Cancer for sure!

This lesion was found in the sigmoid. You have magnification, NBI, dye spray and lift to help you decide. 
WHAT IS THE STAGE OF THIS CANCER?

■ Intramucosal

There is no such thing!

■ sm1 invasion

You can see a disorganised crypt pattern?

■ sm2 invasion

That was my guess!

■ sm3 or 'massive' invasion

I think that the lift is better than that!

explanation

I think that it's difficult to tell the difference between no crypt pattern at all and a severely disrupted crypt pattern. Of course, when the crypt pattern is 'severely disorganised' but some of it is still visible, the lesion will be sm1 or sm2. In contrast, if there is no crypt pattern at all, the lesion is sm3 or beyond (the Japanese call this 'massive invasion').

Instead, I rather rely on the degree of lifting. In this case, the endoscopist decided that the lifting was insufficient for a resection and backed off, referring the patient to our MDT. Biopsies confirmed that the lesion was likely to be malignant and the patient ended up with sigmoid resection.

 I think that there is some sort of crypt pattern in the centre of the lesion.  Furthermore, looking at the slight degree of lifting, my guess would be that the lesion is sm1 or sm2 and therefore potentially endoscopically resectable.  Actually the cancer turned out to be sm2 (T1,N0).