What is serrated polyposis syndrome (SPS)?

Serrated polyposis syndrome (SPS) was formerly called hyperplastic polyposis syndrome. SPS is a rare condition that is characterized by serrated polyps in the colon and/or rectum.

Serrated polyps are a type of growth that stick out from the surface of the colon or rectum. The polyps are defined by their saw-toothed appearance under the microscope. They can often be hard to find. The only way to determine the types of polyps is by removing them and examining them under a microscope.

There are different types of serrated polyps, including:

  • Hyperplastic polyps: These are the most common and are usually located on the left side of the colon. They are not usually precancerous. However, they might call attention to right-sided serrated spots.
  • Sessile serrated polyps [(SSPs), also called sessile serrated adenomas (SSAs)]: These polyps are bigger and are located on the right side. They are not attached by stalks. They are hard to find on endoscopic examination and can turn into cancer somewhat quickly.
  • Serrated adenomas (also called traditional serrated adenomas, or TSAs): These polyps are less common but have dysplasia (abnormal cells) and can progress to cancer.

SPS is defined and diagnosed by criteria set out by the World Health Organization (WHO). People with SPS have a higher risk of developing colorectal cancer and should have a colonoscopy every year once a diagnosis is made. It might be necessary to have colonoscopies every three to six month initially.

Who gets serrated polyposis syndrome (SPS)?

It appears that men and women get SPS at a similar rate. Diagnosis usually occurs when the person is in their 50s or 60s.

Is my family at risk for getting serrated polyposis syndrome (SPS)?

Various studies have suggested that SPS can be inherited, but the inheritance pattern is unknown. First-degree relatives (i.e., parents, siblings and children) of someone with SPS have an increased risk of developing SPS, as well as other colorectal polyps. Approximately 40% of first-degree relatives of people with SPS had polyps found on screening colonoscopy. First-degree relatives should be offered colonoscopy to start at one of the following times, whichever is the soonest: the age of the earliest diagnosis of SPS in the family; at age 40; or 10 years earlier than a diagnosis of colorectal cancer in an SPS family member. Following a baseline exam, colonoscopy should be repeated every five years if no polyps are found. If proximal serrated polyps or multiple adenomatous polyps are found, consider colonoscopy every 1 to 3 years.

What causes serrated polyposis syndrome (SPS)?

SPS results from a tendency to develop serrated polyps in the colon and/or rectum. The exact cause is unknown. Although SPS is believed to be hereditary, no genetic defect has been identified to cause SPS. This means that there is no genetic test that can diagnose SPS.

What are the symptoms of serrated polyposis syndrome (SPS)?

Symptoms are generally caused by the polyps or cancer that develop and are not specific to serrated polyps or to SPS. Common symptoms include:

Patients may not have any symptoms. If you do have any of the above symptoms, you should be evaluated by a physician.

Last reviewed by a Cleveland Clinic medical professional on 09/05/2018.

References

  • Rex DK, Ahnen DJ, Baron JA, Batts KP, Burke CA, et al. Serrated Lesions of the Colorectum: Review and Recommendations From and Expert Panel. Am J Gastroenterol. 2012 Jun 19. doi: 10.1038/ajg.2012.161. [Epub ahead of print];PMID: 22710576
  • Burke CA, Snover DC. Sessile serrated adenomas and their pit patterns: we must first see the forest through the trees. Am J Gastroenterol. 2012 Mar;107(3):470-2. PMID: 22388025
  • Vu HT, Lopez R, Bennett A, Burke CA. Individuals with sessile serrated polyps express an aggressive colorectal phenotype. Dis Colon Rectum. 2011;54(10):1216-23. PMID: 21904135
  • NEJM Group. WHO criteria for serrated polyposis are too restrictive. Accessed 9/13/2018.
  • Chetty R. Traditional serrated adenoma (TSA): morphological questions, queries and quandaries. Journal of Clinical Pathology2016;69:6-11. Accessed 9/13/2018.
  • Syngal S, Brand RE, Church JM, et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110(2):223-62.
  • Byrne, RM, Tsikitis, VM. Colorectal polyposis and inherited colorectal cancer syndromes. Ann Gastroenterol 2018; 31 (1): 1-11. Accessed 9/13/2018.

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