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PubMed2002

Cancer risk assessment from family history: gaps in primary care practice.

OBJECTIVE: To determine whether an adequate amount of family history is being collected and recorded by family practitioners to appropriately identify patients at increased risk for cancer. STUDY DESIGN: Retrospective chart audit. POPULATION: Charts from 500 randomly chosen patients, 40 to 60 years of age, were audited. Of those charts, 400 were from a large academic family practice and 50 charts each were from 2 small community family practices in the greater Philadelphia area. OUTCOMES MEASURED: General features of family history taking were recorded, including presence of a family history and date when recorded, evidence of updated family history data, and presence of a genogram. Cancer features recorded included mention of family history of cancer or colon polyps and, if positive, identification of which relative was affected, site of cancer, and age of diagnosis or death. RESULTS: Most charts (89%) had some family history information recorded, and 55% listed a family history of cancer, either positive or negative. Of the 356 relatives affected with cancer, an age of diagnosis was documented in only 8%; of 183 first-degree relatives with cancer, only 7% had a documented age of diagnosis. Two percent of all charts had any mention of a family history of colon polyps. Sixty-five percent of family histories were recorded at the first visit, and only 35% had any updated family history information. CONCLUSIONS: The number and type of family histories currently being recorded by family practitioners are not adequate to fully assess familial risk of cancer. New strategies will need to be developed to better prepare providers for risk-based clinical decision making.

Adult↗
PubMed1998

[Genetic diagnosis of familial adenomatous polyposis: detection of APC gene mutations based on an in vitro synthetized protein].

Familial adenomatous polyposis of the colon (FAP) is a dominant autosomic disease in which virtually 100% of the affected individuals develop colorectal cancer before the age of forty. The gene responsible for this disease (APC gene) is mutated in the germ line of these patients. The genetic diagnosis of FAP was initially done using linkage analysis. Because 95% of the mutations in APC gene result in a stop codon which will originate a truncated protein, previous authors have proposed that the mutation analysis should be performed using an in vitro synthesized protein (IVSP) assay. In this study we searched for germinal mutations in exon 15 of the APC gene in subjects belonging to families with FAP, using the IVSP assay. Eighty individuals belonging to 23 families were included in this series. We started by studying exon 15 which encompasses 6500/8535 bp and which corresponds to 75% of the coding region. This exon was divided into four fragments, which were amplified by PCR and the product was used in a transcription/translation assay. Mutations resulting in a truncated protein were detected in 9/23 (39%) of the families. This corresponds to 20/42 (48%) of individuals analysed in these nine families. All the mutations were located in the 5' region of exon 15, with seven of them being in the first fragment and the remaining two in the same place of the second fragment. With the exception of two healthy individuals at risk, all the others with a detected mutation, already exhibited clinical manifestations. One of these two individuals was later confirmed to harbor colonic polyps, strengthening the diagnostic accuracy of this IVSP analysis. We also identified 10 other healthy subjects at risk with a negative genetic diagnosis, who were therefore removed from surveillance programs. In conclusion, our results show that IVSP analysis has a high sensitivity as a diagnostic tool and should be used as the first screening method to identify those individuals who have inherited the genetic defect, even before they have developed any symptoms. This will enable us to try new drugs which may potentially delay or prevent the development of colonic polyps.

Adenomatous Polyposis Coli↗
PubMed1995

Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States).

