-
Gastrointestinal Endoscopy Clinics of... Apr 2022Colorectal cancer (CRC) is a common malignancy in the U.S. and worldwide. Most CRC cases arise from precancerous adenomatous and serrated polyps. Established risk... (Review)
Review
Colorectal cancer (CRC) is a common malignancy in the U.S. and worldwide. Most CRC cases arise from precancerous adenomatous and serrated polyps. Established risk factors for conventional adenomas and CRC include age, male sex, family history, obesity and physical inactivity, and red meat intake. White race and tobacco and alcohol use are important risk factors for serrated polyps, which have a distinct risk factor profile compared to conventional adenomas. A history of abdominopelvic radiation, acromegaly, hereditary hemochromatosis, or prior ureterosigmoidostomy also increases CRC risk. Understanding these risk factors allows for targeted screening of high-risk groups to reduce CRC incidence.
Topics: Adenoma; Colonic Polyps; Colorectal Neoplasms; Humans; Incidence; Male; Risk Factors
PubMed: 35361331
DOI: 10.1016/j.giec.2021.12.008 -
Techniques in Coloproctology Dec 2004Adenomas presenting in colon and rectum require different strategies. Those in the rectum are accessible to local endoanal excision while those in the colon can be... (Review)
Review
Adenomas presenting in colon and rectum require different strategies. Those in the rectum are accessible to local endoanal excision while those in the colon can be removed by endoscopic polypectomy. Essentially the decision in both cases centres around the risk of malignancy. Does the tumour itself contain a focus of malignancy? Where invasion has been demonstrated in the tumour, are the regional lymph nodes involved? Rectal adenomas can be assessed by clinical examination, rectal ultrasound and magnetic resonance imaging. Colonic adenomas on the other hand, are assessed by endoscopic appearances amplified by chromo- and zoom-endoscopy techniques and by endoscopic endosonography. In both locations the decision for surgical resection may be necessary in two clinical circumstances: the preoperative assessment of invasion and following the histopathology report where invasion has been demonstrated. With any adenoma with malignant change, a surgical opinion should be obtained. The decision for surgery depends on the risk of failure of the local excision balanced by the risk of morbidity and mortality following major surgery. Patients' wishes in the light of discussion of clinical and pathological prognostic factors are crucial in making the decision. Surgery is more frequently applied for early colonic than rectal cancers. This is due to two main factors: resective colonic surgery has less complications and mortality than anterior resection and transanal local excision may be more radical than endoscopic colonic polypectomy because it excises the full-thickness rectal wall.
Topics: Adenoma; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans
PubMed: 15666109
DOI: 10.1007/s10151-004-0179-9 -
Alimentary Pharmacology & Therapeutics Feb 2022Women and men with colorectal adenomas are at increased risk of colorectal cancer and colonoscopic surveillance is recommended. However, the long-term cancer risk...
BACKGROUND
Women and men with colorectal adenomas are at increased risk of colorectal cancer and colonoscopic surveillance is recommended. However, the long-term cancer risk remains unknown.
AIMS
To investigate colorectal cancer incidence and mortality after adenoma removal in women and men METHODS: We identified all individuals who had adenomas removed in Norway from 1993 to 2007, with follow-up through 2018. We calculated standardized incidence ratios (SIR) and incidence-based mortality ratios (SMR) with 95% confidence intervals (CI) for colorectal cancer in women and men using the female and male population for comparison. We defined high-risk adenomas as ≥2 adenomas, villous component, or high-grade dysplasia.
RESULTS
The cohort comprised 40 293 individuals. During median follow-up of 13.0 years, 1079 women (5.5%) and 866 men (4.2%) developed colorectal cancer; 328 women (1.7%) and 275 men (1.3%) died of colorectal cancer. Colorectal cancer incidence was more increased in women (SIR 1.64, 95% CI 1.54-1.74) than in men (SIR 1.12, 95% CI 1.05-1.19). Colorectal cancer mortality was increased in women (SMR 1.13, 95% CI 1.02-1.26) and reduced in men (SMR 0.79, 95% CI 0.71-0.89). Women with high-risk adenomas had an increased risk of colorectal cancer death (SMR 1.37, 95% CI 1.19-1.57); women with low-risk adenomas (SMR 0.90, 95% CI 0.76-1.07) and men with high-risk adenomas had a similar risk (SMR 0.89, 95% CI 0.76-1.04), while men with low-risk adenomas had reduced risk (SMR 0.70, 95% CI 0.59-0.84).
