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Liu JR, Zhang J, Duan XL. Risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery. World J Gastrointest Surg 2025; 17:101061. [PMID: 40162401 PMCID: PMC11948130 DOI: 10.4240/wjgs.v17.i3.101061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 11/28/2024] [Accepted: 01/13/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND The surgical management of rectal cancer is continuously advancing, with a current emphasis on minimising the need for a permanent stoma. Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation. AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery. METHODS A retrospective analysis of the demographics, preoperative and intraoperative data, and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted. These clinical data were compared between two groups: Patients with sphincter preservation and those without, categorised as the sphincter-preserved and sphincter-unpreserved groups, respectively. RESULTS Of the 179 patients analysed, 150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group. Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group. Conversely, elevated levels of carcinoembryonic antigen, carbohydrate antigen 19-9, and plasma D-dimer were significantly higher in the sphincter-unpreserved group. Significant differences were also observed between the two groups in terms of place of residence, presence of colonic polyps, neoadjuvant chemotherapy, preoperative radiotherapy, mucinous adenocarcinoma, nerve invasion, and tumour height. No significant differences were observed for other parameters. Logistic regression analysis identified colonic polyps, mucinous adenocarcinoma, nerve invasion, and tumour height as independent risk factors for sphincter preservation. CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified. These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.
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Affiliation(s)
- Jia-Rui Liu
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
- Health Science Center, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Jin Zhang
- Department of Clinical Nutrition, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Xiang-Long Duan
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an 710072, Shaanxi Province, China
- Second Department of General Surgery, Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, Shaanxi Province, China
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Li X, Hu M, Wang Z, Liu M, Chen Y. Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps. J Transl Med 2024; 22:361. [PMID: 38632639 PMCID: PMC11022362 DOI: 10.1186/s12967-024-05111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Most colorectal cancers originate from precancerous polyps. This study aimed to determine the prevalence of colorectal polyps with diverse pathological morphologies and to explore the risk factors for colorectal carcinoma in situ (CCS) and neoplastic polyps. METHODS Inpatients admitted from January 2018 to May 2023 were screened through the hospital information system. Polyps were classified according to pathological morphology. The prevalence of polyps was described by frequency and 95% confidence interval. Univariate and multivariate logistic regression analyses were used to explore the risk factors for CCS and neoplastic polyps. RESULTS In total, 2329 individuals with 3550 polyps were recruited. Among all patients, 76.99% had neoplastic polyps and 44.31% had advanced adenomas. Tubular adenoma had the highest prevalence at 60.15%, and the prevalence of CCS was 3.86%. Patients with a colorectal polyp diameter ≥ 1.0 cm or number ≥ 3 were 8.07 times or 1.98 times more likely to develop CCS than were those with a diameter < 1.0 cm or number < 3, respectively (OR 8.07, 95%CI 4.48-14.55, p < 0.0001; and OR 1.98, 95%CI 1.27-3.09, p = 0.002). The risk of CCS with schistosome egg deposition was also significantly increased (OR 2.70, 95%CI 1.05-6.98). The higher the levels of carbohydrate antigen (CA) 724 (OR 1.01, 95%CI 1.00-1.02) and CA211 (OR 1.16, 95%CI 1.03-1.32) in patients with colorectal polyps were, the greater the risk of CCS. When colorectal neoplastic polyps were analyzed, we discovered that for each 1-year increase in age, the risk of neoplastic polyps increased by 3% (OR 1.03, 95%CI 1.02-1.04), p < 0.0001. Patients with a polyp diameter ≥ 1.0 cm had a 2.11-fold greater risk of neoplastic polyps compared to diameter < 1.0 cm patients (OR 3.11, 95%CI 2.48-3.92), p < 0.0001. In addition, multiple polyps and CA199 levels are risk factors for neoplastic polyps. CONCLUSION More than 3/4 of colorectal polyp patients have neoplastic polyps. Patients are more inclined to develop CCS and neoplastic polyps if they have large polyps (> 1.0 cm) or multifocal polyps. The levels of the tumor markers CA724 and CA211 show some potential usefulness for predicting CCS and may be exploited for early identification of high-risk populations.
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Affiliation(s)
- Xiaojuan Li
- Department of Gastroenterology, Minhang Hospital, Fudan University, Shanghai, 201199, China
| | - Mengting Hu
- Department of General Medicine, Minhang Hospital, Fudan University, Shanghai, 201199, China
| | - Zhangjun Wang
- Proprietary Trading Department, Huaan Securities Co., Ltd, Shanghai, 200120, China
| | - Mei Liu
- Department of General Medicine, Minhang Hospital, Fudan University, Shanghai, 201199, China.
| | - Ying Chen
- Department of Gastroenterology, Minhang Hospital, Fudan University, Shanghai, 201199, China.
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Chen TH, Hsu HC, You JF, Lai CC, Tsou YK, Hsu CL, Fann CSJ, Chien RN, Chang ML. Extracellular Nicotinamide Phosphoribosyltransferase as a Surrogate Marker of Prominent Malignant Potential in Colonic Polyps: A 2-Year Prospective Study. Cancers (Basel) 2023; 15:1702. [PMID: 36980589 PMCID: PMC10046025 DOI: 10.3390/cancers15061702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND/AIMS The implications of extracellular nicotinamide phosphoribosyltransferase (eNAMPT), a cancer metabokine, in colonic polyps remain uncertain. METHODS A 2-year prospective cohort study of patients who underwent colonoscopy was conducted. Biochemical parameters and serum eNAMPT levels were analyzed at baseline and every 24 weeks postpolypectomy. NAMPT-associated single-nucleotide polymorphisms (SNPs), including rs61330082, rs2302559, rs10953502, and rs23058539, were assayed. RESULTS Of 532 patients, 80 (15%) had prominent malignant potential (PMP) in colonic polyps, including villous adenomas (n = 18, 3.3%), adenomas with high-grade dysplasia (n = 33, 6.2%), and adenocarcinomas (n = 29, 5.5%). Baseline associations were as follows: colonic polyp pathology (p < 0.001), total cholesterol (p = 0.019), and neutrophil-to-lymphocyte ratio (p = 0.023) with eNAMPT levels; and age (p < 0.001), polyp size (p < 0.001), and eNAMPT levels (p < 0.001) with polyp pathology. Higher baseline eNAMPT levels were noted in patients harboring polyps with PMP than in patients without PMP (p < 0.001), and baseline eNAMPT levels significantly predicted PMP (cutoff: >4.238 ng/mL, p < 0.001). Proportions of eNAMPT-positive glandular and stromal cells were higher in polyps with PMP than in polyps without PMP (64.55 ± 11.94 vs. 14.82 ± 11.45%, p = 0.025). eNAMPT levels decreased within 48 weeks postpolypectomy (p = 0.01) and remained stable afterward regardless of PMP until 96 weeks postpolypectomy. However, those with PMP had a higher degree of eNAMPT decline within 24 weeks (p = 0.046). All investigated SNPs were in linkage disequilibrium with each other but were not associated with eNAMPT levels. CONCLUSION With a link to inflammation and lipid metabolism, along with its decreasing trend after polypectomy, serum eNAMPT may serve as a surrogate marker of PMP in colonic polyps. In situ probing of the NAMPT-associated pathway holds promise in attenuating PMP, as much of the eNAMPT likely originates from colonic polyps.
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Affiliation(s)
- Tsung-Hsing Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Hung-Chih Hsu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Jeng-Fu You
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Cheng-Chou Lai
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yung-Kuan Tsou
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Chia-Lin Hsu
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Cathy S. J. Fann
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115, Taiwan
| | - Rong-Nan Chien
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Ming-Ling Chang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
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Davoodvandi A, Fallahi F, Tamtaji OR, Tajiknia V, Banikazemi Z, Fathizadeh H, Abbasi-Kolli M, Aschner M, Ghandali M, Sahebkar A, Taghizadeh M, Mirzaei H. An Update on the Effects of Probiotics on Gastrointestinal Cancers. Front Pharmacol 2021; 12:680400. [PMID: 34992527 PMCID: PMC8724544 DOI: 10.3389/fphar.2021.680400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/26/2021] [Indexed: 12/28/2022] Open
Abstract
Because of their increasing prevalence, gastrointestinal (GI) cancers are regarded as an important global health challenge. Microorganisms residing in the human GI tract, termed gut microbiota, encompass a large number of living organisms. The role of the gut in the regulation of the gut-mediated immune responses, metabolism, absorption of micro- and macro-nutrients and essential vitamins, and short-chain fatty acid production, and resistance to pathogens has been extensively investigated. In the past few decades, it has been shown that microbiota imbalance is associated with the susceptibility to various chronic disorders, such as obesity, irritable bowel syndrome, inflammatory bowel disease, asthma, rheumatoid arthritis, psychiatric disorders, and various types of cancer. Emerging evidence has shown that oral administration of various strains of probiotics can protect against cancer development. Furthermore, clinical investigations suggest that probiotic administration in cancer patients decreases the incidence of postoperative inflammation. The present review addresses the efficacy and underlying mechanisms of action of probiotics against GI cancers. The safety of the most commercial probiotic strains has been confirmed, and therefore these strains can be used as adjuvant or neo-adjuvant treatments for cancer prevention and improving the efficacy of therapeutic strategies. Nevertheless, well-designed clinical studies are still needed for a better understanding of the properties and mechanisms of action of probiotic strains in mitigating GI cancer development.
