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PubMed1990

Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps.

OBJECTIVE: To determine whether hyperplastic polyps found in the rectosigmoid area of the colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy. DESIGN: Data on patients having colonoscopy collected prospectively according to a set protocol. The size and location of all polyps were noted, and all polyps were biopsied. SETTING: Two university hospitals. PATIENTS: One thousand eight hundred and thirty-six consecutive patients referred for colonoscopy between 31 December 1987 and 31 August 1989. RESULTS: Of the 970 patients who met eligibility requirements, 274 (28.3%) had adenomas and 108 (11.1%) had hyperplastic polyps. The proportion of patients with distal hyperplastic polyps and proximal adenomas (31.9%) was similar to the proportion of those without distal hyperplastic polyps (23.0%) (crude odds ratio, 1.57; 95% CI, 0.77 to 3.06). After adjusting for age and sex, the results were unchanged (adjusted odds ratio, 1.53; CI, 0.82 to 2.88). Patients with distal adenomas, on the other hand, were three times more likely to have proximal adenomas than those without distal adenomas (adjusted odds ratio, 3.42; CI, 1.99 to 5.88). CONCLUSIONS: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomas. Based on the magnitude of the risk difference, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomas. Because rectosigmoid adenomas are associated with proximal adenomas, however, small polyps seen during sigmoidoscopy should be biopsied to determine their type. Colonoscopy should be reserved for patients who are proved to have adenomas.

Adenoma↗
PubMedDate not supplied

[The usefulness of endoscopic polypectomy of rectosigmoid and colon in childhood].

Rectal polyps are relatively frequent in infancy and constitute one of the main causes of hematoquezia during this time of life. They are usually treated with multiple drugs before the correct diagnosis is made. We report our experiences with the use of rectoscopy and colonoscopy for the diagnosis and treatment of 214 patients with rectosigmoid polyps, including other sites in the colon, studied between 1982-1988. The highest incidence was between 3 and 6 years of age (63.8%), and the most frequent location in 253 rectosigmoid polyps (91%) and histologically (99.7%) were juvenile polyps. Endoscopic polypectomy proved to be a valuable method, easy to perform and with few complications to treat colon polyps, thus eliminating the surgical interventions.

Child↗
PubMed1988

[Sonographic imaging and staging of colonic tumors].

Out of 25 clinically, endoscopically or radiologically assured colonic carcinomas 84% could be imaged by sonography and 71% of those could be staged correctly. There were no differences in imaging of carcinomas between different parts of the colon. Sonographic detection of lymphnodules was only partially successful, whereas metastases of the carcinomas were shown in 6 out of 7 cases. Thus sonographic investigation of the colon may provide non-invasive staging of an assured colonic carcinoma and its follow-up controls.

Aged↗
PubMed1984

[Colorectal cancer in the Department of Côte-d'Or].

The present study is based on the data of the digestive tract cancer registry set up for the French department of Cote d'Or (population 455,727). During 1976-1980, 581 colon cancers and 489 rectal cancers were diagnosed. They represent 47 per cent of all recorded gastro intestinal cancers. The annual adjusted incidence rates for colon cancers, adjusted to the world population were 17.5 for males, 13.3 for females. The corresponding rates for rectal cancers were 18.2 for males, 9.7 for females. These rates rank among the high rates found in North America and Western Europe. They are particularly high for rectal cancers. There was an urban predominance for colon cancer in males. Among colorectal cancers, 75 per cent were located in the rectum or sigmoid. Sixty-one per cent of the cases of large bowel cancer underwent curative surgery. The overall 5-year survival rate was 30.0 per cent for colon cancer, 27.4 per cent for rectal cancer. After curative surgery the 5 year survival rates were respectively 53.7 per cent and 47.8 per cent. The most important determinant of survival was the pathological stage of the tumour. These results underline the fact that by its frequency and its severity, colorectal cancer represents a major cancer problem.

Adult↗
PubMed1996

Altered mucin core peptide immunoreactivity in the colon polyp-carcinoma sequence.

