[Follow-up after treatment of colorectal neoplasms].
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Colonic Neoplasms↗
Biomedical subjects
O Kronborg
Publications and source records attributed to O Kronborg.
[Adjuvant treatment in connection with curative surgery of colorectal cancer].
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Chemotherapy, Adjuvant↗
[Requirement of hospital beds in connection with screening for colorectal cancer. The first 5-years of a randomized population survey].
Colorectal cancer puts a major burden on the hospital resources because of its frequency and demands for extensive surgery. Screening with Hemoccult-II detects the disease at an earlier stage in a number of persons. The possible influence upon length of hospital stay is investigated in a randomised trial of 61,938 persons between 45 and 74 years, 30,970 being invited to screening with Hemoccult-II bianually. The first screening was accomplished in 20,672 persons and 17,284 have completed three screenings from 1985 to 1990. The test was positive in 1%, and further examination (colonoscopy) among these revealed cancer in 74 and adenomas in 248 persons. The whole screening group contained 239 persons with cancer and 380 with adenomas, the figures among controls being 216 and 181, respectively. The excess hospital stay in the screening group was 487 days (7%), the major part being one-day admissions for colonoscopy. The average stay was shorter in the screening group and shortest among those with colorectal neoplasia being detected because of positive Hemoccult-II. Measurements of hospital stay included admissions for diagnosis, treatment and complications as well as recurrence within the first year of diagnosis. In conclusion, the excess use of hospital days introduced by screening was limited in the first five years. This will probably later disappear and become negative because of decreasing numbers of cancers in the screening group. Advanced cancers and admissions for possible colorectal cancer will also be less frequent in the screening group.
Adenoma↗
Can Hemoccult-II replace colonoscopy in surveillance after radical surgery for colorectal cancer and after polypectomy?
Surveillance after colorectal carcinoma and adenoma includes colonoscopy, which is a demanding procedure for the patient, doctor, and society. Therefore, it was investigated whether a simple fecal occult blood test could replace colonoscopy. Hemoccult-II (H-II) was performed before 1,244 colonoscopies in patients with previous cancer and before 328 colonoscopies in an adenoma surveillance program. The H-II test was positive in 3 of 9 patients with local recurrence, in 2 of 13 with metachronous cancer, and in 31 of 186 with adenomas. The test was positive more often in patients with large and multiple adenomas, sigmoid adenomas, and adenomas with villous elements and moderate-to-severe dysplasia, but the sensitivity did not reach more than 25 to 40 percent. It was concluded that markers more sensitive than H-II are needed to detect metachronous cancers and new adenomas. In the meantime, colonoscopy has to be used with intervals of several years, but not for detection of local recurrent cancer, which in most cases may be found by simpler means.
Chi-Square Distribution↗
Echo pattern of lymph nodes in colorectal cancer: an in vitro study.
Surgical specimens from 75 patients with colorectal cancer were examined within 15 min of removal with a 7.5 MHz linear-array transducer. The echo pattern of 139 lymph nodes was analysed to evaluate previous criteria of malignancy and to establish other possible criteria, which could be tested in vivo. The pathologist examined each node without knowledge of the sonographic finding. Malignant nodes were larger than benign nodes. Of 21 nodes less than 5 mm in diameter, 20 were benign. Round nodes were malignant more often (45/78) than ovoid nodes (6/61). A homogeneous echo pattern was associated with malignancy in 39 of 82 nodes in contrast to 12 of 57 with a heterogeneous pattern. Thirty-one nodes were ovoid as well as heterogeneous and all of these were benign. A hyperechoic centre was found in 14 nodes of which two were malignant. The highest predictive value for malignancy (59%) was obtained by combining the discriminative properties of shape, homogeneity and echogenicity.
Colorectal Neoplasms↗
Causes of death during the first 5 years of a randomized trial of mass screening for colorectal cancer with fecal occult blood test.
