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“SPECC and SPECULATION”: Is a significant polyp benign or an early colorectal cancer? How do we know and what do we do?

The adenoma-carcinoma sequence in colorectal cancer, proposed by Basil Morson in 1974, is well accepted [1]. It is the basis of bowel cancer screening with the aim of removing pre-cancerous lesions and earlier stage colorectal cancers. Polypectomy may be the most-efficient and cost-effective means of bowel cancer prevention [2–4] and additionally screening can detect asymptomatic cancers at an earlier stage [5]. As these evolve, more polyps will be detected, in some cases requiring complex management [6,7]. As a consequence of these complexities a “SPECC” (Significant Polyp Early Colorectal Cancer) programme has been developed and funded, by the Pelican Cancer Charity as a regionally delivered workshop for Colorectal Multidisciplinary Teams in England and Wales. The programme has been designed and delivered by a multidisciplinary steering faculty, comprising medical and surgical endoscopists, surgeons, histopathologists, oncologists, radiologists and nurse specialists. The key elements revolve around the definition, recognition, documentation, therapeutic strategies and treatment of a “SPECC” aiming to reduce the incidence of overor under-treatment.