Altered mucin glycosylation occurs in colonic adenomas and can correlate with risk for malignant transformation. The purpose of this study was to determine if immunoreactivity of core tandem repeat peptides of specific mucin genes correlates with histopathologic criteria of malignant potential in the colon. Expression of MUC1, MUC2, and MUC3 core tandem repeat proteins was examined in specimens of normal mucosa (n = 20), hyperplastic polyps (n = 10), adenomatous polyps (n = 89), and invasive cancer (n = 19). An immunohistochemical scoring system that takes into account specimen heterogeneity and yields an integrated numerical score subject to statistical analysis was used. RNA message levels from tubular and tubulovillous adenomas (n = 13), normal colon (n = 12), and moderately differentiated adenocarcinomas (n = 8) were determined using RNA slot blot analysis with mucin-specific cDNA probes. MUC1 staining was rarely present in normal colon. MUC2 immunoreactivity was limited to goblet cells in most normal colonic crypts, and MUC3 staining was weakly expressed in the upper crypt regions only. In comparison with normal and hyperplastic specimens, MUC1 and MUC3 immunoreactivity scores were significantly increased in adenomas of increasing villous histology, size, and dysplasia. MUC2 scores were significantly increased in adenomas of greater villous histology and size. Comparable MUC1, MUC2, and MUC3 mRNA levels were present in adenomas and normal colon, whereas mucin mRNA levels were decreased in adenocarcinomas. We conclude that enhanced immunoreactivity of MUC1, MUC2 and MUC3 mucin tandem repeats occurs in adenomatous polyps and is associated with an increased risk for malignant transformation.

Adenoma, Villous↗
PubMed1987

The value of colonoscopic surveillance after curative resection for colorectal cancer or synchronous adenomatous polyps.

Between 1975 and 1984, 270 patients underwent a potentially curative resection for colorectal carcinoma. One hundred eighty-eight patients (70%) underwent preoperative colonoscopy, of which 129 patients (69%) were followed up with at least two postoperative colonoscopies. In 91 patients (70%), preoperative colonoscopy revealed no synchronous adenomatous polyps or cancer. Synchronous adenomatous polyps were found in 35 patients (27%), and three patients (2.3%) had a synchronous invasive cancer. Nineteen (54%) of the 35 patients with synchronous adenomatous polyps developed metachronous adenomatous polyps during the follow-up period compared with 24 (26%) of 91 patients without synchronous adenomatous polyps. The median interval to the development of metachronous adenomatous polyps was 19 months, and all of these polyps were 1 cm or less in size. Patients with synchronous adenomatous polyps less than 30 cm from the primary lesion (68%) developed metachronous polyps more often than did patients whose synchronous adenomatous polyps were more than 30 cm from the primary lesion (37%). Preoperative colonoscopy is important for determining synchronous pathology and identifying patients at risk for metachronous polyps.

Adult↗
PubMed1993

Colonoscopic surveillance after curative resection for colorectal cancer.

Colonoscopic surveillance after resection for colorectal cancer has been advocated to improve detection of anastomotic recurrence, and of synchronous and metachronous tumours. The benefit provided by colonoscopy remains unproven, and the best timing of examination is unclear. To determine the value of colonoscopy after curative resection for large bowel cancer, the efficacy of an endoscopic surveillance programme in the early detection of intraluminal bowel recurrence in a series of patients admitted with colorectal cancer was examined. Between April 1983 and December 1988, 132 patients underwent colonoscopy. Eight (6.1 per cent) were found to have intraluminal recurrence without evidence of extraluminal spread. Six of these recurrences were at the site of anastomosis and two represented metachronous tumour development. All of these patients were symptomatic at the time of diagnosis. In 15 patients (11.4 per cent), adenomatous polyps were discovered during the initial endoscopic examination. These results indicate that colonoscopic surveillance will rarely allow early detection of asymptomatic intraluminal bowel recurrence, but is valuable in the detection of synchronous lesions. Frequent surveillance is not justified in the early postoperative years and colonoscopy should probably be confined to a single procedure to exclude synchronous lesions.

Adenomatous Polyps↗
PubMed1990

Usefulness of performing colonoscopy one year after endoscopic polypectomy.

This retrospective study defines a population with neoplastic colonic polyps who have had colonoscopic polypectomy and, in follow-up within one year, a repeat colonoscopic evaluation. The population was broken down into two groups, one group that had polyps at the second examination and one group that did not. This study determined which factor(s) were significant among this population in distinguishing whether new polyps would be found at one year follow-up. The authors found that among the many variables studied, only polyp multiplicity was significant in predicting polyp recurrence. More than one polyp found at index colonoscopy led to a significant chance of having a new polyp after only one year. Also, it was demonstrated that these "new" polyps were unlikely to have been "missed" polyps from the initial colonoscopy. Because of the shifting location, smaller size, and fewer instances of histologic atypia in these polyps compared with those at index examination, the authors believe that polyps found after one year may be assumed to have arisen de novo. Finally, the authors show that a significant number of polyps occur beyond the reach of the flexible sigmoidoscope (approximately 60 cm). The authors recommend that patients who have polyps undergo a colonoscopic examination. When patients are re-evaluated after having colonoscopic neoplastic polypectomy, they should undergo repeat colonoscopy.

