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Fecal Occult Blood Testing

Which Test?

CRC Screening: Target Lesions

Slide 10

October 2011

Let’s move to the indication of colorectal cancer screening, and first consider the target lesions. These ideally include curable stage cancer as shown here, advanced adenomas (this is usually referring to precursor lesions larger than or equal to 1cm and most likely to progress), and….as is increasingly apparent….serrated polyps. Serrated polyps are precursors to roughly 30% of colorectal cancers, typically right-sided, aggressive in their behavior (with perhaps a more rapid growth and progression rate than adenomas), and inconspicuous on colonoscopy. This is a picture of a serrated polyp. One can hardly see this flat, flesh-colored lesion. That is it. To treat these lesions safely, it often requires a submucosal injection of saline before they are removed by incision. Importantly, these lesions have often been ignored in screening trials, and while there are no data reported on their bleeding rates, given their morphology, it is unlikely that they will be detected by fecal blood testing.

CRC Screening: Target Lesions


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