Colonoscopy: Ascending Colon Cancer - What is the Sequence of Biopsy, Tattoo, etc.

Suggestions to reduce interval cancer after colonoscopy. Currently, we recognize the following four mechanisms: 1. Incomplete colonoscopy to the cecum and cancer missed in the cecum; 2. Overlooked polyps after complete colonoscopy to the cecum; 3. Incomplete polypectomy; 4. Rapid development of cancer before the next scheduled colonoscopy.
Currently, endoscopists typically follow what we have learned over the years - biopsy cancer, place a tattoo, and clear the rest of the colon of all polyps. Recently, another extremely rare possibility for interval cancer after colonoscopy suggested was tumor seeding from cancer which was based on studying a handful of cases in a large healthcare system over years. Suggestions in an editorial to reduce tumor seeding include tattooing before biopsy of cancer, removing other polyps before cancer biopsy, or changing the endoscope after cancer biopsy if polyps need to be removed.
It is a good idea to incorporate these recent observations.