[Precancerous conditions of the lower digestive tract].
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Colon↗
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Results for “Colonic Neoplasms”
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Colonoscopic polypectomy as a tool for management of colonic polyps and detection of new lesions.
Over the past 14 years 1,000 polyps were removed via colonscope and histologically examined. There were 869 neoplastic polyps including 125 carcinomas. Non-neoplastic polyps included 32 inflammatory polyps, 32 metaplastic polyps, 27 juvenile polyps and 17 Peutz-Jeghers type polyps. Ninety-eight focal carcinomas were adequately treated by polypectomy only, whereas 9 out of 26 invasive carcinoma required further operations with one residual carcinoma in the pararectal tissue and colonic wall respectively. The criteria requiring additional surgery in invasive carcinoma are 1) lymphatic permeation of the submucosa, 2) poorly differentiated carcinoma or 3) massive invasion close to the cut end. Not only polypoid adenomas but also flat adenomas were found to exist and seem to play an important role in the adenoma-carcinoma sequence. It became clear that colonscopic polypectomy was a useful tool for the management of colonic polyps.
Adenoma↗
Colo-rectal cancer, the prophylactic effect of polypectomy.
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Colonic Neoplasms↗
[Early clinical diagnosis of stomach and large intestine cancer].
Gastric and colonic cancer, which affect alarmingly also younger age groups to a growing extent, are developing into a serious problem of public health. Not recognized in time, the survival probability is low. The 5-year survival time is 10% with a manifest gastric carcinoma, with colonic cancer it is 30%. If these neoplasias are recognized in a stage in which they correspond to the criteria of an early carcinoma, the chance of recovery will be 90% for the patients. The early gastric carcinoma does not occur without any symptoms, but in more than 80% of the cases it causes differently intensely pronounced symptoms in the epigastric region, with pain, dyspepsia, haemorrhage and loss of weight prevailing. Therefore, epigastric, complaint for more than 4 weeks should give reason for a thorough gastroenterological examination, with endoscopy being superior to radiological examination, even when using advanced methods of examination. Special control is needed for patients of the various risk groups. Patients with a morbus Ménétrie, a pernicious anaemia and a chronic-atrophic gastritis with intestinal metaplasia of the colonic type are exposed to a particularly high risk of carcinoma. Of a special practical importance is the circumstance that a peptic ulcus of the stomach may develop in an already carcinomatously changed mucosa and thus the carcinoma continues growing below a healed peptic lesion. Thus, a gastric ulcer requires a regular and short-term endoscopic control until its final macroscopic and histological healing. The malignant diseases of stomach and large intestine show an inverse behaviour over the past 20 years. The colonic carcinoma develops from an adenoma in 90% of the cases. In most of the cases, this development from the precursors is without any symptoms. Symptoms such as blood in the stools, abdominal pain, change in the action of the bowels, loss of weight, decrease in power and the like indicate already an advanced carcinoma. Among the laboratory tests, only the examination of the faeces for concealed haemorrhage is of some importance as a diagnostic test. The CEA test in not suitable therefore. As also larger adenomas bleed intermittently, there is the chance of recognizing also these prestages of carcinomas by regular examinations of the faeces. In contrast to the simple barium enema, the radiological examination in double contrast reveals changes of the mucosa of the colon up to a size of 1 cm in more than 80% of the cases. Coloscopy, however, is superior to X-ray examination, regarding both expressiveness and efficiency.(ABSTRACT TRUNCATED AT 400 WORDS)
Aged↗
[Mandibular osteoma in colorectal cancer and the cancer family syndrome].
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Adolescent↗
[Roentgen study of the large intestine].
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Adolescent↗
Turner's syndrome associated with sigmoid polyp and colon cancer: report of a case.
A 49-year-old woman with 45,XO karyotype Turner's syndrome and a recent onset of loose-to-watery stool passage was found to have a sigmoid polyp and adenocarcinoma in the ascending colon. Turner's syndrome is a result of a variety of abnormalities of the X chromosome. There are reports that the risk of malignancy, both gonadal and nongonadal in origin, is increased in patients with such chromosomal defects. Although, diet and heredity play important roles in the etiology of colorectal cancer, the relationship between cancer and certain congenital defects should be taken into account.
Adenocarcinoma↗
Carcinoma in situ in nonpolypoid mucosa of the large intestine. Report of a case with significance in strategies for early detection.