Adenoma↗
PubMed1986

The role of colonoscopy in the assessment of patients with colorectal cancer.

A retrospective review of 176 patients with adenocarcinoma of the colon who underwent total colonoscopy preoperatively demonstrated synchronous carcinomas in 3.4 percent and synchronous polyps in 55.1 percent. Full-column barium enemas (68 patients) failed to identify cancer in 22 percent of patients and synchronous polyps in 58 percent of patients, a statistically significant (P less than 0.001) number of false-negative examinations. Double-contrast barium enemas (30 patients) failed to identify cancer in 27 percent of patients and synchronous polyps in 42 percent of patients, also a statistically significant (P less than 0.007) number of false-negative examinations. Full column and air contrast barium enemas identified all index cancers with distant metastases. Air-contrast barium enemas failed to identify 40 percent of "early" index cancers (confined to the bowel wall, negative nodes), and full-column barium enemas failed to identify 32 percent. The incidence of synchronous carcinoma and polyps underscores the need for total colon evaluation when a primary carcinoma is detected. Because of the poor accuracy of barium studies, total colonoscopy is the method of choice for this evaluation.

Adenocarcinoma↗
PubMed1984

Colonoscopy as a routine preoperative procedure for carcinoma of the colon.

Ninety patients with cancer of the colon who had total colonoscopy in the perioperative period have been reviewed. Almost half of the examinations revealed positive findings, three being unsuspected synchronous carcinomas in an area that would not have been resected with the proposed primary cancer. In addition, 79 polyps in 36 patients, the majority of which were also undetected by barium enema, were found and removed at colonoscopy. Thus, patients with carcinoma of the colon, in view of its tendency to be associated with synchronous polypoid disease, should have colonoscopy in the perioperative period. Whenever possible, this should be carried out preoperatively to confirm the diagnosis, to remove suspected or unsuspected polyps, and to detect unsuspected synchronous carcinoma.

Adenocarcinoma↗
PubMed1985

Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy.

Endoscopic polypectomy has become the preferred technique for the removal of most colorectal adenomas. Whether polypectomy alone or segmental colectomy is the appropriate management of the patient whose adenoma contains carcinoma is a controversial issue. We studied 129 colorectal carcinomas that arose in adenomas and in which invasion was no deeper than the submucosa of the underlying colonic wall. The following factors were evaluated: location; gross appearance (sessile versus pedunculated); histologic type of adenoma (tubular, villous, mixed); grade of carcinoma; level of invasion (0--carcinoma confined to the mucosa, 1--head, 2--neck, 3--stalk, 4--submucosa of underlying colonic wall); vascular invasion; and adequacy of excisional margins. Patients were divided into two groups with respect to outcome: adverse (dead from colorectal carcinoma, alive with colorectal carcinoma or positive nodes on colectomy), and favorable (absence of above). Sixty-three patients were treated by polypectomy alone and 66 by colectomy (21 preceded by polypectomy); there were no operative deaths. Mean follow-up was 81 mo. None of 65 patients with carcinoma confined to the mucosa had an adverse outcome, but 8 of 64 patients with invasive carcinoma did. Level 4 invasion (p less than 0.001) and rectal location (p = 0.025) were the only statistically significant adverse prognostic factors. Seven of 28 level 4 lesions and six of 42 rectal lesions had an adverse outcome; level 4 lesions were overrepresented in the rectum (14 of 42; p = 0.032). We conclude that the level of invasion should be the major factor in determining prognosis for the management of carcinoma arising in an adenoma.

Adenocarcinoma↗
PubMed2000

Intermediate markers as surrogate endpoints in cancer research.

