This chapter discusses the case of a 67-year-old lady, who attended for colonoscopy as part of the UK Bowel Cancer Screening Program due to positive guaiac fecal occult blood testing. Colonoscopy revealed six right-sided flat serrated lesions, two of which were greater than 10mm and which were removed by endoscopic mucosal resection. Histology confirmed two large sessile serrated adenomas (SSAs) and further small hyperplastic polyps. A diagnosis of serrated polyposis syndrome was made. The chapter explores how often should the patient undergo surveillance colonoscopy and what genetic counseling should she seek. This patient underwent laparoscopic right hemicolectomy. Pathology confirmed serrated adenocarcinoma, T1N0R0, with lymphatic space invasion. Ideally, the decision between right hemicolectomy and total colectomy might have been made on the basis of the molecular profile of the individual tumor, but evidence for this in clinical practice is awaited.