Colorectal Neoplasia Surveillance and Management

Colorectal neoplasia spans a continuum from benign polyps to invasive carcinoma, with most colorectal cancers arising via the adenoma–carcinoma sequence or serrated pathways. Detection and removal of premalignant lesions through colonoscopy remains the cornerstone of prevention, supported increasingly by non-invasive modalities such as faecal immunochemical testing and molecular stool assays. Patients are stratified into low-, intermediate- and high-risk categories based on polyp number, size and histological features; this stratification informs tailored surveillance intervals aimed at maximising benefit while minimising harm and resource use. Surveillance colonoscopy has been shown to reduce cancer incidence and mortality, yet challenges persist in guideline adherence, procedure capacity, quality assurance and patient uptake. Socioeconomic factors, comorbidity and regional disparities affect participation in surveillance programmes. Recent advances include refinement of risk models incorporating molecular and procedural quality metrics, the integration of organised recall systems to improve adherence and exploration of non-invasive alternatives for low-risk individuals. Globally, implementation of surveillance strategies must balance local resource constraints with the imperative to prevent colorectal cancer and optimise long-term outcomes.

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Colorectal Neoplasia Surveillance and Management publication trend

The graph below shows the total number of articles in colorectal neoplasia surveillance and management across all publications each year (not limited to Nature Index journals).

Technical terms

Adenoma: A benign epithelial tumour arising in the colon that may progress to carcinoma through genetic and morphological changes.

Advanced adenoma: An adenoma ≥10 mm in diameter or exhibiting villous histology or high-grade dysplasia, indicating an elevated risk of malignant transformation.

Surveillance colonoscopy: A scheduled follow-up endoscopic examination performed after polyp removal to detect recurrent or new neoplastic lesions.

Metachronous polyps: New colorectal polyps developing at a site distant in time from the initial lesion, reflecting ongoing risk after polypectomy.

Serrated polyp: A type of colorectal lesion with saw-tooth crypt architecture, encompassing hyperplastic polyps and sessile serrated lesions that follow a distinct molecular pathway to cancer.

References

1. Retrospective Cohort Study: Scope for Improvement—Barriers to Post‐Polypectomy Surveillance in the Integrated Technologies for Improved Polyp Surveillance Cohort. Alimentary Pharmacology & Therapeutics (2025).
2. Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity. Cancer (2016).
3. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. The Lancet Oncology (2017).
4. Long-term colorectal cancer incidence after adenoma removal and the effects of surveillance on incidence: a multicentre, retrospective, cohort study. Gut (2020).
5. Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study. BMC Gastroenterology (2012).
6. Colorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelines. Gut (2021).
7. Molecular stool testing as an alternative for surveillance colonoscopy: a cross-sectional cohort study. BMC Cancer (2017).
8. Adherence to Physician Recommendations for Surveillance in Opportunistic Colorectal Cancer Screening: The Necessity of Organized Surveillance. PLOS ONE (2013).