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PubMed2006

Magnification chromo-colonoscopy.

Chromoscopic colonoscopy using indigo carmine is indispensable for the accurate detection of flat neoplastic lesions. In particular, the dye spray technique facilitates the detection of both flat hyperplastic polyps and highly dysplastic lesions. However, magnification chromo-colonoscopy discriminates adenomas from hyperplastic polyps with greater accuracy than conventional methods by showing distinct and visible pit patterns. A pit pattern represents crypt orifices, which reflect the underlying histological structures and colonoscopists can make histological predictions by observing the pit patterns without obtaining biopsy specimens. The pit patterns are classified as types I, II, IIIL, IIIs, IV and V based on histological characterization of normal mucosa, hyperplastic polyp, polypoid adenoma, flat adenoma, tubulo-villous adenoma and cancerous tissue, respectively. In previous reports, overall accuracy ranged from 80 to 95%. In addition, magnification chromo-colonoscopy is useful for the diagnosis of early cancer associated with substantial invasion of the submucosa, in which type V pits are subclassified as types V-I and V-N. The presence of type V-N pits is significant in correlation to cancer with substantial invasion of the submucosa. Magnification chromo-colonoscopy is useful in clinical decision-making when deciding whether endoscopic resection or bowel resection is the appropriate initial procedure to treat lesions.

Colonic Neoplasms↗
PubMedDate not supplied

OVX1 and CEA in patients with colon carcinoma, colon polyps and benign colon disorders.

The OVX1 tumor marker promises to complement CA125 for detection of early stage ovarian carcinoma. OVX1 has also been shown to be elevated in colon cancer patients. This study is designed to assess serum OVX1 levels in patients with specific stages of colon cancer, colon polyps or other GI disorders. Serum OVX1 and CEA were measured by radioimmunoassay or enzyme immunoassay for 206 patients at the time of colonoscopy or staging for colon carcinoma. In patients with stage I, II, III, or IV colon carcinoma, serum OVX1 was positive in 37%, 48%, 74% and 63%, respectively. Fifty-three percent of patients with colon polyps had elevated OVX1 levels, while OVX1 levels were positive in only 7% of healthy controls. If both OVX1 and CEA were considered, at least one of these markers was elevated in 36%, 60%, 79% or 89% of patients with stage I, II, III or IV colon carcinoma, respectively. The majority of patients with inflammatory bowel disease or diverticulosis also had elevated OVX1 levels. Both markers were positive in 27% of patients with colon carcinoma, and not in any patients with a normal colonoscopy or with a diagnosis of diverticulosis or hemorrhoids. In conclusion, serum OVX1 improves the sensitivity of CEA for detecting colon polyps and colon cancer; however, the use of OVX1 in this setting is hindered by its elevation in non-malignant colonic processes.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed2000

CT of patients with right-sided colon cancer and distal ileal thickening.

OBJECTIVE: The purpose of this study was to analyze the incidence and primary causes of distal ileal wall thickening in 131 patients with right-sided colon cancer. SUBJECTS AND METHODS: During a 2-year period, 131 patients underwent surgical resection for right-sided colon cancer. Of these patients, we analyzed 13 who had distal ileal wall thickening on CT before surgery and also had the cause determined at pathology. CT findings were analyzed with regard to the morphologic features of colonic tumors, bowel wall involvement patterns of the distal ileum, and changes in the pericolic space. RESULTS: Distal ileal wall thickening occurred in 13 (10%) of the 131 patients who had right-sided colon cancer. Three patients had polypoid colon cancer, whereas the other 10 had infiltrative colon cancer. The mean thickness of the involved colonic segments was 1.6 cm (range, 1.0-2.2 cm) with a mean length of 5.2 cm (range, 2.5-10.0 cm). Pericolic infiltration was mild in six patients and moderate in four patients. The mean length and thickness of the affected ileal segments were 3.2 cm (range, 1.5-6.0 cm) and 1.1 cm (range, 0.7-2.0 cm), respectively. On histopathologic examination, neoplastic processes involved the distal ileum in nine (69%) of the 13 patients. This involvement was caused by either direct tumor invasion in seven patients or lymphatic spread in two. In four patients (31%), nonneoplastic processes with edema and congestion involved the distal ileum. CONCLUSION: The distal ileum may be abnormally thickened in about 10% of patients with right-sided colon cancer; this thickening results from tumor extension (69%) or a nontumorous process (31%).

