopic diagnosis of T1 (submucosal) carcinomas will become more important for determining whether detected T1 carcinoma can be cured by endoscopy alone (lesions with <1000 m submucosal invasion) or should be treated by surgery (lesions with 1000 m submucosal invasion). Useful conventional colonoscopic findings suggestive of polypoid-type T1b carcinomas are as follows: an expansion appearance, tumor stiffness or unevenness in the comprehensive view, coarse surface findings, converging folds toward the tumor, poor extension of the surrounding colonic wall, and stiffness or deformity of the colonic lumen. Similarly, useful conventional colonoscopic findings suggestive of flat and depressed-type T1b carcinomas are as follows: an expansion appearance, tumor stiffness or unevenness, protrusion in the depression surface, uneven depression surface, strong redness, converging folds toward the tumor, colonic wall deformity, stiffness of the colonic lumen, and table-like protrusion. If at least one of these colonoscopic findings is detected, then surgery should be considered. However, if none of these colonoscopic findings are detected, endoscopic resection (i.e., endoscopic polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) depending on the lesions shape and size) can be performed.
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