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Affiliation(s)
- Amirhossein Davoodvandi
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Farzaneh Fallahi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Omid Reza Tamtaji
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vida Tajiknia
- Department of Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zarrin Banikazemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Hadis Fathizadeh
- Department of Laboratory Sciences, Sirjan Faculty of Medicine Sciences, Sirjan, Iran
| | - Mohammad Abbasi-Kolli
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maryam Ghandali
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Taghizadeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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Impact of Electronic Chromoendoscopy on Adenoma Miss Rates During Colonoscopy: A Systematic Review and Meta-analysis. Dis Colon Rectum 2019; 62:1124-1134. [PMID: 31162375 DOI: 10.1097/dcr.0000000000001419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The impact of virtual chromoendoscopy such as narrow-band imaging, Fujinon intelligent chromoendoscopy, blue-light imaging, linked-color imaging, and i-SCAN on adenoma detection rate has been variable. However, adenoma miss rate (another measure suggested as a quality indicator) of electronic chromoendoscopy modalities has not been systematically evaluated. OBJECTIVES This study aimed to perform a systematic review and meta-analysis to examine the adenoma miss rate of white-light endoscopy compared with electronic chromoendoscopy. DATA SOURCES Medline, Embase, Scopus, Web of Knowledge, and Cochrane were the data sources for this study. STUDY SELECTION The studies selected were tandem randomized controlled trials of electronic chromoendoscopy modalities compared with white-light endoscopy. INTERVENTIONS Electronic chromoendoscopy compared with white light endoscopy was used to measure the adenoma miss rate. MAIN OUTCOME MEASURES Primary outcome was the pooled adenoma miss rate of electronic chromoendoscopy techniques compared with white-light endoscopy. Secondary outcomes were subgroup analysis, adenoma size analysis, and adenoma detection rate. RESULTS A total of 3507 patients were evaluated from 7 eligible tandem randomized control trials. A total of 1423 patients had white-light endoscopy as the first of the tandem examinations. The rest of the patients had electronic chromoendoscopy as the first of the tandem examination (narrow-band imaging, 988 patients; Fujinon intelligent chromoendoscopy, 728 patients; i-SCAN, 233 patients; blue-light imaging, 64 patients; and linked-color imaging, 71 patients). The pooled adenoma miss rate for electronic chromoendoscopy was not different than white-light endoscopy (17.9% vs 21%; OR, 0.72 (0.67-1.11); I 67%; p = 0.13). When only narrow-band imaging, blue-light imaging, and linked-color imaging were considered, the pooled rate was statistically significant (OR, 0.60 (0.37-0.98); p = 0.04). The pooled adenoma detection rate was not statistically different with electronic chromoendoscopy than white-light endoscopy (OR, 1.02 (0.88-1.19); p = 0.78). LIMITATIONS The small number of studies to assess the impact of each modality limited stratified conclusions. CONCLUSIONS Electronic chromoendoscopy is not associated with a significant reduction in adenoma miss rate compared with white-light colonoscopy.
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Ahadi M, Kazemi Nejad B, Kishani Farahani Z, Mollasharifi T, Jamali E, Mohaghegh Shalmani H, Dehgan A, Saberi Afsharian M, Sadeghi A, Movafagh A, Boran R, Rakhshan A, Moradi A, Heidari MH, Moradi A. Clinicopathologic Features of Colorectal Polyps in Shahid Beheshti University of Medical Sciences (SBMU). Asian Pac J Cancer Prev 2019; 20:1773-1780. [PMID: 31244299 PMCID: PMC7021591 DOI: 10.31557/apjcp.2019.20.6.1773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/24/2019] [Indexed: 12/24/2022] Open
Abstract
Aim: This study was designed to report epidemiologic findings of polyps in Iranian patients, and predict histology of polyp regarding to demographic and colonoscopic findings. Background: Classification of colorectal polyps had been revised in the past two decades and there is a need for polyp categorization in the Iranian Health System. Patients and methods: In this retrospective study, the medical records of patients with colonoscopic diagnosis of polyp in pathology departments of SBMU affiliated teaching hospitals were reviewed. Patient’s slides evaluated and demographics findings were assessed. The anatomical location, macroscopic appearance including size and histological assessment of all polyps were recorded. Results: From total number of 1106 polyps (detected in 862 patients), adenomatous polyps (638 [57.7%]) were the most prevalent findings, followed by colon mucosal tag (184[16.6%]), hyperplastic and serrated polyps (122[11%]), inflammatory polyps (110[9.9%]), hamartomatous (21[1.9%]), and malignant lesions (13[1.2%]). Multivariate logistic regression showed age (each one year increasing age; odds ratio [OR] = 1.026, 95%confidence interval [CI] = 1.016–1.036, p < 0.0001), location of polyp (right colon; OR = 1.905, 95%CI = 1.366–2.656, p < 0.0001), and polyp size of 5-10 mm (OR = 1.662, 95%CI = 1.214–2.276, p = 0.002), and polyp size of >10 mm (OR = 2.778, 95%CI = 1.750–4.411, p< 0.0001) were independently associated with neoplastic polyps. Also, polyp size of >10 mm (OR= 2.613, 95%CI= 1.083-6.307, p=0.033), tubulovillous pattern of polyp (OR= 3.508, 95%CI= 1.666-7.387, p=0.001) and villous pattern of polyp (OR= 10.444, 95%CI= 4.211-25.905, p<0.0001) were associated with high grade dysplasia in neoplastic polyps. Conclusion: Increased age, location of polyp (right colon), increased size of polyp and villous component of polyp could classify patients in high risk groups.
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Affiliation(s)
- Mahsa Ahadi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behrang Kazemi Nejad
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Tahmineh Mollasharifi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elena Jamali
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Mohaghegh Shalmani
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Dehgan
- Department of Pathology, Hamedan University of Medical Sciences, Hamedan, Iran
| | | | - Amir Sadeghi
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, Schoolof Medicine, Shahid Behesti University of Medical Sciences, Tehran, Iran
| | - Roxana Boran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azadeh Rakhshan
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arsham Moradi
- University of Toronto, Department of Biology, Toronto, Canada
| | - Mohammad Hassan Heidari
- Department of Anatomy, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moradi
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pandurangan AK, Divya T, Kumar K, Dineshbabu V, Velavan B, Sudhandiran G. Colorectal carcinogenesis: Insights into the cell death and signal transduction pathways: A review. World J Gastrointest Oncol 2018; 10:244-259. [PMID: 30254720 PMCID: PMC6147765 DOI: 10.4251/wjgo.v10.i9.244] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/05/2018] [Accepted: 06/28/2018] [Indexed: 02/05/2023] Open
Abstract
Colorectal carcinogenesis (CRC) imposes a major health burden in developing countries. It is the third major cause of cancer deaths. Despite several treatment strategies, novel drugs are warranted to reduce the severity of this disease. Adenomatous polyps in the colon are the major culprits in CRC and found in 45% of cancers, especially in patients 60 years of age. Inflammatory polyps are currently gaining attention in CRC, and a growing body of evidence denotes the role of inflammation in CRC. Several experimental models are being employed to investigate CRC in animals, which include the APCmin/+ mouse model, Azoxymethane, Dimethyl hydrazine, and a combination of Dextran sodium sulphate and dimethyl hydrazine. During CRC progression, several signal transduction pathways are activated. Among the major signal transduction pathways are p53, Transforming growth factor beta, Wnt/β-catenin, Delta Notch, Hippo signalling, nuclear factor erythroid 2-related factor 2 and Kelch-like ECH-associated protein 1 pathways. These signalling pathways collaborate with cell death mechanisms, which include apoptosis, necroptosis and autophagy, to determine cell fate. Extensive research has been carried out in our laboratory to investigate these signal transduction and cell death mechanistic pathways in CRC. This review summarizes CRC pathogenesis and the related cell death and signal transduction pathways.
