Cappell Mitchell S
Division of Gastroenterology, William Beaumont Hospital, MOB 233, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
Gastroenterol Clin North Am. 2008 Mar;37(1):129-60, vii-viii. doi: 10.1016/j.gtc.2007.12.003.
Most colon cancers arise from conventional adenomatous polyps (conventional adenoma-to-carcinoma sequence), while some colon cancers appear to arise from the recently recognized serrated adenomatous polyp (serrated adenoma-to-carcinoma theory). Because conventional adenomas and serrated adenomas are usually asymptomatic, mass screening of asymptomatic patients has become the cornerstone for detecting and eliminating these precursor lesions to reduce the risk of colon cancer. Colonoscopy has become the primary screening test because of its high sensitivity and specificity, and the ability to perform polypectomy. Other screening tests include guaiac tests or fecal immunochemical tests (FIT) for fecal occult blood, and flexible sigmoidoscopy. A minimal colonoscopic withdrawal time of 6 minutes is important to maximize polyp detection at colonoscopy. Chromoendoscopy is an experimental technique used to highlight abnormal colonic areas to identify neoplastic tissue and to potentially determine the histology of colonic polyps at colonoscopy based on superficial pit anatomy.
大多数结肠癌起源于传统腺瘤性息肉（传统腺瘤-癌序列），而一些结肠癌似乎起源于最近才认识到的锯齿状腺瘤性息肉（锯齿状腺瘤-癌理论）。由于传统腺瘤和锯齿状腺瘤通常无症状，对无症状患者进行大规模筛查已成为检测和消除这些癌前病变以降低结肠癌风险的基石。结肠镜检查因其高灵敏度和特异性以及进行息肉切除术的能力，已成为主要的筛查测试。其他筛查测试包括用于检测粪便潜血的愈创木脂测试或粪便免疫化学测试（FIT），以及乙状结肠镜检查。结肠镜检查时至少6分钟的退镜时间对于最大限度地发现息肉很重要。色素内镜检查是一种实验技术，用于突出结肠异常区域以识别肿瘤组织，并有可能在结肠镜检查时根据浅表隐窝解剖结构确定结肠息肉的组织学类型。
