Normal Colon.- A. Anatomic Considerations.- B. Histology.- Pathology.- A. General Prevalence and Anatomic Distribution.- B. Gross Appearance.- Multiplicity.- Size.- C. Microscopic Features.- Tubular versus Villous Adenomas.- Degree of Dysplasia.- Problems in Grading Dysplasia.- Carcinoma in a Polyp.- Morphometric Studies.- D. Differential Diagnosis.- Hyperplastic (Metaplastic) Polyps.- Mixed Hyperplastic-Adenomatous Polyps.- Juvenile Polyps.- Hamartomatous Polyps.- Polypoid Carcinoma.- Nonepithelial Polyps.- E. The Diminutive Polyp.- F. Other Characteristics of Polyps.- Kinetics.- Electron Microscopy.- Histochemistry.- Markers.- Tissue Culture.- DNA Content.- Doubling Time.- Regression of Polyps.- G. Histogenesis of Polyps.- Adenomatous Polyposes.- A. Familial Polyposis Coli and Gardner's Syndrome.- B. Other Adenomatous Polyposis Syndromes.- C. The Genetics of Adenoma Transmission.- Malignant Potential of Adenomatous Polyps.- A. Association of Polyps and Carcinomas.- Risk Factors for Carcinomas among Polyp-Bearers.- Natural History of Polyps; Metachronous Carcinomas.- Peak Incidences of Adenomatous Polyps and Colorectal Carcinomas.- Metachronous Carcinomas in Subjects with Synchronous Polyps and Carcinomas.- Prevalence of Polyps in Subjects with Colorectal Carcinomas.- Opposing Views.- B. Histological Evidence of Malignant Transformation.- C. Adenomatous Remnants in Carcinomas.- D. Epidemiological Evidence and Etiological Factors.- Sex and Age.- Relationship of Polyps and Colorectal Carcinomas.- Dietary and Other Factors.- Etiology.- E. Findings in Experimental Animals.- Observations.- Genesis of Tumors.- Interpretation of Findings and Relevance to Humans.- F. Alternate Hypotheses of Carcinogenesis.- The Flat Mucosa.- Other Routes.- Nonadenomatous Polyps.- Inflammatory Bowel Disease.- Miscellaneous.- The Field Effect.- Hereditary Nonpolyposis Colorectal Cancer.- G. Conclusions.- Evidence of Malignant Potential of Adenomatous Polyps.- Significance of Malignant Potential of Adenomatous Polyps.- The Problem of the Metachronous Carcinoma.- Detection and Management.- A. Screening, Diagnostic, and Surveillance Techniques.- Principles of Screening.- The At-Risk Population to Be Screened.- Digital Examination of the Rectum.- Stool Blood Tests.- Barium Enema (BE).- Endoscopy.- Proctosigmoidoscopy.- Colonoscopy.- Sensitivity.- Comparisons with Barium Enema.- Effectiveness of Screening.- B. The Malignant Polyp.- The Problem.- Frequency.- Risk Factors for Malignancy in a Polyp.- Size.- Multiplicity.- Villous Component.- Degree of Dysplasia.- Effects of Study Design and Polyp Processing Technique.- Statistical Analysis.- Adverse Outcomes.- Level of Submucosal Invasion by Carcinoma.- Postpolypectomy Therapy.- C. Endoscopic Polypectomy.- How Polyps Are Detected.- Rationale for Detection and Eradication of Polyps.- Manpower and Cost Considerations.- Therapy of Diminutive Polyps.- Polypectomy Technique.- D. Postpolypectomy Surveillance Recommendations.- Recurrent Polyps.- Risk Factors for New Polyps.- Surveillance Schedules.- Effectiveness and Cost of Surveillance.- E. The National Polyp Study.- F. Polyp Registries.- Conclusions.- Glossary and Abbreviations.

Adenomatous Polyps of the Colon: Pathobiological and Clinical Features consolidates the vast body of basic science and clinical data associated with adenomatous polyps of the colon, much of it inspired by the realization that most colorectal carcinomas seem to arise in such polyps. This book strives to evaluate these data, with particular emphasis on their implications for management of polyp-bearing subjects. Topics comprehensively explored include anatomy and histology of the normal colon; pathologic characteristics of adenomatous polyps, differential diagnosis, and grading schemes for degree of dysplasia and villosity; adenomatous polyposes; histologic and epidemiologic evidence for the malignant potential of adenomatous polyps; and detection and management, with special attention to endoscopy, endoscopic polypectomy, the malignant polyp, and post-polypectomy surveillance schedules.

The past 20 years have seen a surge of research into colorectal cancer, which is a reflection of the need to improve our methods of treating patients suffering from this increasingly common form of cancer. Greater knowledge of the basic mechanisms involved in colorectal carcinogenesis is an essential prerequisite to improvements in cancer prevention. In this volume the editors have brought together an impressive list of experts to cover the epidemiology, pathophysiology, morphology and basis for new diagnostic and therapeutic approaches to early detection and prevention. This broad scientific approach provides the reader with up-to-date review of our current state of knowl edge of colorectal carcinogenesis and indicates how this information can be used to generate more research and create new opportunities for diagnosis and treatment. This is a book of knowledge and ideas, some of them still at the stage of theoretical interest, but others with practical potential for the care of patients. I recommend it to those who have a research interest in colorectal carcinogenesis, as well as to readers who wish to know just how far medical scientists have progressed in their efforts to achieve the ideal of cancer prevention."