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Affiliation(s)
- Ashok kumar Pandurangan
- Cell Biology Laboratory, Department of Biochemistry, University of Madras, Guindy Campus, Chennai 600025, India
- School of Life sciences, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai 600048, India
| | - Thomas Divya
- Cell Biology Laboratory, Department of Biochemistry, University of Madras, Guindy Campus, Chennai 600025, India
| | - Kalaivani Kumar
- School of Life sciences, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai 600048, India
| | - Vadivel Dineshbabu
- Cell Biology Laboratory, Department of Biochemistry, University of Madras, Guindy Campus, Chennai 600025, India
| | - Bakthavatchalam Velavan
- Cell Biology Laboratory, Department of Biochemistry, University of Madras, Guindy Campus, Chennai 600025, India
| | - Ganapasam Sudhandiran
- Cell Biology Laboratory, Department of Biochemistry, University of Madras, Guindy Campus, Chennai 600025, India
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Jung P, Park SB, Kim HW, Kang DH, W. Choi C, Kim SJ, Nam HS, Ryu DG, Hong JB, Kim DJ. Cimetropium bromide does not improve polyp and adenoma detection during colonoscope withdrawal: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore) 2018; 97:e11253. [PMID: 29924056 PMCID: PMC6023662 DOI: 10.1097/md.0000000000011253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Endoscopic inspection of colonic mucosa is disturbed by colonic folds and peristalsis, which may result in missed polyps. Cimetropium bromide, an antispasmodic agent, inhibits peristalsis and colonic spasms, which may improve polyp detection. The purpose of this randomized, double-blind, placebo-controlled study was to investigate whether cimetropium bromide could improve polyp and adenoma detection in the colorectum and right colon. METHODS Patients undergoing screening or diagnostic colonoscopy were randomized to receive intravenous cimetropium bromide (5 mg) or placebo after cecal intubation. The primary outcomes were the number of polyps per patient (PPP) and adenomas per patient (APP); secondary outcomes were the polyp detection rate (PDR), adenoma detection rate (ADR), and advanced neoplasm detection rate (ANDR). RESULTS A total of 181 patients were analyzed; 91 patients received cimetropium bromide and 90 patients received placebo. Cimetropium bromide and placebo groups did not significantly differ in the PPP and APP for the colorectum (1.38 ± 1.58 vs 1.69 ± 2.28, P = .298; 0.96 ± 1.27 vs 1.11 ± 1.89, P = .517, respectively) and right colon (0.70 ± 0.95 vs 0.78 ± 1.21, P = .645; 0.47 ± 0.81 vs 0.51 ± 0.81, P = .757, respectively). Two groups also did not significantly differ in the PDR, ADR, and ANDR for the colorectum and right colon. Furthermore, there were no difference between groups in the PPP, APP, PDR, ADR, and ADNR in a sub-analysis of expert and non-expert endoscopists. CONCLUSIONS Cimetropium bromide did not improve polyp and adenoma detection in the colorectum and right colon during colonoscope withdrawal, regardless of the expertness of the endoscopist. However, its use may be helpful in patients with active peristalsis or for beginning endoscopists during standard colonoscopy without a transparent cap.
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Affiliation(s)
- Peel Jung
- Department of Internal Medicine, Good Moonhwa Hospital, Dong-Gu, Busan
| | - Su B. Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Hyung W. Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Dae H. Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Cheol W. Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Su J. Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Hyeong S. Nam
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Dae G. Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Joung B. Hong
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan
| | - Dong J. Kim
- Department of Internal Medicine, Ilsin Christian Hospital, Dong-Gu, Busan, Republic of Korea
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Fei W, Chen L, Chen J, Shi Q, Zhang L, Liu S, Li L, Zheng L, Hu X. RBP4 and THBS2 are serum biomarkers for diagnosis of colorectal cancer. Oncotarget 2017; 8:92254-92264. [PMID: 29190912 PMCID: PMC5696178 DOI: 10.18632/oncotarget.21173] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/29/2017] [Indexed: 01/13/2023] Open
Abstract
The potential role of serum RBP4 and THBS2 as biomarker in colorectal cancer (CRC) diagnosis has never been studied. We investigated in large sample using quantitative ELISA method to explore whether serum RBP4 and THBS2 can act as biomarkers for CRC diagnosis. The concentration of RBP4 and THBS2 was measured in 402 CRC patients' serum samples and 218 normal controls' serum samples. The results showed that the average RBP4 and THBS2 concentrations in normal controls were significantly higher than in CRC patients (36.5±11.4μg/mL vs 21.8±8.7μg/mL and 20.5±6.1ng/mL vs 14.5±7.3ng/mL, respectively), both p<0.001. RBP4 distinguished CRC patients from normal individuals with the area under the receiver operating characteristic curve (AUC) performing at 0.852, with sensitivity of 74.9% and specificity of 81.7%. While THBS2 distinguished CRC patients performing AUC at 0.794, with sensitivity of 64.9% and specificity of 87.1%. The ability of RBP4 and THBS2 serum concentration distinguishing CRC from normal controls showed better than that of serum CEA (AUC=0.818) or CA19-9 (AUC=0.650) concentration. This is the first study to report RBP4 and THBS2 as diagnosis serum biomarkers for CRC, which might be a good supplement for CEA or CA19-9 for clinical diagnosis.
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Affiliation(s)
- Weiqiang Fei
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Li Chen
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jiaxin Chen
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Qinglan Shi
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Lumin Zhang
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Shuiping Liu
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Lingfei Li
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Lili Zheng
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xiaotong Hu
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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10
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Bejarano PA, Garcia-Buitrago MT, Berho M, Allende D. Biologic and molecular markers for staging colon carcinoma. COLORECTAL CANCER 2016. [DOI: 10.2217/crc.15.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biomarkers in the field of pathology and oncology may allow for the detection of disease, assessment of prognosis or to predict response to certain therapy. Molecular abnormalities in colorectal cancer genesis may occur due to chromosome instability, microsatellite instability and DNA methylation (CpG island methylator phenotype). These alterations are associated in some cases to sporadic carcinomas whereas in others are seen in syndrome-related tumors and are the basis for the use of different biomarkers in the clinical setting. These may include mismatched repair gene/proteins, RAS, BRAF, PIK3CA, which help to determine tumor prognosis and predict response to certain drugs.
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Affiliation(s)
- Pablo A Bejarano
- Department of Pathology Cleveland Clinic Florida, 2900 Weston Road, Weston, FL 33331, USA
| | - Monica T Garcia-Buitrago
- Department of Pathology, University of Miami School of Medicine, 1611 NW 12 Ave. Holtz Bldg, Miami, FL 33136, USA
| | - Mariana Berho
- Department of Pathology Cleveland Clinic Florida, 2900 Weston Road, Weston, FL 33331, USA
| | - Daniela Allende
- Department of Pathology Cleveland Clinic, Cleveland, OH 9500 Euclid Avenue Cleveland, OH 44195, USA
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11
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Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies. Int J Colorectal Dis 2016; 31:319-25. [PMID: 26415565 DOI: 10.1007/s00384-015-2404-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A substantial interobserver variation in the differential diagnosis of hyperplastic polyps (HPs) and sessile or traditional serrated adenomas (SSAs/TSAs) has been described. METHODS The aim of this study is to determine the magnitude of reclassification of HPs and associated factors after pathological reassessment of specimens from screening and surveillance colonoscopies, and to estimate its consequences for follow-up recommendations. RESULTS Among 1694 screening and surveillance colonoscopies, a total of 536 polyps were initially diagnosed as HPs and remained unchanged in 88.5% (n = 474), whereas 7.6 (n = 41) and 1.1% (n = 6) were reclassified as SSA and TSA, respectively. Compared to definite HPs, SSAs were found more frequently in men than in women (82.9 vs. 61.2%, p < 0.05), and in individuals ≥65.0 years (51.2 vs. 31.6%, p = 0.05). Also, more SSAs were >5 mm in size (36.6 vs. 6.3%, p < 0.05) and were localized in the proximal colon (31.7 vs. 11.8%, p < 0.05). In a mixed model analysis, age ≥65.0 years (OR 4.13, 95% CI 1.22-14.2), snare polypectomy (OR 23.6, 95% CI 4.86-115), and coincident advanced adenomas (OR 7.56, 95% CI 1.31-43.5) were significantly (p < 0.05) associated with reclassification to SSAs. Only 0.53% of patients had received false recommendations for follow-up visits based on the incorrect HP diagnosis. A c.1799T>A, p.V600E BRAF mutation was detected in 21.9 % (n = 9) of reclassified SSAs. CONCLUSION Considering these factors may be helpful in serrated lesions that are difficult to allocate. Incorrect recommendations regarding control colonoscopy intervals due to misdiagnosed HPs can explain only a small fraction of interval colorectal cancers.