A case of carcinoma in situ of the flat, nonpolypoid mucosa of the large intestine in a 32-year-old man is reported. This case is of unusual importance because it was detected by endoscopy and was effectively managed; it sheds further light into the histogenesis of large intestinal carcinomas; and it points to alternate strategies for early detection and prevention of large intestinal carcinomas.
Adult↗
Incidence of synchronous and metachronous colorectal carcinoma.
Two hundred and twenty-three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty-four patients (10.7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis--synchronous carcinoma. In the other six cases a second carcinoma was found at a later time--metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma is discussed.
Adult↗
History of colorectal polypectomy and risk of subsequent colorectal cancer.
In a case control study, which formed part of a large, population-based investigation of the incidence, aetiology and survival of colorectal cancer, 24 of 715 cases and 4 of 727 age/sex group matched controls gave a past history of bowel polypectomy (X21 = 17, P less than 0.001, relative risk = 6.37, 95 per cent confidence interval = 2.2-18.6). There was no significant sex or site difference associated with a history of previous polypectomy. These findings are consistent with the view that colorectal polyps are markers of risk (sixfold in the present study) for the subsequent development of colorectal cancer. The data also support the emerging practice that those with adenomatous polyps need regular surveillance of their large bowel as a screening measure.
Adenocarcinoma↗
Pre-operative or postoperative colonic examination for synchronous lesions in colorectal cancer.
A review of 130 consecutive large bowel examinations at which a cancer of the colon or rectum was diagnosed has been undertaken. Of 50 patients examined by colonoscopy, the whole colon was seen in only 21 (42 per cent) and almost half of these had a tumour in the caecum or ascending colon. In most cases, an incomplete examination was the result of narrowing of the lumen by the tumour preventing passage of the endoscope. Of 80 patients examined by double contrast barium enema, the entire length of the colon was visualized in 83 per cent but the quality of the examination was sufficient to confidently exclude synchronous neoplastic lesions in only 51 per cent. The incidence of synchronous cancer in this series was within the expected range, although two such cancers were not detected until laparotomy, but the incidence of synchronous adenomas was two-thirds of the expected number in colonoscopy patients and one-third in those examined by barium enema. It is concluded that, in patients with known colorectal cancer, preoperative investigation is unreliable for the detection of all synchronous neoplasia and that patients should have postoperative colonoscopy.
Adult↗
Cronkhite-Canada syndrome associated with colon cancer: report of a case.
A 68-year-old man with the clinical features of Cronkhite-Canada syndrome developed cancer of the ascending colon. Although Cronkhite-Canada syndrome has always been considered a benign condition, it may be a premalignant disorder, as suggested by the clinical course of the patient whose case is described herein.
Adenocarcinoma, Mucinous↗
Survival of 727 patients with single carcinomas of the large bowel.
The outcome of 727 patients presenting with solitary colorectal carcinoma over a seven-year period is reviewed. Of the patients, 52 per cent were females 45 per cent were over 70 years and 31 per cent had an emergency admission. Of the tumors, 43 per cent occurred in the rectum and 40 per cent were stage D (not treated curatively). Predisposing causes included inflammatory bowel disease (n = 12) and abdominal irradiation (n = 6); associated adenomatous polyps were present in 22 per cent of resection specimens. Hospital mortality rates (20 per cent overall) were adversely affected by emergency admission (36 per cent), age greater than 70 years (29 per cent) and advanced, stage D disease (31 per cent). Corrected overall five-year survival rate was 32 per cent and, after curative resection, 59 per cent. Of patients in whom curative resection included contiguous organs, 47 per cent survived five years. Survival was reduced in patients over 70 years (26 per cent), in emergency admissions (24 per cent), in poorly differentiated tumors (18 per cent), and if tumor fixity was present (14 per cent). Factors contributing to a favorable outlook included a long history (greater than one year) and a tumor situated in the left colon. Recurrence developed in 47 per cent of patients surviving curative resection and was seldom diagnosed at a curable stage.
Adenocarcinoma↗
Lymphangioma of the large intestine. Report of a case.
Lymphangiomas of the large intestine have been reported more frequently since the development and widespread use of the colonic fiberscope. It is possible to endoscopically diagnose lymphangiomas because they are lustrous and smooth on the surface, pliable on compression, and half of them have a stalk or a waist at the base. Lymphangiomas of the colon and rectum under 20 mm in diameter can be safely resected by electrocautery, thereby avoiding unnecessary operation.
