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PubMed2003

Colon polyps and cancer.

A large number of studies published last year in peer-reviewed medical journals help to better define the advantages and limitations of the different options for colorectal cancer screening. Direct colonoscopy screening appears to have the greatest potential to markedly reduce both the incidence and mortality of colorectal cancer, but many obstacles limiting its widespread use in the general at-risk population still exist, and many questions remain incompletely answered. Recent studies stress the fact that finding and resecting advanced adenomatous polyps, and thereby preventing cancer, is becoming a primary objective of screening programs. Several papers also show the potential of emerging new methods of screening for specific markers in stool and for imaging the colon with computed-tomographic colonography (virtual colonoscopy). Other important publications highlighted in this review deal with the diagnosis of colorectal neoplasia, familial colorectal cancer, colorectal polyps and the adenoma-carcinoma sequence, and new and novel methods of improving the efficiency and safety of colonoscopic polypectomy.

Adenomatous Polyps↗
PubMed1983

The fluoroscopic barium enema in colonic polyp detection.

The results of 1,500 barium enema studies done by vigorous manual palpation under fluoroscopy were reviewed to determine the adequacy of this technique in detecting polyps above the proctoscopic level. Of the 1,500 patients examined, 103 (7%) were diagnosed radiographically as having a total of 149 polyps. Polyps were found at proctoscopy in about 10% of the 1,500 patients. Colonoscopy or surgery was performed on 35 of the 103 patients. Of the 52 polyps discovered during these procedures, only three were missed at fluoroscopic barium enema study, a false-negative rate of 6%. Fourteen patients whose barium enemas initially were reported as negative for polyps or neoplasia had colonoscopy. Two of the 14 patients had positive findings, for a true-negative rate of 86%. If the detection rate of 7% found at barium enema, taking into account an overlap of 10%, is combined with the rate of 7.5% found at proctoscopy, a frequency of about 14% emerges in detecting polyps in the rectum and in the colon. Thus, the fluoroscopic barium enema when combined with proctoscopy is a sensitive method in the detection of colorectal polyps. In addition, it has the advantage of rapid execution and relatively low cost.

Barium Sulfate↗
PubMed1998

Activators of the nuclear receptor PPARgamma enhance colon polyp formation.

A high-fat diet increases the risk of colon, breast and prostate cancer. The molecular mechanism by which dietary lipids promote tumorigenesis is unknown. Their effects may be mediated at least in part by the peroxisome proliferator-activated receptors (PPARs). These ligand-activated nuclear receptors modulate gene expression in response to fatty acids, lipid-derived metabolites and antidiabetic drugs. To explore the role of the PPARs in diet-induced carcinogenesis, we treated mice predisposed to intestinal neoplasia with a synthetic PPARgamma ligand. Reflecting the pattern of expression of PPARgamma in the gastrointestinal tract, treated mice developed a considerably greater number of polyps in the colon but not in the small intestine, indicating that PPARgamma activation may provide a molecular link between a high-fat diet and increased risk of colorectal cancer.

Adenocarcinoma↗
PubMed1983

Colon polyp morphology on double-contrast barium enema: its pathologic predictive value.

The morphologic appearance of 96 polyps seen on double-contrast barium enema was reviewed to assess the predictive value of various signs described to diagnose malignancy. Size, surface contour, basal indentation, and pedunculation were studied. Sessile polyps had an appreciable incidence of malignancy, with size being the best indicator of that risk. Pedunculation was found to be a reliable sign of benignity in predicting the absence of malignant invasion into the adjacent colonic wall. Polyps under 1 cm and having a smooth contour were invariably benign. Conversely, polyps larger than 1 cm with a lobulated contour and basal indentation had a significant incidence of malignancy.

Adenoma↗
PubMed1994

Focal polypoid ischemia of the colon: atheroemboli presenting as a colonic polyp.

Cholesterol emboli are known to imitate a variety of disease processes, thereby leading to delayed diagnosis. We describe a patient with a localized polypoid mass of the colon without endoscopic evidence of generalized ischemic colitis. Histologic evaluation revealed this polyp to be the result of localized ischemia with identifiable submucosal atheroemboli. Localized polyp formation appears to be a rare manifestation of atheroemboli; consequently, focal ischemia, caused by atheroemboli, should be added to the differential diagnosis of polyps of the colon.

Colitis, Ischemic↗