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12
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Schramm C, Mbaya N, Franklin J, Demir M, Kuetting F, Toex U, Goeser T, Steffen HM. Patient- and procedure-related factors affecting proximal and distal detection rates for polyps and adenomas: results from 1603 screening colonoscopies. Int J Colorectal Dis 2015; 30:1715-22. [PMID: 26272199 DOI: 10.1007/s00384-015-2360-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Screening colonoscopy is less effective in reducing the incidence of proximal compared to distal colorectal cancer, presumably because of missed adenomas and advanced lesions during endoscopy. Thus, effectiveness and success of colorectal cancer (CRC) screening programs depend decisively on the quality of the endoscopic procedures. METHODS A retrospective analysis of 1603 average risk screening colonoscopies to calculate and to identify determinants of separate detection rates for proximally and distally located polyps, adenomas, and advanced adenomas was performed. RESULTS 56.1 % of 1603 individuals included were men, and the mean age was 60.2 ± 10.2 years. Distal detection rates were markedly higher compared to proximal detection rates for polyps (40.9 vs. 23.8 %), adenomas (21.3 vs. 16.2 %), and advanced adenomas (4.0 vs. 2.0 %). A gradual increase in detection rates with increasing age was found for proximal and distal localization. Gender difference was also seen for polyps and adenomas, but not for advanced adenomas. In multivariate analysis, age <65.0 years and female gender were independently associated with a lower separate polyp detection rate (PDR) and adenoma detection rate (ADR). The use of propofol was the only procedure-related variable significantly associated with higher polyp detection rate. CONCLUSION Since age and gender affect detection rates of proximally and distally located polyps and adenomas, the requirement of a specific gender-related limit in total detection rates may be insufficient as a quality indicator for screening colonoscopies.
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Affiliation(s)
- Christoph Schramm
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Nadine Mbaya
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jeremy Franklin
- Institute for Medical statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Muenevver Demir
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Fabian Kuetting
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ulrich Toex
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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13
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Schick BA, McLean CA, Driman DK. Negative colorectal polyp biopsies: the utility of cutting deeper levels. Virchows Arch 2015; 467:10.1007/s00428-015-1866-9. [PMID: 26475150 DOI: 10.1007/s00428-015-1866-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/22/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
The objectives of this study were to determine the frequency with which deeper levels reveal a lesion in polyp biopsies where no polyp was found on initial sections and to identify features that predict such occult (histologically unapparent) lesions. All initially negative biopsy specimens were accumulated over an 18-month period. Following standard sections, three to ten levels were cut, 50 μm apart. The presence of any lesion, the level at which it was found, the location, number and size of fragments, number of levels obtained, presence of any lymphoid aggregate, endoscopic size and appearance, and bowel preparation quality were recorded. There were 214 specimens, mean patient age 61.4 years (range 27-86 years). Deeper levels revealed a lesion in 52/214 (24.3 %) cases; 76.9 % were tubular adenomas (TA), 21.2 % were hyperplastic polyps, and one was a leiomyoma. All TAs were negative for high-grade dysplasia and malignancy. The mean level at which TAs were found was 1.85 (range 1-9). Male sex (p = 0.021) and right-sided location (p = 0.0075) were statistically significant predictors of an occult TA. As the presence of an adenoma affects screening, pathologists should consider "pursuing" polyps when initial sections reveal no lesion, after ascertaining the incidence of occult lesions in their own practice.
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Affiliation(s)
- Brian A Schick
- London Health Sciences Centre and Western University, London, ON, Canada
| | - Carolyn A McLean
- London Health Sciences Centre and Western University, London, ON, Canada
| | - David K Driman
- London Health Sciences Centre and Western University, London, ON, Canada.
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, 339 Windermere Road N6A 5A5, London, ON, Canada.
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14
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Silva SME, Rosa VF, Santos ACND, Almeida RMD, Oliveira PGD, Sousa JBD. Influence of patient age and colorectal polyp size on histopathology findings. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:109-13. [PMID: 25004288 PMCID: PMC4678682 DOI: 10.1590/s0102-67202014000200006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Abstract
Background Colorectal cancer is a major cause of morbidity and mortality and can arise
through the adenoma-carcinoma sequence. Colonoscopy is considered the method of
choice for population-wide cancer screening. Aim To assess the characteristics of endoscopically resected polyps in a consecutive
series of patients who underwent colonoscopy at a university hospital and compare
histopathology findings according to patient age and polyp size. Methods Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively
examined patients. The sample was restricted to reports that mentioned colorectal
polyps. A chart review was carried out for collection of demographic data and
histopathology results. Data were compared for polyps sized ≤0.5 cm and
≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm.
Finally, all polyps resected from patients aged 49 years or younger were compared
with those resected from patients aged 50 years or older. Results A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies
included in the sample (11.5%). Polyps >1 cm tended to be pedunculated
(p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a
villous component (p=0.000), and dysplasia (p=0.003). These findings held true
when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more
likely to have sessile polyps (p=0.023) and polyps located in the proximal colon
(p=0.009). There were no significant differences between groups in histopathology
or presence of dysplasia. Conclusion Polyp size is associated with presence of adenomas, a villous component, and
dysplasia, whereas patient age is more frequently associated with sessile polyps
in the proximal colon.
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Affiliation(s)
- Silvana Marques e Silva
- Coloproctology Service, University Hospital of Brasília, Brasília University, Brasília, DF, Brazil
| | - Viviane Fernandes Rosa
- Coloproctology Service, University Hospital of Brasília, Brasília University, Brasília, DF, Brazil
| | | | | | | | - João Batista de Sousa
- Coloproctology Service, University Hospital of Brasília, Brasília University, Brasília, DF, Brazil
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15
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Larrinaga G, Perez I, Sanz B, Beitia M, Errarte P, Fernández A, Blanco L, Etxezarraga MC, Gil J, López JI. Dipeptidyl-peptidase IV activity is correlated with colorectal cancer prognosis. PLoS One 2015; 10:e0119436. [PMID: 25790122 PMCID: PMC4366149 DOI: 10.1371/journal.pone.0119436] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 01/14/2015] [Indexed: 12/15/2022] Open
Abstract
Background Dipeptidyl-peptidase IV (EC 3.4.14.5) (DPPIV) is a serine peptidase involved in cell differentiation, adhesion, immune modulation and apoptosis, functions that control neoplastic transformation. Previous studies have demonstrated altered expression and activity of tissue and circulating DPPIV in several cancers and proposed its potential usefulness for early diagnosis in colorectal cancer (CRC). Methods and principal findings The activity and mRNA and protein expression of DPPIV was prospectively analyzed in adenocarcinomas, adenomas, uninvolved colorectal mucosa and plasma from 116 CRC patients by fluorimetric, quantitative RT-PCR and immunohistochemical methods. Results were correlated with the most important classic pathological data related to aggressiveness and with 5-year survival rates. Results showed that: 1) mRNA levels and activity of DPPIV increased in colorectal neoplasms (Kruskal-Wallis test, p<0.01); 2) Both adenomas and CRCs displayed positive cytoplasmic immunostaining with luminal membrane reinforcement; 3) Plasmatic DPPIV activity was lower in CRC patients than in healthy subjects (Mann-U test, p<0.01); 4) Plasmatic DPPIV activity was associated with worse overall and disease-free survivals (log-rank p<0.01, Cox analysis p<0.01). Conclusion/significance 1) Up-regulation of DPPIV in colorectal tumors suggests a role for this enzyme in the neoplastic transformation of colorectal tissues. This finding opens the possibility for new therapeutic targets in these patients. 2) Plasmatic DPPIV is an independent prognostic factor in survival of CRC patients. The determination of DPPIV activity levels in the plasma may be a safe, minimally invasive and inexpensive way to define the aggressiveness of CRC in daily practice.
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Affiliation(s)
- Gorka Larrinaga
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
- * E-mail:
| | - Itxaro Perez
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Begoña Sanz
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Maider Beitia
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Peio Errarte
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Ainhoa Fernández
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lorena Blanco
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - María C. Etxezarraga
- Department of Anatomic Pathology, Basurto University Hospital,University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Javier Gil
- Department of Physiology, Faculty of Medicine and Dentistry,University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - José I. López
- Department of Anatomic Pathology, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain
- BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
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16
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Perez I, Blanco L, Sanz B, Errarte P, Ariz U, Beitia M, Fernández A, Loizate A, Candenas ML, Pinto FM, Gil J, López JI, Larrinaga G. Altered Activity and Expression of Cytosolic Peptidases in Colorectal Cancer. Int J Med Sci 2015; 12:458-67. [PMID: 26078706 PMCID: PMC4466510 DOI: 10.7150/ijms.11808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/29/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The role of peptidases in carcinogenic processes and their potential usefulness as tumor markers in colorectal cancer (CRC) have been classically attributed to cell-surface enzymes. The objective of the present study was to analyze the activity and mRNA expression of three cytosolic peptidases in the CRC and to correlate the obtained results with classic histopathological parameters for tumor prognosis and survival. METHODS The activity and mRNA levels of puromycin-sensitive aminopeptidase (PSA), aminopeptidase B (APB) and pyroglutamyl-peptidase I (PGI) were measured by fluorimetric and quantitative RT-PCR methods in colorectal mucosa and tumor tissues and plasma samples from CRC patients (n=81). RESULTS 1) PSA and APB activity was higher in adenomas and carcinomas than in the uninvolved mucosa. 2) mRNA levels of PSA and PGI was lower in tumors. 3) PGI activity in CRC tissue correlated negatively with histological grade, tumor size and 5-year overall survival of CRC patients. 4) Higher plasmatic APB activity was independently associated with better 5-year overall survival. CONCLUSIONS Data suggest that cytosolic peptidases may be involved in colorectal carcinogenesis and point to the determination of this enzymes as a valuable method in the determination of CRC prognosis.