The main purpose of population screening for colorectal cancer is to reduce mortality from the disease. The criteria of death from colorectal cancer are defined in the present randomized trial of 61,938 persons between 45 and 74 years old, and the need for an impartial death review committee was demonstrated. Causes of death within the first 5 years are described within subgroups of the test group and compared with those in the control group. Death rates were higher among non-responders to screening than among controls and among those in whom Hemoccult-II had been performed at least once. Persons with negative Hemoccult-II had a lower death rate than controls. The overall autopsy rate was 32%. Lethal complications from treatment of colorectal neoplasia were evaluated per se. Death from colorectal cancer occurred in 74 persons in the total screening group and in 91 among controls. Sources of bias are discussed. A method of evaluating possible benefit to those being screened is suggested. Final results cannot be expected before 1996.
Aged↗
Interval cancers in screening with fecal occult blood test for colorectal cancer.
Interval cancers, which are cancers diagnosed in spite of one or more negative screening tests, were studied in a randomized population with Hemoccult-II for colorectal cancer in 61,938 persons between 45 and 74 years old. Three biannual screenings were performed from 1985 to 1991, and 52% of all the cancers detected after doing at least one Hemoccult-II test were interval cancers (81 persons). These were more advanced than cancers diagnosed after a positive Hemoccult-II test, of larger size, less frequently of Dukes stage A, more often invading neighboring organs, and less often resectable for cure. They were located in the rectum more often than cancers diagnosed by screening and cancers in controls. Otherwise, interval cancers did not differ from cancers in controls or cancers in non-responders, and all characteristics suggested that no delay in diagnosis resulted from one or more negative Hemoccult-II tests, compared with controls. However, even if screening with Hemoccult-II demonstrates a reduction in mortality from colorectal cancer, the present high number of interval cancers makes it necessary to look for other methods of screening populations for colorectal cancer.
Aged↗
Screening guidelines for colorectal cancer.
A review is given of methods and results of screening for colorectal cancer in average-risk and high-risk groups. Possible methods are digital rectal exploration, endoscopic examination, barium enemas, faecal occult blood tests, tumour markers like carcinoembryonic antigen, Ca-19-9, and others, and gene markers. Final results of large randomized population studies with faecal occult blood tests are expected within the next few years, but it will probably be necessary to add flexible sigmoidoscopy to achieve a major reduction in mortality from colorectal cancer in average-risk persons. Recommendations for screening in high-risk groups are proposed, but strong support for these guidelines are still missing, an exception being first-degree relatives of individuals with familial adenomatous polyposis; the other high-risk groups include members of hereditary non-polyposis colorectal cancer families, relatives of patients with sporadic colorectal cancer, patients with colorectal adenomas, patients with previous colorectal cancer, and patients with inflammatory bowel disease.
Colonoscopy↗
[Curative local excision of colorectal cancer. A prospective study].
The importance of local treatment for early colorectal cancer is apparent because of increasing endoscopical activity for diagnostic purposes and screening. Curative local treatment was attempted in 63 patients with polypoid, mobile tumours thought to be within the bowel wall and without palpable lymph nodes in the perirectal tissue. Tumours more than 3 cm in diameter were excluded, unless they were pedunculated or were believed to be adenomas with carcinoma. Removal was effected by polypectomy, piecemeal removal, peranal excision, posterior rectotomy or colotomy. Complications were few, and hospitalization was shorter than after conventional surgery, but one patient died from treatment. More extensive surgery followed in 12 patients, in whom cancer remained in the resection margin or where this could not be excluded. However, seven of the 12 patients had no residual cancer tissue. Survival without recurrence was longer in patients with tumours below 3 cm in diameter. Recurrence was seen in nine patients, but not in those with cancer limited to head and the stalk of pedunculated tumours and not with cancer limited to the luminal part of submucosa, regardless of shape of tumour. Adenoma in continuity with cancer did not influence survival significantly, but synchronous adenomas in other parts tended to increase recurrence-free survival. Local treatment is satisfactory in most patient with cancer within pedunculated polyps and in some with cancer in sessile polypopid tumours. Criteria of selection are not optimal and the use of endoluminal ultrasound examinations must be evaluated in prospective trials. At present, conventional surgery should be used when cancer in the resection margin cannot be excluded, when cancer is present in the deeper layers of muscularis propria and in patients with poorly differentiated cancers.
