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flat-depressed type early cancers
£Figure1Fflat-depressed type cancers exceeding 10mm

Early colorectal cancer or adenoma has been considered mostly to be of the elevated type, and superficial types, particularly the flat-depressed type, have been regarded as rarity. Therefore, endoscopic treatment has been limited to polypectomy. However, thanks to the efforts of Dr. Shinei Kudo et al. of the Division of Gastroenterology, Akita Red Cross Hospital, flat-depressed type early cancers have come to be detected frequently on close examination of the colon by total colonoscopy. This has made strip biopsy necessary for the diagnosis and treatment.

Since most of flat-depressed type cancers exceeding 10mm in diameter reach the submucosa, they are not indications of strip biopsy, and few of them can be resected as intramucosal cancers. Therefore, flat-depressed type cancers should be regarded as indications of strip biopsy when they are 10mm or smaller.

The figure shows flat-depressed early colon cancer about 10mm in diameter. The lesion had a borderline size between an indication and no indication of strip biopsy, but we performed endoscopic resection after through consultation with the patient. The lesion turned out to be an intramucosal cancer, and we, for the time being,consider that complete cure could be achieved by endoscopic resection. However, for the above reasons, immediate open surgery instead of endoscopic resection is recommended for flat-depressed type cancers of this or greater size.