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Affiliation(s)
- Itxaro Perez
- 1. Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lorena Blanco
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Begoña Sanz
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Peio Errarte
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Usue Ariz
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Maider Beitia
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Ainhoa Fernández
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Alberto Loizate
- 3. Department of Surgery, Basurto University Hospital, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
| | - M Luz Candenas
- 4. Institute for Chemical Research, CSIC-Isla de la Cartuja, Sevilla, Spain
| | - Francisco M Pinto
- 4. Institute for Chemical Research, CSIC-Isla de la Cartuja, Sevilla, Spain
| | - Javier Gil
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - José I López
- 5. Department of Anatomic Pathology, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Gorka Larrinaga
- 1. Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
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17
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Larrinaga G, Perez I, Blanco L, Sanz B, Errarte P, Beitia M, Etxezarraga MC, Loizate A, Gil J, Irazusta J, López JI. Prolyl endopeptidase activity is correlated with colorectal cancer prognosis. Int J Med Sci 2014; 11:199-208. [PMID: 24465166 PMCID: PMC3894405 DOI: 10.7150/ijms.7178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/23/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Prolyl endopeptidase (PEP) (EC 3.4.21.26) is a serine peptidase involved in differentiation, development and proliferation processes of several tissues. Recent studies have demonstrated the increased expression and activity of this cytosolic enzyme in colorectal cancer (CRC). However, there are no available data about the impact of this peptidase in the biological aggressiveness of this tumor in patient survival. METHODS The activity of PEP in tissue (n=80) and plasma (n=40) of patients with CRC was prospectively analyzed by fluorimetric methods. Results were correlated with the most important classic pathological data related to aggressiveness, with 5-year survival rates and other clinical variables. RESULTS 1) PEP is more active in early phases of CRC; 2) Lower levels of the enzyme in tumors were located in the rectum and this decrease could be related with preoperative chemo-radiotherapy; 3) PEP activity in tissue was higher in patients with better overall and disease-free survival (log-rank p<0.01, Cox analysis p<0.01); 4) Plasmatic PEP activity was significantly higher in CRC patients than in healthy individuals and this was associated with distant metastases and with worse overall and disease-free survivals (log-rank p<0.05, Cox analysis p<0.05). CONCLUSIONS PEP activity in tissue and plasma from CRC patients is an independent prognostic factor in survival. The determination of PEP activity in the plasma may be a safe, minimally invasive and inexpensive way to define the aggressiveness of CRC in daily practice.
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Affiliation(s)
- Gorka Larrinaga
- 1. Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Itxaro Perez
- 1. Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Lorena Blanco
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Begoña Sanz
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Peio Errarte
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Maider Beitia
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - María C Etxezarraga
- 3. Department of Anatomic Pathology, Basurto University Hospital, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Alberto Loizate
- 4. Department of Surgery, Basurto University Hospital, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Javier Gil
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Jon Irazusta
- 2. Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - José I López
- 5. Department of Anatomic Pathology, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain; ; 6. BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
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Larrinaga G, Perez I, Ariz U, Sanz B, Beitia M, Errarte P, Etxezarraga C, Candenas ML, Pinto FM, López JI. Clinical impact of aspartyl aminopeptidase expression and activity in colorectal cancer. Transl Res 2013; 162:297-308. [PMID: 23948443 DOI: 10.1016/j.trsl.2013.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/09/2013] [Accepted: 07/23/2013] [Indexed: 12/12/2022]
Abstract
Aspartyl aminopeptidase (ASP; EC 3.4.11.21) is a widely distributed and abundant cytosolic enzyme that regulates bioactive peptides such as angiotensin II. It has been demonstrated that the expression and activity of this enzyme is modified in tissue and serum of patients with several types of cancer. However, the involvement of ASP in the neoplastic development and survival of patients with colorectal cancer (CRC) has not been analyzed to date. The activity and messenger RNA expression of ASP in tumor tissue (n = 71) and plasma (n = 40) of patients with CRC was analyzed prospectively using fluorometric and quantitative real-time polymerase chain reaction methods. Data obtained from tumor tissue were compared with those from the surrounding normal mucosa. Classic pathologic parameters (grade, stage, nodal invasion, distant metastases and perineural, lymphatic, and vascular invasion) were stratified following ASP data and analyzed for 5-year survival. ASP was upregulated in CRC tissues, and greater activity correlated significantly with the absence of lymph node metastases and with better overall survival. Inversely, greater plasmatic ASP activity was associated with worse overall and disease-free survival. Data suggest that ASP is involved in colorectal neoplasia and point to this enzyme as a potential useful diagnostic tool in clinical practice.
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Affiliation(s)
- Gorka Larrinaga
- Department of Nursing I, School of Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; Department of Physiology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain.
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Naini BV, Odze RD. Advanced precancerous lesions (APL) in the colonic mucosa. Best Pract Res Clin Gastroenterol 2013; 27:235-56. [PMID: 23809243 DOI: 10.1016/j.bpg.2013.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/08/2013] [Indexed: 01/31/2023]
Abstract
Colorectal cancer is a leading cause of cancer death worldwide. Most colorectal cancers are preventable. Surveillance colonoscopy is used to detect and remove precancerous lesions. Although the majority of precancerous lesions develop sporadically, some have an inherited component. In this review, we summarize the clinical, pathologic, and molecular features of advanced precancerous lesions of the colon. The most common and clinically important intestinal polyposis syndromes, and their genetics, are also discussed. Finally, current recommendations regarding the treatment and surveillance of precancerous lesions, both in the sporadic and in inherited setting, are reviewed.
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Affiliation(s)
- Bita V Naini
- David Geffen School of Medicine at UCLA, Department of Pathology & Lab Medicine, Box 951732, 1P-172 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095-1732, USA.
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Hu X, Sui X, Li L, Huang X, Rong R, Su X, Shi Q, Mo L, Shu X, Kuang Y, Tao Q, He C. Protocadherin 17 acts as a tumour suppressor inducing tumour cell apoptosis and autophagy, and is frequently methylated in gastric and colorectal cancers. J Pathol 2013; 229:62-73. [PMID: 22926751 DOI: 10.1002/path.4093] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 08/08/2012] [Accepted: 08/15/2012] [Indexed: 01/13/2023]
Abstract
Gastric and colorectal cancers are among the most common cancers worldwide and cause serious cancer mortality. Both epigenetic and genetic disruptions of tumour suppressor genes (TSGs) are frequently involved in their pathogenesis. Here, we studied the epigenetic and genetic alterations of a novel TSG-PCDH17 and its functions in the pathogenesis of these tumours. We found that PCDH17 was frequently silenced and methylated in almost all gastric and colorectal tumour cell lines as well as in ∼95% of primary tumours, but not in normal gastric and colonic mucosa. Moreover, its deletion was detected in only 18% of gastric and 12% of colorectal cancer tissues, suggesting that epigenetic and genetic inactivation of PCDH17 are both involved in gastric and colorectal tumourigenesis. PCDH17 protein expression was significantly correlated with low tumour stage and less lymph node metastasis of gastric and colorectal cancer patients, indicating its potential as a tumour marker. Restoring PCDH17 expression inhibited tumour cell growth in vitro and in vivo through promoting apoptosis, as evidenced by increased TUNEL staining and caspase-3 activation. Furthermore, PCDH17-induced autophagy, along with increased numbers of autophagic vacuoles and up-regulated autophagic proteins Atg-5, Atg-12 and LC3B II. Thus, PCDH17 acts as a tumour suppressor, exerting its anti-proliferative activity through inducing apoptosis and autophagy, and is frequently silenced in gastric and colorectal cancers. PCDH17 methylation is a tumour-specific event that could serve as an epigenetic biomarker for these tumours.