Adult↗
[Colonoscopy after radical surgery for colorectal cancer. A 10-year prospective study of 309 patients].
Experience from ten year colonoscopic follow-up in patients after radical surgery for colorectal cancer is presented. In all, 309 patients below 76 years were included from 1978 to 1983. All had preoperative proctoscopy and barium enema. Colonoscopy was performed perioperatively, every six months the first three years, four and five years, seven to eight years and ten years after surgery. A minority had double-contrast barium enemas. Synchronous adenomas were removed during surgery and at perioperative colonoscopy and these patients had the same risk of metachronous cancer as those without synchronous adenomas. Five patients with six metachronous cancers, all had new curative surgery. Patients with synchronous adenomas had a higher risk of metachronous adenomas, but had a better prognosis than those without synchronous adenomas. Colonoscopically demonstrated intraluminal local recurrence in the colon could not be treated with new radical surgery in contrast to four out of eight intraluminal recurrences in the rectum. Most local recurrences were extraluminal and were diagnosed by other means.
Adenoma↗
Population screening for colorectal cancer, the goals and means.
The causes of colorectal cancer are complex and in most cases obscure, making primary prevention impossible at present. Secondary prevention by finding and treating early asymptomatic cancers may possibly reduce mortality from this very common cancer. Results from conventional treatment have changed little during recent decades and are unsatisfactory, with more than half of the patients dying from the disease. The incidence has increased during recent years in many countries, making it vital to evaluate possible benefits from screening. This review considers different methods of screening for colorectal cancer and includes an overview of continuing European controlled randomised trials with the faecal occult blood test, Haemoccult-II. No final evaluation is possible, but advantages and drawbacks of different strategies are discussed. Assuming that the goal of reducing mortality is achieved, several other problems remain unsolved: the organisation of screening, the training of doctors in endoscopy, cost benefit and cost effectiveness all of which will have to be solved before a population screening can be recommended. Present screening tools are not ideal and we have to continue the search for better markers of early colorectal cancers and even possible precursors like adenomas.
Barium Sulfate↗
[Rectoscopy and Hemoccult II in irritable colon. A prospective study].
It was investigated whether Hemoccult-II test (H-II) could reduce the number of colonic examinations in patients with the irritable bowel syndrome, with normal rigid proctoscopic findings. A negative H-II was obtained in 299 patients from general practice and a positive test in nine. Colonoscopy was done in 157 and double contrast barium enema in 142 after random allocation. The nine patients with positive H-II all had colonoscopy. Among the 299 with negative H-II, colonic adenomas were detected in ten and an early cancer in an adenoma in the sigmoid colon; overlooked rectal adenomas were found in three, rectal cancer in one, rectal carcinoid in another and a coecal cancer, which could be palpated, in a third patient. Two patients with colonic cancer and one with adenoma were detected among those with positive H-II. All patients were followed by clinical examination after one year. In conclusion, colonic examination should carry a low priority in patients with symptoms of irritable bowel, negative Hemoccult-II and normal rigid proctoscopic findings performed by an experienced examiner. The investigation confirmed the recommendation of total colonoscopy in patients with a positive H-II and added support for increasing number of endoscopy services in contrast to those of diagnostic radiology, which should be reduced.
Adenoma↗
[Is clinical diagnosis alone unacceptable in acute appendicitis?].
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Acute Disease↗
[The pH and acidity of feces in colorectal neoplasms].
The pH and faecal titratable acidity in fresh faeces were measured in patients with colo-rectal carcinoma or adenoma and in normal individuals. Significantly higher pH values and lower acidity were found in patients with cancer than in normal individuals. Patients with cancer had pH greater than 6.90 more frequently than normal. Patients with adenomata did not differ significantly from normal individuals. These results support performance of intervention trials with lowering of the pH in the colon with the object of cancer prophylaxis even although the causal connection is obscure.