Because studies with surrogate cancer endpoints can be smaller, faster, and substantially less expensive than those with frank cancer outcomes, the use of surrogate endpoints is undeniably attractive. This attractiveness is likely to grow in coming years as the rapidly advancing discoveries in cell and molecular biology generate new therapies requiring testing and new markers that could plausibly serve as surrogates for cancer. Surrogate endpoint studies can certainly be suggestive. They continue to play a legitimate role in phase II studies, and they may give the right answers about intervention effects on or exposure associations with cancer. The problem is the uncertainty attached to most potential surrogates. Except for those few surrogates that are both necessary for and developmentally relatively close to cancer, the existence of plausible alternative pathways makes inferences about cancer from many surrogates problematic. Merely being on the causal pathway to cancer does not in itself constitute surrogate validity. It is the totality of causal connections that is critical. There is, unfortunately, a fairly extensive history of quite plausible surrogate markers giving the wrong answer about various chronic disease therapies. There is no reason to believe that cancer surrogacy is immune to such inferential difficulties. This article is, in part, an invitation, even a plea, for researchers to carry out the investigations necessary to evaluate potential surrogates, particularly surrogate-cancer studies and intervention or exposure-surrogate-cancer mediation analyses. Such studies are needed to generalize from surrogate endpoint findings to cancer. There is, however, an implicit and perhaps unavoidable irony here: the large, long, expensive studies required to evaluate potential surrogates fully are precisely the studies that surrogates were designed to replace. The exposure dependence alluded to earlier complicates matters further: establishing validity for a given surrogate for one intervention or exposure vis-à-vis cancer does not necessarily translate into validity for another intervention or exposure. One can enhance the inferential strength of surrogacy by using further "downstream" markers. Results of trials with CIN3 as an endpoint are arguably more persuasive than those from intervention studies with HPV infection endpoints. Similarly, one could consider only the advanced adenoma (> or = 1 cm, villous elements, or high-grade dysplasia) as the primary endpoint in adenoma recurrence trials. The inferential gain, however, comes with substantial costs: studies with CIN3 endpoints must be much larger than those with HPV infection endpoints; adenoma recurrence trials with sufficient rates of recurrence of advanced adenomas must be five or six times larger than trials with any recurrent adenomas as endpoints. A law emerges here: in using surrogate endpoints, inferential certainty is directly associated with study cost. In other words, one gets what one pays for. The problems inherent in using surrogate endpoints need not be regarded as a cause for pessimism in cancer research. If anything, the limitations of surrogacy are reminders of the complexity of cancer causation and affirm the continued importance of large clinical trials and observational epidemiologic studies with explicit cancer endpoints.

Adenocarcinoma↗
PubMed2000

Morphologic progression of polypoid colon cancer invading muscularis propria.

To clarify the morphologic progression of polypoid growth in colon cancer invading the musculasris propria, we assessed the morphologic changes in 50 such cancers according to the size and shape of the polyp. The shape of the head of the polyp was defined at the widest slice as semicircular or ulcerated. As the cancer invaded the musculasris propria, the head of the polyp thickened and the structure of the head progressively collapsed, causing its shape to change from semicircular to ulcerated. The proliferating cell nuclear antigen percentage of cells with positively stained nuclei labeling index, determined at the deepest point of invasion, significantly correlated with the morphologic progression of the polyp from semicircular to ulcerated (63.2 +/- 6.7% and 74.9 +/- 7.2%, respectively; P < 0.05). These results indicate that the proliferating cell nuclear antigen labeling index may be a useful marker for the morphologic progression of invasive colonic polyps.

Adult↗
PubMedDate not supplied

Incident rates of colonic neoplasia according to age and gender: implications for surveillance colonoscopy intervals.

INTRODUCTION: Current guidelines endorse surveillance colonoscopy at 3 to 5 years following initial detection of neoplasia. However, individual patients' risks may vary according to age and gender. This study aimed to characterize neoplasia recurrence in a large patient cohort undergoing surveillance colonoscopy. METHODS: All patients undergoing two colonoscopies at least 12 months apart between 1996 and 2000, with detection and removal of a polyp on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to age (<50, 50-64, 65-74, > or =75 years) and gender. RESULTS: Overall, 1803 patients underwent two colonoscopies at least 12 months apart (median interval, 140 weeks) with removal of a polyp on initial examination. Polyps > or =5 mm were detected in 334 (19%) patients and polyps > or =10 mm in 105 (6%) on subsequent endoscopy. All age and gender groups were well matched with respect to size of polyp detected on initial colonoscopy (P = 0.2). Kaplan-Meier curves and a Cox proportional hazards model demonstrated similar rates of neoplasia recurrence for all patients irrespective of age and gender. CONCLUSIONS: Similar rates of neoplasia recurrence were observed among patients of different gender and age groups on surveillance colonoscopy. From a health resource utilization perspective, these findings support current recommendations for similar surveillance intervals for patients regardless of age and gender.

Adenoma↗