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Affiliation(s)
- Xiaotong Hu
- Biomedical Research Centre and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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Gonçalves AR, Ferreira C, Marques A, Ribeiro LC, Velosa J. Assessment of quality in screening colonoscopy for colorectal cancer. Clin Exp Gastroenterol 2011; 4:277-81. [PMID: 22235171 PMCID: PMC3254205 DOI: 10.2147/ceg.s25596] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The effectiveness of screening colonoscopy in decreasing the incidence of colorectal cancer (CRC) is largely dependent on the detection of polyps and the quality of the procedure. Several key quality measures have been proposed to improve the effectiveness of screening colonoscopies. AIM To evaluate quality indicators of screening colonoscopy in a tertiary hospital. METHODS All CRC screening colonoscopies performed between 2005 and 2009 in a single tertiary center were reviewed for internationally accepted quality measures. RESULTS Of the 1545 individuals who underwent first-time screening colonoscopy 38% were male and 62% were female. The mean age of the patients was 60.4 years and the mean difference in ages was ± 10.3 years. Cecal intubation rate was 91% (1336), however ileocecal valve photo documentation was performed in only 81% (1248) colonoscopies. The quality of bowel preparation was classified as: good 76% (1171), reasonable 11% (174), and poor 13% (200). Polyp detection rate (PDR) was 33% (503). The prevalence of polyps ≥1 cm in size was 5% (82). PDR was significantly higher in men than in women (44% [260] vs 25% [243], P = 0.0001). Other factors significantly influencing PDR were quality of bowel preparation (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 0.9-1.6) and age over 50 (OR: 1.9, 95% CI: 1.3-2.9). Left colonic polyps were associated with a risk ratio of 2.3 (95% CI: 1.8-2.9) of lesions in the other colonic segments compared to no polyps in the left colon. None of the colonoscopists reported withdrawal time. CONCLUSION Cecal intubation rate and quality of bowel preparation were suboptimal. The polyp detection rate compares favorably to accepted standards and its main determinants are male sex, age >50 years, quality of bowel preparation, and the presence of left colonic polyps.
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Affiliation(s)
- Ana Rita Gonçalves
- Department of Gastroenterology and Hepatology, Hospital Santa Maria-CHLN, Lisboa 1068, Portugal
| | - Carlos Ferreira
- Department of Gastroenterology and Hepatology, Hospital Santa Maria-CHLN, Lisboa 1068, Portugal
| | - António Marques
- Department of Gastroenterology and Hepatology, Hospital Santa Maria-CHLN, Lisboa 1068, Portugal
| | - Luís Carrilho Ribeiro
- Department of Gastroenterology and Hepatology, Hospital Santa Maria-CHLN, Lisboa 1068, Portugal
| | - José Velosa
- Department of Gastroenterology and Hepatology, Hospital Santa Maria-CHLN, Lisboa 1068, Portugal
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Metwally M, Agresti N, Hale WB, Ciofoaia V, O'Connor R, Wallace MB, Fine J, Wang Y, Gross SA. Conscious or unconscious: The impact of sedation choice on colon adenoma detection. World J Gastroenterol 2011; 17:3912-5. [PMID: 22025879 PMCID: PMC3198020 DOI: 10.3748/wjg.v17.i34.3912] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/29/2011] [Accepted: 04/05/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine if anesthesiologist-monitored use of propofol results in improved detection of adenomas when compared with routine conscious sedation.
METHODS: This retrospective study was conducted at two separate hospital-based endoscopy units where approximately 12 000 endoscopic procedures are performed annually, with one endoscopy unit exclusively using anesthesiologist-monitored propofol. Three thousand two hundred and fifty-two patients underwent initial screening or surveillance colonoscopies. Our primary end point was the adenoma detection rate, defined as the number of patients in whom at least one adenoma was found, associated with the type of sedation.
RESULTS: Three thousand two hundred and fifty-two outpatient colonoscopies were performed by five selected endoscopists. At least one adenoma was detected in 27.6% of patients (95% CI = 26.0-29.1) with no difference in the detection rate between the anesthesiologist -propofol and group and the gastroenterologist-midazolam/fentanyl group (28.1% vs 27.1%, P = 0.53).
CONCLUSION: The type of sedation used during co-lonoscopy does not affect the number of patients in whom adenomatous polyps are detected.
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23
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Buchner AM, Shahid MW, Heckman MG, Diehl NN, McNeil RB, Cleveland P, Gill KR, Schore A, Ghabril M, Raimondo M, Gross SA, Wallace MB. Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 2011; 73:1223-31. [PMID: 21481861 DOI: 10.1016/j.gie.2011.01.060] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/26/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies examining the effect of fellow participation on adenoma detection rate in colonoscopy have yielded conflicting results, and factors such as adenoma size and location have not been rigorously evaluated. OBJECTIVE To examine whether fellow participation during screening, surveillance, or diagnostic colonoscopy affects overall, size-specific, or location-specific adenoma or polyp detection rate. METHODS This was a retrospective study of 2430 colonoscopies performed in our ambulatory surgical center between September 2006 and December 2007, comparing adenoma and polyp detection rates of colonoscopies performed by fellows with supervising staff endoscopists (n = 318) with colonoscopies performed by staff endoscopists without fellow participation (n = 2112). Study participants included patients who underwent screening, surveillance, or diagnostic colonoscopies in our GI suite. Logistic regression analysis was used to evaluate the association of fellow participation with adenoma and polyp detection. RESULTS There was evidence of a higher rate of small (<5 mm) adenoma detection in colonoscopies with a fellow present (25% vs 17%, P = .001). This remained significant after multiple-testing adjustment (P ≤ .003 considered significant). Findings were similar, although not significant for small polyps (36% vs 29%, P = .007). There was a trend toward increased adenoma detection in colonoscopies with a fellow present compared with those without (30% vs 26%, P = .11). Multivariable adjustment for potentially confounding variables did not alter these associations. LIMITATIONS The study had a retrospective design, and information regarding bowel preparation was not available for 37% of patients. CONCLUSION Fellow involvement was associated with increased detection rates of small adenomas, providing evidence that the presence of a fellow during colonoscopy plays a role in enhancing the effectiveness of the examination.
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Affiliation(s)
- Anna M Buchner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA
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Macken E, Moreels T, Vannoote J, Siersema PD, Van Cutsem E. Quality assurance in colonoscopy for colorectal cancer diagnosis. Eur J Surg Oncol 2010; 37:10-5. [PMID: 20951537 DOI: 10.1016/j.ejso.2010.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/20/2010] [Indexed: 12/19/2022] Open
Abstract
Colonoscopy can prevent colorectal cancer, but its effectiveness is diminished by operator-dependent factors. Therefore, quality assurance programs should be implemented in all colonoscopy practices. Adherence to quality performance measures varies among different countries, and physicians seem reluctant to adopt them. We provide an overview of the existing guidelines for colonoscopy quality assurance, and a summary of the quality control initiatives in Belgium and the surrounding countries.
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Affiliation(s)
- E Macken
- Antwerp University Hospital, Division of Gastroenterology & Hepatology, UZ Antwerp, Wilrijkstraat 10, Antwerp, Belgium.
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25
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26
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Godeberge P, Blain A, Christidis C, Mal F. [Medical-surgical decision-making for the treatment of polypoid lesions of the colon]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:S152-S157. [PMID: 18479859 DOI: 10.1016/j.gcb.2008.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- P Godeberge
- Département médico-chirurgical de pathologie digestive, institut mutualiste Montsouris, université Paris-5, 42, boulevard Jourdan, 75014 Paris, France.
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Amatruda JF, Patton EE. Genetic models of cancer in zebrafish. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2008; 271:1-34. [PMID: 19081540 DOI: 10.1016/s1937-6448(08)01201-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Firmly established as a model system for development, the zebrafish is now emerging as an effective system for the study of the fundamental aspects of tumorigenesis. In keeping with the striking anatomical and physiological similarity between fish and mammals, zebrafish develop a wide spectrum of cancers resembling human malignancies. The potential for zebrafish as a cancer model derives from its strengths as an experimental system for developmental biology. Despite 450 million years of evolutionary distance, the pathways that govern vertebrate development including signaling, proliferation, cell movements, differentiation, and apoptosis-indeed, the same pathways that are often misregulated in tumorigenesis-are highly conserved between humans and zebrafish. This, together with a complete genome sequence and an array of tools for gene manipulation, makes the construction of robust, physiological zebrafish cancer models increasingly possible.
