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Cellular and Molecular Biology... Dec 2023Colorectal cancer (CRC) is one of the most common fatal malignancies caused by environmental and genetic factors. Considering the increasing frequency of CRC worldwide,...
Colorectal cancer (CRC) is one of the most common fatal malignancies caused by environmental and genetic factors. Considering the increasing frequency of CRC worldwide, especially in China, the importance of research on CRC is more widely defined. A recent study focused on molecular pathways involved in colon cancer carcinogenesis to improve cancer diagnosis and treatment to identify new biomarkers. Colon cancer is the result of dysplasia in primary growths of the intestine, known as polyps. These early growths are unknown and different in terms of morphology, molecular mechanisms, and the ability to cause colon cancer. This study aims to investigate the expression level of the CUL3 gene in polyps and colorectal cancer. This cross-sectional study collected 300 colorectal tissue biopsy samples, including 40 tumor tissue samples, 73 precancerous lesions with their adjacent tissue, and 31 normal tissue samples. The expression of the CUL3 gene was investigated by the Real-time PCR method. There was no significant difference in CUL3 mRNA expression between polyp tissues and their adjacent samples (p = 0.41). Our results showed no statistically significant difference in CUL3 gene expression between tumor tissues and their adjacent thermal samples (p = 0.78) and between tumor and polyp groups (p = 0.53). CUL3 may play an essential role in regulating cancer and CRC progression by stimulating the proteasomal degradation of various tumor suppressors or oncogenes. Studies on the effective substrates of CUL3 in colorectal cancer are essential.
Topics: Humans; Biomarkers, Tumor; Colonic Neoplasms; Colorectal Neoplasms; Cross-Sectional Studies; Cullin Proteins; Gene Expression
PubMed: 38279499
DOI: 10.14715/cmb/2023.69.14.5 -
Gastroenterology May 2024One goal of colorectal cancer (CRC) screening is to prevent CRC incidence by removing precancerous colonic polyps, which are detected in up to 50% of screening... (Review)
Review
One goal of colorectal cancer (CRC) screening is to prevent CRC incidence by removing precancerous colonic polyps, which are detected in up to 50% of screening examinations. Yet, the lifetime risk of CRC is 3.9%-4.3%, so it is clear that most of these individuals with polyps would not develop CRC in their lifetime. It is, therefore, a challenge to determine which individuals with polyps will benefit from follow-up, and at what intervals. There is some evidence that individuals with advanced polyps, based on size and histology, benefit from intensive surveillance. However, a large proportion of individuals will have small polyps without advanced histologic features (ie, "nonadvanced"), where the benefits of surveillance are uncertain and controversial. Demand for surveillance will further increase as more polyps are detected due to increased screening uptake, recent United States recommendations to expand screening to younger individuals, and emergence of polyp detection technology. We review the current understanding and clinical implications of the natural history, biology, and outcomes associated with various categories of colon polyps based on size, histology, and number. Our aims are to highlight key knowledge gaps, specifically focusing on certain categories of polyps that may not be associated with future CRC risk, and to provide insights to inform research priorities and potential management strategies. Optimization of CRC prevention programs based on updated knowledge about the future risks associated with various colon polyps is essential to ensure cost-effective screening and surveillance, wise use of resources, and inform efforts to personalize recommendations.
Topics: Humans; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Risk Factors; Risk Assessment
PubMed: 38224860
DOI: 10.1053/j.gastro.2023.11.305 -
United European Gastroenterology Journal May 2024The primary benefit of post-colorectal cancer (CRC) colonoscopic surveillance is to detect and remove premalignant lesions to prevent metachronous CRC. Current...
BACKGROUND
The primary benefit of post-colorectal cancer (CRC) colonoscopic surveillance is to detect and remove premalignant lesions to prevent metachronous CRC. Current guidelines for long-term colonoscopic surveillance post early age onset CRC (EOCRC) resection are based on limited evidence. The aims of this study were to assess the diagnostic yield of colonoscopic surveillance post-EOCRC resection and identify molecular and clinicopathological risk factors associated with advanced neoplasia.
METHODOLOGY
A retrospective cohort study of prospectively collected data was conducted at St Mark's hospital, London, United Kingdom, for patients diagnosed with EOCRC who underwent at least one episode of post-CRC colonoscopic surveillance between 1978 and 2022. We collected clinicopathological data including tumour molecular status and neoplasia detection rates.