Adult↗
PubMed2002

Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089.

BACKGROUND: The incidence of second primary colorectal cancer in patients with a history of colon cancer, compared with patients with a history of adenomatous polyps, is unknown. It is unclear whether guidelines for colonoscopy screening in patients with polyps are appropriate for patients with previous colon cancer. OBJECTIVE: To determine the incidence of second primary colorectal cancer after treatment for localized colon cancer and to compare this incidence with that of first primary colorectal cancer in both the general population and high-risk patients. DESIGN: Historical cohort study. SETTING: An international, multi-institutional trial of adjuvant 5-fluorouracil-based chemotherapy for localized colon cancer. PATIENTS: 3278 patients with resected stage II and stage III colon cancer. MEASUREMENTS: Occurrence of endoscopic or radiologic colon surveillance and incidence of second primary colorectal cancer. RESULTS: Forty-two cases of second primary invasive colon cancer were found over 15 345 person-years of follow-up, yielding an incidence rate of 274 per 100 000 person-years (95% CI, 196 to 369 per 100 000 person-years) and a cumulative incidence of 1.5% (CI, 1.1% to 2.0%) at 5 years. This rate was compared with rates of first colon cancer in two reference groups: the general population and patients who had undergone frequent colonoscopy and polypectomy because of a history of adenomatous polyps; standardized incidence ratios were 1.6 (CI, 1.2 to 2.2) and 6.8 (CI, 2.7 to 22.0), respectively. CONCLUSION: The incidence of second primary colorectal cancer remains high despite intensive surveillance strategies.

Adenoma↗
PubMedDate not supplied

[Endoscopic treatment of polyps of the large intestine: authors' experience with 250 cases of polypectomy].

The Authors report their experience of endoscopic polipectomy. This technique represents a gold standard treatment for polyps of the colon-rectum because it is safe and effective, being correlated with low-risk of complications as perforation and hemorrhage. Hospitality stay was only 24-48 hours. The polyps were histologically examined and grade of dysplasia was determined. The patients underwent surgical resection of the colon when an invasive carcinoma was found.

Adult↗
PubMed1999

[Retrospective radiographic study of growth of colorectal carcinoma].

Sixty-two patients with 73 colon cancers who were radiographically overlooked were eventually confirmed and treated. The author referred to the films of the past barium enema and tried to determine what kind of morphological changes in the radiologic appearance. And furthermore, pathological features of the lesions were analysed. The following results were obtained: 1) In the cases of colorectal cancer that were retrospectively estimated as the mucosal cancer in the past X-ray films, a rapid growth pattern of tumors was observed after submucosal invasion and during the transition to advanced cancer. 2) The majority of early forms of advanced cancer were suspicious in terms of flat elevation and sessile colorectal lesions. 3) Advanced cancers could be classified pathologically into two types, polypoid growth (PG-ca) and non-polypoid growth (NPG-ca). The two types differed in tumor diameter, and one case of the NPG-ca type in our series showed a slow-growth pattern.

Adult↗
PubMed1990

Synchronous carcinoma of the colon and rectum.