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Affiliation(s)
- James F Amatruda
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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28
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Millen AE, Subar AF, Graubard BI, Peters U, Hayes RB, Weissfeld JL, Yokochi LA, Ziegler RG. Fruit and vegetable intake and prevalence of colorectal adenoma in a cancer screening trial. Am J Clin Nutr 2007; 86:1754-64. [PMID: 18065596 DOI: 10.1093/ajcn/86.5.1754] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Research on the association between fruit and vegetable intake and risk of colorectal adenoma is inconclusive. OBJECTIVE We studied whether intake of fruit, vegetables, or their subgroups is associated with a lower risk of prevalent colorectal adenoma. DESIGN In men and women (aged 55-74 y) who were screened for colorectal cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (1993-2001), we compared 3,057 cases with at least one prevalent histologically verified adenoma of the distal large bowel with 29,413 control subjects. Using a food-frequency questionnaire, we quantified intake of fruit and vegetables in the 12 mo before screening as energy-adjusted pyramid servings/d (ps/d). Adjusted odds ratios (ORs) and 95% CIs were estimated by logistic regression. RESULTS Risk of distal adenoma was significantly lower among subjects in high (approximately 5.7 ps/d) versus low (approximately 1.2 ps/d) quintiles of total fruit intake (OR: 0.75; 95% CI: 0.66, 0.86, P for trend <0.001), which was not completely explained by dietary folate or fiber intake. Inverse associations between adenoma and total fruit intake were observed regardless of adenoma histopathology and multiplicity. However, the protective effect was seen only for colon and not rectal adenoma. Total vegetable intake was not significantly associated with reduced risk of adenoma. ORs for colorectal adenoma among persons with high versus low intakes of deep-yellow vegetables, dark-green vegetables, and onions and garlic were significantly related to lower risk of adenoma, although the P for trend for dark-green vegetables was not significant. CONCLUSION Diets rich in fruit and deep-yellow vegetables, dark-green vegetables, and onions and garlic are modestly associated with reduced risk of colorectal adenoma, a precursor of colorectal cancer.
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Affiliation(s)
- Amy E Millen
- University at Buffalo, School of Public Health and Health Professions, Department of Social and Preventive Medicine, Buffalo, NY 14214-8001, USA.
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Lam TJ, Wong BCY, Mulder CJJ, Peña AS, Hui WM, Lam SK, Chan AOO. Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong. World J Gastroenterol 2007; 13:3873-7. [PMID: 17657845 PMCID: PMC4611223 DOI: 10.3748/wjg.v13.i28.3873] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the distribution and frequency of advanced polyps over eight years.
METHODS: 6424 colonoscopies were reviewed during the study period 1998 to 2005. The study period was subdivided into period I: 1998 to 2001 and period II: 2002-2005.
RESULTS: 1856 polyps (33% advanced polyps) and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6 ± 13.8 years, respectively. Advanced polyps were mainly left sided (59.5%). Advanced polyps were found in patients ≤ 60 years from 17.7% in periodI to 26.3% in period II (P < 0.05), especially in male subjects ≤ 60 years (21.6% vs 31.6%, P < 0.05). Advanced tubulovillous polyps rose from 21.5% in period I to 29.5% in period II (P < 0.05). Whereas cancers in male patients ≤ 60 years were similar in both periods: 23.2% vs 16.5% (P > 0.05).
CONCLUSION: Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shift towards a proximal location.
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Affiliation(s)
- Tze-Jui Lam
- Department of Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands
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Rerknimitr R, Ratanapanich W, Kongkam P, Kullavanijaya P. Differences in characteristics of colorectal neoplasm between young and elderly Thais. World J Gastroenterol 2006; 12:7684-9. [PMID: 17171800 PMCID: PMC4088053 DOI: 10.3748/wjg.v12.i47.7684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the differences of clinical characteristics of colorectal neoplasm including polyps between the elderly and young Thai patients.
METHODS: Colonoscopy database from December 2000 to October 2004 was retrospectively analyzed. There were 1822 eligible patients who underwent colonoscopy (with a mean age of 56.6 years). Patients were classified into two groups: the older age group (aged ≥ 60 years; n = 989) and the younger age group (aged < 60 years; n = 833). Data were recorded on age, colonoscopic indications, tumor location, colonoscopic findings and their related histological findings.
RESULTS: Colorectal malignancy related lesions were more often found in the older age group (21%) than in the younger age group (12%). Left-sided lesions were detected more commonly than right-sided in both age groups in approximately two-thirds of all cases. Hematochezia showed greater association with left-sided lesions in the elderly. No relationship was found between age and neoplasm staging and severity.
CONCLUSION: The chance of detecting colorectal neoplasm by colonoscopy was higher in the elderly than in the young Thais. However, both groups had the lesions predominantly located in the left side.
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Affiliation(s)
- Rungsun Rerknimitr
- Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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Jonkers D, Ernst J, Pladdet I, Stockbrügger R, Hameeteman W. Endoscopic follow-up of 383 patients with colorectal adenoma: an observational study in daily practice. Eur J Cancer Prev 2006; 15:202-10. [PMID: 16679862 DOI: 10.1097/01.cej.0000195710.56825.b1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Endoscopic removal of colorectal adenomas reduces the incidence and mortality of colorectal cancer (CRC), but follow-up surveillance is recommended. Compliance with the Dutch surveillance guidelines and detection of neoplasia during follow-up has been evaluated in daily practice. From 1987 to 1996, 383 consecutive patients with colorectal adenomas (56.4% male, 61.8+/-11.3 years) were included and followed until December 2000. The mean follow-up was 80.5+/-42.5 months with 2.2+/-0.9 follow-up endoscopies. A total of 32.5 and 27.3% of follow-up endoscopies were performed >25% (time between advised and actual endoscopy) too late or too early, respectively. At the end of follow-up, 33.4% of patients had left the follow-up (two-thirds died) and 60.1% were known with co-morbidity. A first, second, third, fourth and fifth follow-up endoscopy had been performed in 327, 238, 132, 64 and 35 patients, respectively. Adenomatous polyps (with high-risk polyps) were detected in 100% (42.6%) of the index endoscopies and in 25.1% (17.4%), 23.9% (10.5%), 28.0% (12.1%), 34.4% (25.0%) and 37.1% (17.1%) of the first to fifth follow-up endoscopy, respectively. CRC was diagnosed in seven patients (46.1+/-22.9 months after index endoscopy), resulting in a standardized incidence ratio of 1.4 (confidence interval 0.6-3.0, P=0.4) compared to the general population. In this daily practice, high numbers of total and high-risk adenomatous polyps were found during follow-up surveillance. The incidence of CRC was not significantly different from the general population, which might be due to the intensive follow-up and removal of polyps. These findings support the importance of follow-up surveillance. However, the high overall morbidity and mortality should be taken into account when selecting patients for an intensive follow-up programme.
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Affiliation(s)
- Daisy Jonkers
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, The Netherlands.
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Davila RE, Rajan E, Baron TH, Adler DG, Egan JV, Faigel DO, Gan SI, Hirota WK, Leighton JA, Lichtenstein D, Qureshi WA, Shen B, Zuckerman MJ, VanGuilder T, Fanelli RD. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc 2006; 63:546-57. [PMID: 16564851 DOI: 10.1016/j.gie.2006.02.002] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Raquel E Davila
- American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Ste. 202, Oak Brook, IL 60523, USA
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Helzlsouer KJ, Erlinger TP, Platz EA. C-reactive protein levels and subsequent cancer outcomes: results from a prospective cohort study. Eur J Cancer 2006; 42:704-7. [PMID: 16513341 DOI: 10.1016/j.ejca.2006.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 01/11/2006] [Indexed: 11/15/2022]
Abstract
Chronic inflammation has been implicated in the pathogenesis of many common chronic diseases, including cancer. C-reactive protein (CRP) concentration is a non-specific serum marker of inflammation, and higher levels have been observed among individuals who go on to develop cardiovascular disease. Nested case-control studies were conducted within the CLUE II study, a community-based cohort, to examine the association between CRP concentrations and subsequent development of colorectal or prostate cancer. CRP concentrations were higher among individuals who went on to develop colon cancer, but not rectal or prostate cancer, compared with controls. The association between CRP concentrations and development of colon cancer is consistent with other evidence suggesting a role of inflammation and cancer. Preventive interventions that decrease systemic chronic inflammation have the potential to reduce certain types of cancer as well as cardiovascular disease. However, the potential benefits of anti-inflammatory chemopreventive agents must be weighed against their adverse effects before widespread use is recommended.
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Affiliation(s)
- Kathy J Helzlsouer
- Prevention and Research Center, Mercy Medical Center, 6th Floor, 227 St. Paul Place, Baltimore, MD 21202, USA.
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Abstract
Although oral contrast agents are known to improve the accuracy of CT colonography (CTC) by tagging fluid and stool, it is not well recognized that oral contrast also adheres to the surface of polyps. The authors' objective was to quantitate the frequency of contrast adhering to polyps. Three hundred thirty-eight optical colonoscopy-proven polyps were identified on CTC of all of the 216 patients with polyps in a larger cohort of screening patients. CT scans of polyps were analyzed for adherent contrast (ie, a thin coat/adherent drops) in at least one view (prone/supine). Forty-six percent of the 312 polyps not touching a contrast pool had adherent contrast. Polyps with villous histology were significantly more likely to have adherent contrast (77% [20/26] vs. 43% [124/286], P<0.001). Oral contrast agents often tag polyp surfaces in a pattern that is distinct from internal tagging of adherent stool, which must be recognized during CTC interpretation. Polyps with villous histology show a higher rate of contrast adherence than nonvillous polyps.