Hyperplastic polyps of the colon reveal a geographic distribution similar to that of colorectal cancer and adenomatous polyps. However, unlike adenomas--known precursors of colorectal cancer--little is known about the etiology or clinical significance of the hyperplastic polyp. In this prospective study, we set out to determine the main dietary and other lifestyle factors in the United States that might be associated with this lesion. Hyperplastic polyps of the distal colon and rectum were diagnosed in 219 of 12,922 men of the Health Professionals Follow-up Study having had an endoscopic procedure between 1986 and 1992, and 175 of 15,339 women of the Nurses' Health Study who had undergone an endoscopy for a variety of reasons between 1980 and 1990. After adjusting for age, family history of colon cancer, history of previous endoscopy, and total energy intake using multiple logistic regression, those consuming 30 g or more of alcohol per day were at increased risk relative to nondrinkers among men (relative risk [RR] = 1.69; 95 percent confidence interval [CI] = 1.01-2.80) and women (RR = 1.79, CI = 1.02-3.15). Current smoking also was found to be associated strongly positively with hyperplastic polyps in men (RR = 2.45, CI = 1.59-3.75) and women (RR = 1.96, CI = 1.16-2.86). High intake of folate was associated inversely with risk in both men (RR = 0.74, CI = 0.49-1.11, between high and low intakes of folate) and women (RR = 0.45, CI = 0.28-0.74, between high and low intakes of folate). Among macronutrients, a suggestive increase in risk existed with intake of animal fat, although this was attenuated in the full multivariate model (RR[men] = 1.48, CI = 0.94-2.41, and RR[women] = 1.22, CI = 0.77-1.94) between high and low quantities of animal fat intake. These prospective data provide evidence of associations between low folate intake, alcohol consumption, and current cigarette smoking, and risk of hyperplastic polyps of the distal colon and rectum. These same factors also have been found to be related to adenoma and cancer of the colon. The hyperplastic polyp is an indicator of populations at high risk for colorectal carcinoma, and it also may serve as a marker for factors that influence neoplastic evolution.

Adult↗
PubMed1984

Management of patients with polyps containing malignancy removed by colonoscopic polypectomy.

The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinoma in situ (CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow-up has been six to 84 months (mean 36 months). Twenty-seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.

Adenoma↗
PubMed1989

Bowler-hat sign: a simple principle for differentiating polyps from diverticula.

The bowler-hat sign has been described both with colonic polyps and with diverticula. The authors describe a simple principle for evaluating a bowler-hat sign in order to determine whether it is caused by a polyp or a diverticulum. If the bowler hat points toward the center of the long axis of the bowel, it represents an intraluminal structure (ie, a polyp). If, however, it points away from the center of the long axis of the bowel, it represents an extraluminal structure (ie, a diverticulum). Only if the bowler hat is located in the midline or is directly parallel to the long axis of the bowel is it impossible to classify the abnormality as a polyp or a diverticulum. The value of this principle was confirmed with both a radiographic model and a blinded review of radiographs from 37 cases demonstrating the bowler-hat sign. When a bowler hat is present on a double-contrast barium enema examination, use of this principle provides a simple and objective means of differentiating a polyp from a diverticulum.

Barium Sulfate↗
PubMedDate not supplied

Operative colonoscopic endoscopy.

There are several conditions where operative colonoscopy is useful. Acute colonic pseudo-obstruction or Ogilvie's syndrome is characterized by a acute distension of the colon. Although medical management may be sufficient in many cases, endoscopic decompression must be performed when colonic distension is greater than 12 cm. Insertion of decompression tube to avoid rapid recurrence seems to be adequate. In case of massive lower intestinal hemorrhage, colonoscopy seems to be more accurate than mesenteric angiography. Such endoscopic examination requires an experienced endoscopist. Colonoscopic polypectomy has become the standard method for removal of colonic polyps. Factors influencing the rate of complications have been studied. While the number of complications was very low, we have observed that all the major hemorrhages were immediate when the blended current was used, but delayed when the pure coagulation current was applied. Endoscopic laser photocavitation is a valuable palliative method treating rectal adenocarcinoma in well selected patients. Indeed, if the patients survive sufficiently long after initial therapy, it becomes increasingly difficult to achieve persistent palliation with laser therapy.

Adenocarcinoma↗
PubMedDate not supplied

[Distribution of polyps in the inside region of Vizcaya (Spain): implications for diagnostic tests and colorectal cancer screening].