Reports on the incidence of synchronous carcinoma of the colon and rectum have varied from 2 to 11 per cent. The variability is a result of a lack of uniformity in criteria of diagnosis, differences in the population studied and differences in time period used. In this study, we evaluated the incidence and distribution of synchronous lesions during a recent time period before the use of colonoscopy became widespread. We reviewed the records of all patients with newly diagnosed adenocarcinoma of the colon and rectum who were operated upon at our institution between 1976 and 1981. In a total group of 1,000 patients of which 52 per cent were men, there were 54 patients or 5.4 per cent who had synchronous carcinomas. The group of patients with synchronous carcinomas were older than the group with nonsynchronous carcinomas (72.4 versus 68.8 years). There was also a higher incidence of associated benign polyps in the group with synchronous carcinomas (70 versus 30 per cent for a nonsynchronous carcinomas). The anatomic distribution of carcinomas of the colon and rectum in the group with synchronous lesions (111 in total) revealed a higher percentage of carcinomas located on the right side (29.7 versus 22.5 per cent), although the difference did not reach statistical significance. Synchronous carcinomas were located in nonadjacent segments of the colon in 37 per cent. There was no difference in stage between the groups with and without synchronous carcinomas. The preoperative identification of synchronous lesions by either colonoscopy or barium enema is important for the proper treatment of patients with carcinoma of the colon and rectum. Failure to locate these tumors may lead to the demise of the patient.

Adenocarcinoma↗
PubMed1985

[Colonoscopy detection of polyps in patients operated on for colorectal cancer. Prospective study].

Subjects operated upon for colorectal carcinoma seem to constitute a population at high risk of a second colorectal malignancy and/or colonic adenoma (polyp). Ninety-four such patients were examined by colonoscopy. Their distribution by age and sex and the location of cancers in the colon were comparable to those reported in the literature. Colonoscopy was performed 12 +/- 6 months after surgery in 52 patients and was complete in 90% of them. Twenty-seven patients (52%) were found to have one or several polyps distributed throughout the colonic frame and varying in size from 2 to 75 mm (75% were less than 10 mm long). The larger the polyp, the more severe the dysplasia. Three malignant polyps were discovered; they were more than 10 mm in diameter. The colonoscopic examination was repeated annually over more than 3 years in 30 patients: at first repeat examination 54% had polyps which were still present in more than 30% at subsequent examinations. It is concluded that patients operated upon for colorectal carcinoma are at high risk of polyps and/or a second colorectal carcinoma and must therefore be followed-up by repeated colonoscopy.

Colonic Neoplasms↗
PubMedDate not supplied

[Polyps with an invasive degenerated focus].

Advances in technology of flexible endoscopes have greatly changed the management of patients with adenomatous polyps of the colon and rectum. Some controversy still exists concerning the best treatment for invasive polyps. For some authors, invasive polyps need radical operation, while others think that unless cancer goes beyond the bounds of a removed polyp, endoscopic resection is an adequate procedure. We designed a study of 65 patients presenting an invasive carcinoma arising in adenomatous polyps and who underwent a colorectal resection thereafter, in order to determine which endoscopic and histological features correlated best with a curative treatment by polypectomy. When the group of "non-curative polypectomies", (carcinoma in the surgical specimen: 34 patients) was compared to the group of "curative polypectomies" (carcinoma in the surgical specimen: 31 patients), there was no significant difference in the number of pedunculated or sessile polyps but a polyp's size exceeding 30 mm was significantly more frequent in the group of "non-curative polypectomies" (P less than 0.005) as well as a tubulo-villous or villous histological type (P less than 0.001) and presence of vascular neoplastic invasion (P less than 0.01). In conclusion, a surgical resection after endoscopic polypectomy of a polyp containing an invasive carcinoma is necessary for a polyp's size exceeding 30 mm, for a villous or tubulo-villous type and in the presence of vascular neoplastic invasion in the pathological analysis of the removed polyp.

Adenoma↗
PubMed1987

[Colorectal cancer and synchronous adenomatous or malignant polyps--factors influencing its incidence].

A retrospective study was made of 433 patients with colorectal cancer who were operated on between January, 1971 and September, 1986. Two-hundred and forty-eight synchronous polyps (226 adenomas and 22 carcinomas) were found in 128 patients (29.6%). The incidence of polyps varied according to the patient's age, sex, family history of colorectal cancer, and also according to the macroscopic classification, depth of infiltration, and the number of the primary tumors. Of these, macroscopic classification seemed to be the most important factor determined by multivariate analysis. The incidence of synchronous polyps of the protuberant type were the highest (50%), as compared to the ulcerating type (28%) and the infiltrating type (19%) (p less than 0.03).

Adenoma↗
PubMed1988

Background mucosal changes in colorectal carcinomas.

