Laterally spreading tumors in the colon and rectum.

The large and relatively flat colorectal neoplastic lesions called laterally spreading tumors are classified as nonpolypoid despite some mixed patterns with protruding nodules. Large hyperplastic polyps and sessile serrated lesions are non-neoplastic lesions that also have this morphology and may potentially progress to neoplasia. All these large and relatively flat lesions are more frequent in the proximal colon and less conspicuous than polypoid lesions. Their underdiagnosis is a major factor in the failure of colonoscopy to prevent cancer in the proximal colon. The treatment of laterally spreading tumors by endoscopic resection (endoscopic mucosal resection, piecemeal endoscopic mucosal resection, endoscopic submucosal dissection), or by surgery is based on a careful morphologic analysis, taking into account the size and surface with nodules or depression. The technique of endoscopic submucosal dissection should be diffused because it reduces the number of surgical indications.