INTRODUCTION: The importance of colonic polyp is increasing because colorectal cancer (CRC) screening is based on their identification. However, consensus is lacking on which technique should be used in CRC screening, whether colonoscopy or other methods such as sigmoidoscopy, which shows good sensitivity only in distal segments of the colon. We studied the characteristics and localization of polyps in our environment to verify their tendency to change localization and determine the implications of this in screening. MATERIAL AND METHODS: We reviewed the prevalence and characteristics of colonic polyps in 3604 patients who underwent colonoscopy for various causes in our service, as well as their distribution in 837 patients with a diagnosis of polyps who underwent complete colonoscopy. Localization proximal or distal to the splenic flexure and polyp size (less than or more than 1 cm) were analyzed. RESULTS: Polyps were found in 28.3% of 3604 patients (11.7% showed polyps > or = 1 cm). Of the 837 patients who underwent complete colonoscopy, proximal polyps were found in 44.9% (14.6% showed polyps > or = 1 cm), while distal polyps were found in 79.9% (30.3% showed polyps > or = 1 cm). Both proximal and distal polyps were found in 24.8%. The probability of finding both proximal and distal lesions was 31%. Proximal lesions without distal lesions were found in 20% of the patients (5.6% presented polyps > or = 1 cm), and consequently sigmoidoscopy would miss 15.6% of polyps > or = 1 cm. CONCLUSIONS: A relatively high percentage of patients with proximal polyps > or = 1 cm would remain undiagnosed if complete colonoscopy were only performed in patients with distal polyps. Because of the well-known increase in the frequency of proximal polyps and because a considerable number of these present without distal sentinel lesions, there are increasing arguments for considering colonoscopy as the basic technique for CRC screening.

Colon↗
PubMed2005

Immunohistochemical distribution of vanilloid receptor, calcitonin-gene related peptide and substance P in gastrointestinal mucosa of patients with different gastrointestinal disorders.

The immunohistochemical distribution of capsaicin/vanilloid (transient receptor potential vanilloid 1, TRPV1) receptors and neuropeptides (CGRP, SP) was studied in the gastrointestinal mucosal biopsies of patients with gastritis, erosions, ulcers, polyps, adenocarcinoma, chronic inflammatory bowel diseases, polyps without and with hyperplasia, dysplasia and adenocarcinoma in colon. The studies were carried out in 127 patients and 30 people with only functional dyspepsia (without any histological alteration). The results were: (1) the positivity of TRPV1 receptor and CGRP was detected, and weak participation of SP was detected in patients with different gastric diseases; (2) the presence of TRPV1, CGRP and SP could be detected in chronic inflammation of bowel disease; (3) SP could not detected in patients with colon polyps, dysplasia and adenocarcinoma; (4) the presence of TRPV1 and CGRP was proved in colon dysplasia and adenocarcinoma. We conclude that (1) the immunohistochemical distribution of TRPV1, CGRP and SP differs in gastrointestinal diseases of the upper and lower tract, and (2) the participation of TRPV1, CGRP and SP differs significantly in these different gastrointestinal diseases.

Adenocarcinoma↗
PubMed2001

Polyp retrieval after colonoscopic polypectomy: use of the Roth Retrieval Net.

BACKGROUND: All colon polyps removed during colonoscopy should be recovered and submitted for histopathologic analysis. Published information is scant regarding techniques and devices for retrieval of polyps after polypectomy. The Roth Retrieval Net is a novel device that has been used to retrieve foreign bodies from the GI tract, but its use as a polyp retrieval device has not previously been described. METHODS: A chart review was conducted over a 7-month period by one gastroenterologist in an office setting of all patients who had polyps retrieved after piecemeal polypectomy by using the Roth Retrieval Net. RESULTS: All resected polyps were completely retrieved in a time-efficient manner. Histopathologic evaluation was not compromised by the use of this device. CONCLUSIONS: The Roth Retrieval Net is well suited for retrieval of multiple polyp fragments after colonoscopic polypectomy.

Colon↗
PubMed1995

Juvenile polyposis.

Juvenile polyposis is an uncommon condition characterized by the development of multiple juvenile polyps, predominantly in the colon but also in the rest of the gastrointestinal tract. The condition usually presents in childhood; only 15 per cent of patients present as adults. The rarer and often fatal form, namely, juvenile polyposis of infancy, is typified by diarrhoea, protein-losing enteropathy, bleeding and rectal prolapse. The more common form of juvenile polyposis (affecting the colon, stomach and small bowel) occurs in the first or second decade with rectal bleeding and anaemia. A family history of the condition is found in 20-50 per cent of patients with apparently an autosomal dominant trait. The gene for juvenile polyposis has not yet been identified. Epithelial dysplasia is common and the cumulative risk of colorectal cancer is > 50 per cent. Various extracolonic abnormalities may also occur. Most patients are treated surgically for colonic polyps, although endoscopic polypectomy is also an option. The rest of the gastrointestinal tract should be screened as should asymptomatic first-degree relatives.