Colonic Neoplasms↗
Plastic wound protectors do not affect wound infection rates following laparoscopic-assisted colectomy.
BACKGROUND: Wound protectors are plastic sheaths that can be used to line a wound during surgery. Wound protectors can facilitate retraction of an incision without the need for other mechanical retractors and have been proposed as deterrents to wound infection. The purpose of this study was to define the ability of wound protectors to reduce the rate of infection when used in laparoscopic-assisted colectomy. METHODS: We completed a retrospective review of the medical records of patients undergoing nonemergent laparoscopic-assisted colectomy between February 1999 and November 2002. All completely laparoscopic cases were excluded. The wound protector, when used, was applied to the extraction incision during the externalized portion of the procedure (colon and mesentery transection, anastomosis). Outcomes for patients with and without the use of a wound protector were compared. RESULTS: A total of 141 patients underwent laparoscopic-assisted colectomy (98 for benign/malignant tumors, 35 for diverticular disease, and eight for Crohn's disease). There were no differences between the wound protector group ( n = 84) and the no wound protector group ( n = 57) with respect to mean age (55 vs 58 years), average body mass index (27 vs 29 kg/m2), gender, indication for surgery, comorbidities, antibiotics used, or mean operative time (185 vs 173 min). Nine patients in the wound protector group and eight in the no wound protector group developed a wound infection at the colon extraction site ( p = 0.42). Patients undergoing resection for Crohn's disease or diverticulitis had a higher infection rate (18.6%) than patients undergoing resection for polyps or cancer (9.2%; p < 0.05). No wound recurrence of cancer was observed in either group at a mean follow-up of 23 months (range, 3-48). CONCLUSIONS: The wound protector, although useful for mechanical retraction of small wounds, does not significantly diminish the rate of wound infection at the bowel resection/anastomotic site. Patients undergoing elective resection for inflammatory processes have higher infection rates than patients undergoing laparoscopic-assisted colectomy for polyps or cancer.
Adult↗
Laparoscopic colon resection for polyps: a good novice case?
PURPOSE: Laparoscopic colon resection of the endoscopically unresectable polyp has been considered an ideal case for the surgeon with moderate laparoscopic colectomy experience because tissues are not inflamed and the lymphadenectomy may not need to be as extensive compared with that required for cancer. To assess the appropriateness of this approach, we evaluated the incidence of invasive cancer in a series of laparoscopic colon resections for polyps. METHODS: A retrospective review was performed of 55 consecutive patients undergoing laparoscopic colon resection for endoscopically unresectable polyps during a 35-month period. Colonoscopy data, polyp characteristics, and final colon pathology were reviewed. RESULTS: On final pathologic examination, 18.2 percent of patients had invasive adenocarcinoma. Patient age, gender, indication for colonoscopy, polyp size, polyp location, polyp characteristics, and colonoscopic biopsy pathology were not predictive of adenocarcinoma on final pathology. CONCLUSIONS: A significant number of endoscopically unresectable polyps harbor adenocarcinoma, thereby requiring a formal lymphadenectomy at resection. Caution should be exercised when considering the laparoscopic resection of an endoscopically unresectable polyp as a "learning" case.
Adenocarcinoma↗
Practical uses of chromoendoscopy and magnification at colonoscopy.
New technologies in the form of high-magnification or zoom colonoscopy complemented by chromoscopic agents permits early detection of neoplastic colorectal lesions, particularly flat and depressed types. Establishing suitability for endoscopic resection or surgical excision can be enhanced using these techniques. Chromoscopic colonoscopy may play an important role in the routine endoscopic colorectal cancer surveillance programs in patients assuming a high risk of colorectal neoplasia. This article summarizes recent data regarding the prevalence and histopathologic characteristics of flat and depressed colorectal lesion in Western cohorts and describes how their detection and management can be improved by chromoscopy and magnification technology. The techniques required for chromoscopic colonoscopy and magnification imaging are outlined along with a review of the literature on these subjects.
Adenoma↗
Radiological evidence for the polyp/cancer sequence in the colon.
Three cases of frank malignancy developing in pre-existing colonic polyps are presented. Although this sequence of events is well recognised, it is rarely demonstrated radiologically. The cases illustrate the importance of identifying and appropriately treating polypoid colonic lesions.
Adenocarcinoma↗