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Affiliation(s)
- Stacy D O'Connor
- Radiology Department, National Institutes of Health, Bethesda, MD and Uniformed Services University of the Health Sciences, Bethesda, MD 20892-1182, USA
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Bu ZD, Li ZY, Xie YQ, Ji JF, Su XQ. Clinicopathological analysis of 50 rectal cancer cases diagnosed as adenoma in biopsy. Chin J Cancer Res 2005. [DOI: 10.1007/s11670-005-0013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cappell MS. From colonic polyps to colon cancer: pathophysiology, clinical presentation, and diagnosis. Clin Lab Med 2005; 25:135-177. [PMID: 15749236 DOI: 10.1016/j.cll.2004.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epidemiologists, basic researchers, clinicians, and public health administrators unite! Develop and implement a simple, safe, and effective preventive and screening test for colon cancer. The public will willingly and enthusiastically accept such a test. Many thousands of lives are at stake every year.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA.
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37
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Pakiz B, Flatt SW, Mills KC, Jordan LJ, Carethers JM, Rock CL. Quality of life and diet intervention in individuals at risk for recurrence of colorectal adenomas. Psychooncology 2005; 14:85-93. [PMID: 15386785 PMCID: PMC4428563 DOI: 10.1002/pon.822] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effect of participation in a diet intervention study on self-reported quality of life (QOL) with subjects at risk of recurrence of colorectal adenomas was explored in 77 men and women, aged 18-80 years, with a history of adenomatous polyps. Participants were randomly assigned to intervention and control groups and followed for 1 year. Dietary goals for the intervention group included reduced intake of fat and increased intakes of fiber, calcium, and vegetables and fruit. Diet counseling was provided by telephone. Anthropometric measurements were obtained and dietary intakes were assessed at baseline and 6 and 12 months. The quality of life factors questionnaire (QF), designed to explore the absolute effects of the diet intervention on participants' perceived QOL, was administered at baseline and study end. Based on repeated 24-h dietary recalls, the intervention group reported significantly higher consumption of vegetables, fruit, low-fat dairy products, fiber, and calcium at 12 months. There were no significant differences in total QF scores for the two groups at study end, and no significant changes within groups between baseline and study end. Findings suggest that even though the intervention participants made significant modifications in their eating behavior, these changes did not impact their perceived QOL negatively.
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Affiliation(s)
- Bilge Pakiz
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0901, USA.
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Cappell MS. The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps. Med Clin North Am 2005; 89:1-vii. [PMID: 15527807 DOI: 10.1016/j.mcna.2004.08.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A review of the pathophysiology, clinical presentation, and diagnosis of colon cancer and colonic polyps is important and timely. This field is rapidly changing because of breakthroughs in the molecular basis of carcinogenesis and in the technology for colon cancer detection and treatment. This article reviews colon cancer and colonic polyps, with a focus on recent dramatic advances, to help the pri-mary care physician and internist appropriately refer patients for screening colonoscopy and intelligently evaluate colonoscopic findings to reduce the mortality from this cancer.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA.
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Gupta RA, Wang D, Katkuri S, Wang H, Dey SK, DuBois RN. Activation of nuclear hormone receptor peroxisome proliferator-activated receptor-delta accelerates intestinal adenoma growth. Nat Med 2004; 10:245-7. [PMID: 14758356 DOI: 10.1038/nm993] [Citation(s) in RCA: 220] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2003] [Accepted: 01/15/2004] [Indexed: 02/07/2023]
Abstract
We treated Apc(min) mice, which are predisposed to intestinal polyposis, with a selective synthetic agonist of peroxisome proliferator-activated receptor-delta (PPAR-delta). Exposure of Apc(min) mice to the PPAR-delta ligand GW501516 resulted in a significant increase in the number and size of intestinal polyps. The most prominent effect was on polyp size; mice treated with the PPAR-delta activator had a fivefold increase in the number of polyps larger than 2 mm. Our results implicate PPAR-delta in the regulation of intestinal adenoma growth.
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Affiliation(s)
- Rajnish A Gupta
- Department of Medicine, The Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-6838, USA
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40
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Adrales GL, Harold KL, Matthews BD, Sing RF, Kercher KW, Heniford BT. Laparoscopic "radical appendectomy" is an effective alternative to endoscopic removal of cecal polyps. J Laparoendosc Adv Surg Tech A 2002; 12:449-52. [PMID: 12590728 DOI: 10.1089/109264202762252749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The endoscopic removal of cecal polyps can be complicated by hemorrhage, perforation, or incomplete resection. Laparoscopic radical appendectomy represents a safe alternative for the definitive resection and accurate pathologic evaluation of selected cecal polyps. METHODS Patients with cecal cap polyps not involving the ileocecal valve were candidates for laparoscopic radical appendectomy. Intraoperative colonoscopy and resection of the appendix and cecum to the level of the ileocecal valve were accomplished via three midline ports. For each patient, histologic evaluation by frozen section ruled out malignancy and ensured complete resection. RESULTS Five patients, four of whom had significant medical comorbidities, presented with large adenomatous polyps contained within the cecum. Each polyp was determined to be unresectable endoscopically; therefore, a laparoscopic radical appendectomy was performed. One patient with cirrhosis also underwent intraoperative liver ultrasonography and biopsies, which contributed to the longest operative time and hospital stay. The histologic diagnosis by frozen section was benign for each patient. The mean operative time was 95 minutes, and the mean length of hospital stay was 1.8 days. No postoperative complications were observed during a mean follow-up of 6 months. CONCLUSION Laparoscopic "radical appendectomy" is an effective treatment for selected cecal adenomatous polyps. Our ability to resect the polyps completely and avoid a standard right hemicolectomy supports this approach.
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Affiliation(s)
- Ginal L Adrales
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am 2002; 86:1253-1288. [PMID: 12510454 DOI: 10.1016/s0025-7125(02)00077-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Flexible sigmoidoscopy and colonoscopy have revolutionized the clinical management of colonic diseases. Colonoscopy is a highly sensitive and specific test. Colonic diseases often produce characteristic colonoscopic findings, as well as characteristic histologic findings, as identified in colonoscopic biopsy or polypectomy specimens. Colonoscopy is relatively safe, with a low incidence of serious complications, such as colonic perforation, hemorrhage, cardiopulmonary arrest, or sepsis. Colonoscopy is becoming more important clinically because of more widespread use of screening colonoscopy for colon cancer, application of therapeutic colonoscopy, and exciting new technical improvements.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, Department of Medicine, State University of New York, Downstate Medical School, Brooklyn, NY, USA
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Abstract
CRC, the second-leading cause of cancer death in the United States, is a highly preventable disease. Ironically, available and effective screening technologies are not consistently applied, even as new ones are developed. This discordance between preventive opportunity and practice conveys a sobering message regarding nontechnologic issues that must be addressed if the promise of CRC prevention is to be realized. Our response to this message will determine the public health impact of cancer prevention. In the 1980s, cancer chemoprevention was regarded as scientific speculation. Within the last decade, however, cancer has been recognized as a late, nonobligate stage of carcinogenesis, a chronic process that provides time and targets for preventive intervention. Further advances are emerging out of rigorous clinical testing, which remains the limiting factor in transforming ingenious concepts into useful tools for the prevention of CRC. The challenges and rewards of participation in chemoprevention research--both as patients and health care providers-have never been greater.
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Affiliation(s)
- Ernest T Hawk
- Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Division of Cancer Prevention, EPN, Suite 2141, 6130 Executive Boulevard, Bethesda, MD 20892-7317, USA.
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Abstract
Research over the past decade has established that the progression from normal colonic epithelium to colon cancer is in every case a step-wise process in which specific pathologic and molecular markers can be identified for study and clinical therapy. Genetic and epigenetic instability appears fundamentally important to this process. We have now determined that this neoplastic progression occurs along a limited set of pathways, in which specific tumor suppressors are inactivated or oncogenes activated in a defined order. Although incomplete, our new understanding of the process of carcinogenesis in the colon has already significantly impacted patient care and will continue to do so for the foreseeable future. Increasingly rapid research developments and technologic advances will transform the way we prevent, diagnose, and treat this common and deadly form of cancer.
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Affiliation(s)
- John P Lynch
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, 415 Curie, Boulevard, Philadelphia, PA 19104, USA.
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44
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45
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Colorectal Cancer Screening and Surveillance. COLORECTAL CANCER 2002. [DOI: 10.1007/978-3-642-56008-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Anwar S, White J, Hall C, Farrell WE, Deakin M, Elder JB. Sporadic colorectal polyps: management options and guidelines. Scand J Gastroenterol 1999; 34:4-11. [PMID: 10048725 DOI: 10.1080/00365529950172754] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S Anwar
- Dept. of Surgery, Keele University, Staffs., UK
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