The entire colonic mucosa of 51 cases of colorectal carcinoma was examined histologically. Mucosal lesions including goblet cell hyperplasia, crypt dilatation, ulceration with regeneration, basal cell hyperplasia, metaplastic lesions, and adenomas were encountered. Goblet cell hyperplasia (80.4%) was most prominent adjacent to the carcinoma (transitional mucosa). Whether this represents a precancerous change is controversial. Crypt dilatation (57%) is considered a nonspecific change due to mucosal injury and indicates obstruction to the outlet of the crypts. Ulceration (6%) is often proximal to the carcinoma and is considered secondary to stasis and ischaemia due to obstruction. Basal cell hyperplasia is particularly prominent at the site of lymphoid follicles. It is suggested that the hyperplasia is a reactive response to the presence of stimuli in the intestinal content. It is observed that metaplastic lesions have their origin from these foci of basal cell hyperplasia. The presence of basal cell hyperplasia in metaplastic polyps (14%) indicates that they are active lesions in the process of formation and growth. The occurrence of metaplastic lesions may provide an indication of an adverse environment and a vulnerable mucosa. Adenomas have their origin from basal cells of colonic crypts. They are present in 47% of colorectal carcinoma. The findings support the view that adenomas are the most common and important precursor lesion associated with colorectal carcinoma in man. No de novo foci of malignant transformation was encountered but this does not exclude the possibility of de novo carcinogenesis of the colorectum.

Adenoma↗
PubMed1985

Genetic and familial factors in colorectal cancer.

Of the patients with colorectal cancer, there are some with hereditary disorders such as familial polyposis coli, Gardner's syndrome, Turcot's syndrome, and cancer family syndrome in which colorectal adenocarcinoma develops at a significantly high frequency, and these hereditary diseases are very important and interesting from the viewpoint of carcinogenesis as well as tumorigenesis. On the other hand, Peutz-Jeghers syndrome and juvenile polyposis which likewise are hereditary diseases are often considered to be accompanied with colorectal cancer. On these grounds, 49 cases of familial polyposis coli (including Gardner's syndrome), 12 cases of Peutz-Jeghers syndrome, one case of juvenile polyposis, six pedigrees of cancer family syndrome, experienced at the National Cancer Center Hospital from 1962 to 1984 were reviewed with particular emphasis placed on the recent progress and the natural history of these diseases. Furthermore, a comparative study between single colorectal cancers (1,034 cases) and multiple ones (89 cases) was carried out from the standpoint of familial aggregation and cumulative age incidence. A high association with genetic factors was found in multiple primary colorectal cancer with a family history of colorectal cancer as well as in the well-known hereditary diseases mentioned above. The author presented a conception of the relationship between the human body and tumors from the viewpoint of a comparison among infantile and childhood tumors, hereditary tumors, familial aggregative tumors and the usual tumors observed in old age.

Adenoma↗
PubMed1985

The air contrast barium enema--indications and validity.

The double-contrast barium enema is a highly accurate and readily available procedure which is capable of diagnosing benign and malignant disease of the colon at an early state. The level of accuracy is a function of the radiologist's knowledge and willingness to assume complete responsibility for the patient. While reasonable results may be obtained with the high-kilovoltage single-contrast method, it is our opinion that the double contrast examination is the more sensitive procedure and therefore the technique of choice. The double-contrast examination ideally compliments the colonoscope and offers an alternative method for initial survey procedures or low cost follow-up examinations.

Adenoma↗
PubMed1984

[Possibilities of the local removal of villous tumors of the large intestine].

The study was concerned with the long-term results of local removal of villous tumors of large bowel in 144 cases. A statistical analysis of the treatment results versus such factors as patient's age, size and anatomical pattern of tumor, tumor invasion, villous tumor multiplicity and the concomittance of the latter with tubular adenoma of large bowel as well as the procedure of local removal furnished fresh evidence in support of local intervention provided tumor is free of invasive growth. Radical surgery should be indicated in cases of invasion or villous tumor growing per continuitatem.

Adenoma↗