Adenoma↗
Observer reproducibility in grading dysplasia in colorectal adenomas: comparison between two different grading systems.
The two most well known and well defined grading systems for dysplasia in colorectal adenomas were compared with regard to reproducibility. The Konishi-Morson system (KMS) operates with several histological and cytological variables and grades of mild, moderate, and severe dysplasia. The Kozuka system is based on the extent of nuclear pseudostratification and also has three grades of dysplasia (III-V). As the group of severe dysplasia is very large in this system, it was extended with two higher grades, similarly based on individual histological criteria, known hereafter as the extended Kozuka system (EKS). Fifty six adenomas were graded by two observers, each observer grading twice according to the KMS criteria and twice according to EKS criteria. Intraobserver reproducibility was excellent for the KMS and moderate for the EKS, but this was not significant. The overall interobserver reproducibility was similar (moderate) for the KMS and for the EKS. Kappa values for interobserver reproducibility on individual categories were excellent for severe dysplasia according to the KMS, but low for all other categories in both systems. By simplifying both systems into two groups a high reproducibility can be obtained, but this implies that all the original grades (III-V) for the EKS must be grouped together. It is therefore recommended that a simplified KMS is used for further studies on the biological importance of dysplasia and for comparison between histological changes and other markers for colorectal neoplasia.
Adenoma↗
Risk and surveillance of individuals with colorectal polyps. Who Collaborating Centre for the Prevention of Colorectal Cancer.
Since colorectal adenomas are very probably the precursors of colorectal cancer, their detection and removal should result in a decrease in the incidence and mortality from colorectal cancer. Individuals who harbour an adenoma have a 30-50% probability of having additional adenomas at that time, and a 30% probability of having additional adenomas later. Adenomas are prevalent in countries where colorectal cancer is prevalent, about two-thirds of them being tubular and the rest tubulovillous or villous. The initial management of patients with an adenoma consists in searching by colonoscopy the entire colon and removing all additional polyps. Surgical resection is required wherever there is invasive cancer with adverse histological factors. Follow-up in most patients can be after 2-4 years, earlier follow-up being reserved for patients with numerous polyps or with a polyp that had been removed piecemeal. The results of ongoing trials should provide firm guidelines for follow-up and could also be used in mathematical modelling to examine alternative strategies and to help understand the evolving patterns of appearance of new polyps. Finally, a deeper understanding of the biology and inherited and acquired genetics will help identify individuals at risk for adenomas initially and at follow-up. Nutritional factors may also provide a basis for prevention of adenomas in high-risk countries. Many of these issues are being addressed in current research.
Adenoma↗
Screening of average-risk individuals for colorectal cancer. WHO Collaborating Centre for the Prevention of Colorectal Cancer.
Recent developments in screening, diagnosis and treatment of colon cancer could lead to a reduction in mortality from this disease. Removal of adenomas, identification of risk factors, appropriate application of accurate diagnostic tests, and aggressive anatomic-surgical resection of colon cancers may already be having a favourable impact. Screening of average-risk populations over the age of 50 also offers promise in the control of this important cancer. The disease is of sufficient magnitude to deserve detection at an early stage with better prospects of patient survival, since screening tests with moderate sensitivity and high specificity are available. Flexible sigmoidoscopy and faecal occult blood tests are sufficiently acceptable to be included in case-finding among patients who are in the health care system. The results of current controlled trials involving more than 300,000 individuals for evaluating the impact of screening on mortality from colon cancer are needed before this approach can be recommended for general public health screening of the population. Further research is required to develop better screening tests, improve patient and physician compliance, and answer more definitively critical questions on cost-effectiveness. Mathematical modelling using current and new data can be used to determine the effectiveness of screening in conjunction with recommendations for primary prevention.
Colorectal Neoplasms↗
[Screening of cancer, advantages and disadvantages].
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Humans↗