CONCLUSIONS
After adenoma removal, women had an increased risk of colorectal cancer death, while men had reduced risk, compared to the general female and male populations. Sex-specific surveillance recommendations after adenoma removal should be considered.
Topics: Adenoma; Colonoscopy; Colorectal Neoplasms; Female; Follow-Up Studies; Humans; Incidence; Male; Risk Factors
PubMed: 34716941
DOI: 10.1111/apt.16686 -
The New England Journal of Medicine Mar 2016
Review
Topics: Adenoma; Age Factors; Barium Sulfate; Colonoscopy; Colorectal Neoplasms; DNA, Neoplasm; Early Detection of Cancer; Enema; Feces; Female; Humans; Male; Neoplasm Staging; Occult Blood; Practice Guidelines as Topic; Risk Factors
PubMed: 26981936
DOI: 10.1056/NEJMra1513581 -
The New England Journal of Medicine Jul 2016
Topics: Adenoma; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male
PubMed: 27464215
DOI: 10.1056/NEJMc1604867 -
The New England Journal of Medicine Jul 2016
Topics: Adenoma; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male
PubMed: 27464216
DOI: 10.1056/NEJMc1604867 -
The New England Journal of Medicine Jul 2016
Topics: Adenoma; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male
PubMed: 27464213
DOI: 10.1056/NEJMc1604867 -
Cancer Science Dec 2022Although many chemopreventive studies on colorectal tumors have been reported, no effective and safe preventive agent is currently available. We searched for candidate...
Although many chemopreventive studies on colorectal tumors have been reported, no effective and safe preventive agent is currently available. We searched for candidate preventive compounds against colorectal tumor comprehensively from United States Food and Drug Administration (FDA)-approved compounds by using connectivity map (CMAP) analysis coupled with in vitro screening with colorectal adenoma (CRA) patient-derived organoids (PDOs). We generated CRA-specific gene signatures based on the DNA microarray analysis of CRA and normal epithelial specimens, applied them to CMAP analysis with 1309 FDA-approved compounds, and identified 121 candidate compounds that should cancel the gene signatures. We narrowed them down to 15 compounds, and evaluated their inhibitory effects on the growth of CRA-PDOs in vitro. We finally identified resveratrol, one of the polyphenolic phytochemicals, as a compound showing the strongest inhibitory effect on the growth of CRA-PDOs compared with normal epithelial PDOs. When resveratrol was administered to Apc mice at 15 or 30 mg/kg, the number of polyps (adenomas) was significantly reduced in both groups compared with control mice. Similarly, the number of polyps (adenomas) was significantly reduced in azoxymethane-injected rats treated with 10 or 100 mg/resveratrol compared with control rats. Microarray analysis of adenomas from resveratrol-treated rats revealed the highest change (downregulation) in expression of LEF1, a key molecule in the Wnt signaling pathway. Treatment with resveratrol significantly downregulated the Wnt-target gene (MYC) in CRA-PDOs. Our data demonstrated that resveratrol can be the most effective compound for chemoprevention of colorectal tumors, the efficacy of which is mediated through suppression of LEF1 expression in the Wnt signaling pathway.