Adenomatous Polyposis Coli↗
PubMed1990

Production and characterization of a new monoclonal antibody to colorectal carcinoma.

This study describes a new murine monoclonal antibody (MoAb) 5C1 raised against human colorectal carcinoma, which gave a differential reaction on formalin-fixed sections of the gastrointestinal tract. The MoAb 5C1 of immunoglobulin M (IgM) isotype reacted with both the cytoplasm and membrane of all normal colonic epithelia, and with all benign colonic polyps and all premalignant colonic lesions. However, there was a decreased expression of the 5C1 antigen in most cases of colonic malignancy and it was this feature that makes MoAb 5C1 unique. The distribution of the 5C1 epitope in normal gastrointestinal tract is limited to a few epithelial cells in the mid-portion of the small intestine but this distribution increased progressively down the digestive tract until it was found on greater than 90% of normal epithelial cells (in membrane and cytoplasm) of the colon. In addition, the 5C1 epitope was present on mucin secreting cells from normal organs of the gastrointestinal, reproductive and pulmonary tract and benign and malignant tissues of the colon. On Western blots, MoAb 5C1 was found to detect a heterogeneous population of molecules with molecular weights greater than 100 kDa with the strongest staining bands found between 230 and 300 kDa. MoAb 5C1 does not detect carcino-embryonic antigens (CEA), human milk fat globules (HMFG), human lymphocyte antigens (HLA) or ABO blood group antigens. The combination of its presence in mucin secreting cells and its broad molecular weight bands suggest that the antigen detected is a mucin.

Animals↗
PubMed2003

[State of the art of MR colonoscopy].

MR colonoscopy is suitable for colorectal cancer screening. This imaging modality is non-invasive, has no harmful side effects and provides a high diagnostic accuracy. MR colonoscopy has been found to be highly sensitive and specific in detecting colorectal lesions > 10 mm in size. Since colonic polyps are difficult to differentiate from residual stool, colonic cleansing has been unavoidable but reduces patient acceptance. Cleansing of the bowel can be avoided if the signal of stool is rendered different from its surrounding. This can be achieved by adding an agent to the food that tags the feces (fecal tagging). This article describes current techniques of MR colonoscopy as well as first results with fecal tagging.

Aged↗
PubMed2002

NSAID inhibition of GI cancer growth: clinical implications and molecular mechanisms of action.

Epidemiological studies suggest that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) reduce the incidence of and mortality from colorectal, gastric, and esophageal cancers. The precise mechanisms by which NSAIDs exert their chemopreventive effects are not fully explained, but likely involve inhibition of cyclo-oxygenase, the enzyme that converts arachidonic acid to prostaglandins. Two isoforms of this enzyme, cyclo-oxygenase 1 (COX-1) and COX-2, have been identified. COX-2 is absent in normal mucosa but is overexpressed in colonic, gastric, and esophageal cancers, as well as their precursor lesions. The inhibition of COX-2 through either pharmacological agents or gene deletion results in suppression of colonic polyp formation. NSAIDs reduce colonic, gastric, and esophageal cancer cell growth, in part, by inducing apoptosis. However, the antineoplastic effects of NSAIDs may be partly independent of their ability to inhibit COX-2. The mechanisms involved in the antineoplastic actions of NSAIDs include inhibition of angiogenesis (essential for delivery of oxygen and nutrients to a growing tumor), induction of apoptosis (which is usually reduced in cancer cells) by stimulation of proapoptotic genes, and direct inhibition of cancer cell growth by blocking signal transduction pathways responsible for cell proliferation.

Animals↗
PubMed2001

Clinical features and therapeutic outcomes of 65 patients with acromegaly at Tokyo Women's Medical University.

