Serrated polyps Colorectal carcinogenesis and clinical implications

Colorectal cancer (CRC) arises from polyps during the course of several years. Besides adenomatous polyps, serrated polyps have been identified as precursors of colorectal cancer (CRC) and 15-30% of all CRCs may arise via the “serrated neoplasia pathway”. This finding has resulted in a paradigm shift in cancer prevention, since nowadays also all clinically relevant serrated polyps should be detected and resected during colonoscopy. Post-colonoscopy interval carcinomas are defined as CRCs, diagnosed within the time interval to the next surveillance colonoscopy. A relatively large proportion of these post-colonoscopy interval CRCs arise from serrated polyps. This problem seems to be caused by an assemblage of several clinical as well as translational issues.
The studies described in this thesis were performed to further clarify the serrated neoplasia pathway and to try and improve the clinical management of serrated polyps in order to decrease the number of CRCs arising from serrated polyps.