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Anatomical aspects of a SPECC of the colon and rectum

The concept of a significant polyp and early colorectal cancer (SPECC) of the colon and rectum has implications for clinical management depending on the specific anatomical site of the lesion. There are two key issues for all SPECC lesions: ‘Does the neoplasm look benign or have malignant features?’ and ‘Can this SPECC be removed endoscopically or does complete removal require surgical bowel resection?’. Further considerations revolve around specific patient preference, patient fitness and risk/balance of oncological cure [1]. It is pertinent to note that the anatomical location of a SPECC is similar to that of colon and rectal cancer. A recent multicentre UK study on 383 SPECC lesions reported that 33% were classified as originating in the rectum, 27% in the left colon and 29% in the ascending colon and caecum [2].