Topics: Mice; Rats; Animals; Resveratrol; Adenoma; Colorectal Neoplasms; Wnt Signaling Pathway; Chemoprevention; Lymphoid Enhancer-Binding Factor 1
PubMed: 36082704
DOI: 10.1111/cas.15576 -
Expert Review of Molecular Diagnostics Mar 2009The evaluation of short- and long-term risk for developing cancer in patients with colorectal adenomas is controversial. Good, reliable predictors of cancer risk in any... (Review)
Review
The evaluation of short- and long-term risk for developing cancer in patients with colorectal adenomas is controversial. Good, reliable predictors of cancer risk in any adenoma are currently lacking and are limited to adenoma size, number and histologic type. In fact, the evaluation of any adenoma or precancer lesion (e.g., hyperplastic polyps, serrated adenoma or aberrant crypt foci) within the colorectum may be assessed by a number of techniques ranging from direct visualization through the endoscope, to microscopic assessment, and to evaluation at the molecular level. Emerging techniques may yield improved methods of adenoma risk-assessment in the near future. For one, newer endoscopy technologies include chromoendoscopy or endocytoscopy, which now render endoscopists able to resolve the surface and subsurface mucosa at cellular resolution in vivo and in real time - thus, bringing the microscope to the patient's bedside. This new era in endoscopic imaging is dubbed 'histoendoscopy'. Further, while traditional views of classifying protruding and sessile lesions include those of Haggitt, the sm-classification, the Japanese and the so-called Vienna classifications to evaluate neoplasia, the development of new molecular techniques may give way to new methods of classifying preneoplasia and precancerous lesions. This review discusses some pros and cons of risk evaluation technologies in the colorectal tract by endoscopy, microscopy, and quantitative and molecular features. The morphometry-based studies performed over the past decades for the quantitative assessment of cellular and nuclear features within adenomas have failed to yield results amenable for clinical translation and are unlikely to improve further and gain widespread use with current technology. Rather, emerging knowledge of pathway-specific markers through the outlining of a molecular classification will likely be the basis for improved detection and diagnosis. The emerging genomic and proteomic technologies allowing for noninvasive tests to detect (asymptomatic) cancer and neoplasia are discussed. Lastly, the importance of recognizing bias and pitfalls and the adherence to guidelines for biomarker research are addressed.
Topics: Adenoma; Biomarkers, Tumor; Colorectal Neoplasms; Endoscopy; Humans; Risk Factors
PubMed: 19298137
DOI: 10.1586/14737159.9.2.125 -
Clinical and Translational... Aug 2023Patients with serrated polyposis syndrome (SPS) have an increased risk to develop colorectal cancer (CRC). Due to an abundance of serrated polyps, these CRCs are assumed...
INTRODUCTION
Patients with serrated polyposis syndrome (SPS) have an increased risk to develop colorectal cancer (CRC). Due to an abundance of serrated polyps, these CRCs are assumed to arise mainly through the serrated neoplasia pathway rather than through the classical adenoma-carcinoma pathway. We aimed to evaluate the pathogenetic routes of CRCs in patients with SPS.
METHODS
We collected endoscopy and pathology data on CRCs and polyps of patients with SPS under treatment in our center. Our primary end point was the proportion of BRAFV600E mutated CRCs, indicating serrated pathway CRCs (sCRCs). CRCs lacking BRAFV600E most likely inferred a classical adenoma-carcinoma origin (aCRCs). We assessed patient, polyp, and CRC characteristics and stratified for BRAFV600E mutation status.
RESULTS
Thirty-five patients with SPS harbored a total of 43 CRCs. Twenty-one CRCs (48.8%) carried a BRAFV600E mutation, 10 of which lacked MLH1 staining and 17 (81%) were located in the proximal colon. Twenty-two CRCs (51.1%) did not carry a BRAFV600E mutation and were MLH1 proficient. Of these 22 putatively aCRCs, 17 (77.3%) were located distally and one-third (36.4%) harbored a pathogenic KRAS or NRAS mutation. In patients with BRAFwt -CRCs, a higher ratio of the median number of conventional adenomas versus serrated polyps was found (4 vs 13) than patients with BRAFV600E -CRCs (1 vs 14).
DISCUSSION
Our study indicates that in patients with SPS, the ratio of sCRCs:aCRCs on average is 50:50. This elevated sCRC:aCRC ratio in patients with SPS, when compared with non-SPS patients, correlates well with the differences in the ratios of the numbers of sessile serrated lesions and conventional adenomas in patients with SPS and non-SPS patients, respectively.
Topics: Humans; Colonic Polyps; Colorectal Neoplasms; Adenomatous Polyposis Coli; Adenoma; Carcinoma
PubMed: 37352472
DOI: 10.14309/ctg.0000000000000611