OBJECTIVE: The purpose of this study was to survey the clinical characteristics, complications, and therapeutic outcome in patients with acromegaly. PATIENTS AND METHODS: The clinical features of 65 patients with acromegaly (31 males, 34 females; mean age: 50+/-2 yr.) who were admitted to Tokyo Women's Medical University between 1990 and 1999 were analyzed retrospectively from medical records. RESULTS: The retrospective analysis revealed that the diagnosis of acromegaly was preceded by approximately 8.1+/-1.1 years of signs and symptoms of the disease. Forty-six of the 65 patients (71%) had macroadenomas, 16 (25%) had microadenomas, and the remaining three had empty sella. The rate of biochemical cure or remission was 81% for microadenoma (13/16), 64% for macroadenoma without extrasellar extension (9/14), and 13% for macroadenoma with cavernous sinus extension (2/15). Eighteen (28%) patients had impaired glucose tolerance (IGT) and 32 (49%) had diabetes mellitus (DM). After treatment for acromegaly, glucose metabolism was analyzed again in 38 patients, and it improved in 26 patients with IGT or DM. Twenty-five of 65 patients (38%) had hypertension. Of 26 patients who underwent barium enema or colonoscopy, 10 had colonic polyps and 4 had colon cancer. CONCLUSION: This study suggests that long-term excessive growth hormone (GH) secretion causes many complications. Therefore, awareness of the early symptoms and signs of acromegaly and long-term careful management of complications, along with therapy to reduce serum GH/insulin-like growth factor (IGF)-I levels, are important for patients with acromegaly.

Acromegaly↗
PubMed2002

[Endoscopic methods of treatment of precancerous lesions of the colon].

The endoscopic method--colonoscope, has become the tool of choice for diagnosing many colonic disorders, including the acute and chronic inflammatory bowel disease, lower gastrointestinal bleeding, benign and malignant tumors, and various others abnormalities appearing on the radiographs. The colonoscope is also useful and become the main confirmation method in screening for and monitoring colonic cancer. In the same time, colonoscopy offers numerous therapeutic options. The colonic polyps, well-known colonic precancerous lesions, with incidence ranges from 7 to 50%, can be removed completely during the colonoscopy, with a snare or biopsy forceps (polypectomy). Early cancers limited to the mucosal layer (intraepithelial cancer or carcinoma in situ) can be treated endoscopically too (mucosectomy), as well as various gastrointestinal bleeding (with sclerotherapy, electrocoagulation, APC, laser-fotocoagulation), inflammatory and postsurgical strictures (endoscopic dilation), and foreign bodies in the rectum and sigma (endoscopic extraction).

Colonic Neoplasms↗
PubMed1976

[Juvenile colonic mucosal polyps in adults].

The histology of all intestinal polyps removed endoscopically during the last 30 months has been reviewed. Among the 90 patients with a total of 154 polyps, 3 cases of juvenile polyps were found. All three were male adults who were aged 29, 34, and 50 years. In two patients the lesion was solitary, while one had polyposis with about 100 polyps. Macroscopically the juvenile polyps cannot be distinguished from adenomatous polyps, but their histologic appearance is typical. They are considered to be hamartomas and have no tendency to become malignant. Thus, juvenile polyposis does not represent a precancerous lesion as adenomatous polyposis does, and must therefore be treated differently. Therapy consists of endoscopic removal of all polyps. In order to differentiate juvenile from adenomatous polyps with certainty, histological examination of at least one polyp is necessary. This differential diagnosis is the indispensable precondition for appropriate therapy.

Adenoma↗
PubMed1990

[Secretion of thyrocalcitonin and parathyroid hormone in diffuse polyposis of the colon].

The article presents data obtained in studying the content of calcium regulating hormone thyrocalcitonin and parathyroid hormone in blood plasma of patients with diffuse polyposis of the colon prior to and after a radical surgical treatment. The content of these hormones was also studied in extracts from colonic polyps. The concentration The concentration of thyrocalcitonin was found to decrease after operation. The elevated concentration of thyrocalcitonin was established in polyp extracts which might suggest its "ectopic secretion" in the polyp tissue in diffuse polyposis. Removal of the colon with polyps is followed by normalization of metabolism in the organism which proves the expediency of early surgical treatment.

Adenomatous Polyposis Coli↗