RESULTS
In total, 908 colonoscopic surveillance procedures were performed in 195 patients over 2581.3 person-years of follow-up. The diagnostic yields of metachronous CRC, advanced adenomas and non-advanced adenomas were 1.76%, 3.41% and 22.69% respectively. Sixteen patients (8.21%) developed metachronous CRC, and the majority (87.5%) were detected more than 3 years post index EOCRC diagnosis. Detection of advanced neoplasia was significantly higher in EOCRC patients with Lynch syndrome (26.15%) compared with those in whom Lynch syndrome was excluded (13.13%) (OR, 2.343; 95% CI, 1.014-5.256; p = 0.0349).
CONCLUSIONS
During colonoscopic surveillance post-EOCRC resection, the long-term risk of developing metachronous advanced neoplasia remains high in the context of Lynch syndrome, but this trend is not as clearly evident when Lynch syndrome has been excluded.
Topics: Humans; Colonoscopy; Male; Female; Retrospective Studies; Colorectal Neoplasms; Middle Aged; Adenoma; Risk Factors; Age of Onset; Neoplasms, Second Primary; Adult; Early Detection of Cancer; Aged; Precancerous Conditions
PubMed: 38170450
DOI: 10.1002/ueg2.12516 -
European Journal of Surgical Oncology :... Feb 2024Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is...
BACKGROUND
Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians.
METHODS
We conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors.
RESULTS
Regression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = -5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872-0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection.
CONCLUSION
Age, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.
Topics: Humans; Child, Preschool; Retrospective Studies; Gallbladder Neoplasms; Gallbladder Diseases; Ultrasonography; Adenoma; Polyps
PubMed: 38159390
DOI: 10.1016/j.ejso.2023.107930 -
ACG Case Reports Journal Dec 2023The role of endoscopy in the management of traditionally surgical conditions continues to evolve. Endoscopic techniques, including endoscopic mucosal resection and more...
The role of endoscopy in the management of traditionally surgical conditions continues to evolve. Endoscopic techniques, including endoscopic mucosal resection and more recently endoscopic submucosal dissection, which remove cancerous and precancerous lesions in the gastrointestinal tract, continue to grow in use. In addition, therapeutic endoscopic ultrasound has evolved to include the management of patients with acute cholecystitis. Here, we present an 83-year-old man with acute calculus cholecystitis, who was considered ineligible for cholecystectomy and had a giant duodenal polyp that obstructed the visualization of the duodenal lumen, preventing the successful placement of lumen-apposing metal stents. Volume reduction of a duodenal polyp was performed through epinephrine injection to assist in the successful endoscopic ultrasound-guided gallbladder drainage. Subsequently, the patient underwent elective endoscopic mucosal resection to remove the giant duodenal polyp.
PubMed: 38130478
DOI: 10.14309/crj.0000000000001243 -
Surgical Endoscopy Mar 2024Colorectal cancer arises from precancerous lesions, primarily adenomatous and serrated polyps. Some polyps pose significant technical endoscopic challenges due to their...
BACKGROUND
Colorectal cancer arises from precancerous lesions, primarily adenomatous and serrated polyps. Some polyps pose significant technical endoscopic challenges due to their size, location, and/or morphology. A standardized protocol for documentation and management of these polyps can optimize clinical outcomes.
METHODS
A Quality Improvement project compared patients with a complex polyp (non-pedunculated, > 2 cm), for 12 months prior and 12 months after protocol introduction. Documentation and polyp management details were compared pre- and post-implementation using the Chi-square test.
RESULTS
69 patients were diagnosed with complex polyps prior to the protocol introduction and 72 after. 79% (112/141) of patients underwent endoscopic mucosal resections (EMR) locally, and 14.9% (21/141) underwent surgery locally. After protocol introduction, there was significant improvement in documentation of suspicious appearing polyps (21.7% to 47.2%, P = 0.001), luminal circumference (14.5% to 34.7%, P = 0.005), and management plans (87.0% to 97.2%, P = 0.023); other elements of documentation were similar. The number of patients reviewed at multidisciplinary conference (MDC) increased from 1 to 61% (P < 0.005). Patients rebooked in a 1 h endoscopy time slot increased from 19 to 58% (P < 0.005), as did specific consent for EMR from 22 to 57% (P < 0.005). Among patients with polyps 3 cm or greater (23 pre, 36 post), MDC review increased from 4 to 67% (P < 0.005), primary polypectomy decreased from 72 to 23% (P = 0.001), patients rebooked in a double endoscopy slot increased from 33 to 75% (P = 0.005), and specific consent increased from 39 to 75% (P = 0.014). There were less polyp recurrences (12/42 pre and 1/50 post) among the post-protocol cohort (P < 0.001).
CONCLUSIONS
The introduction of a formalized protocol for complex polyp adjudication and management has led to improved documentation, multidisciplinary discussion, and optimal complex polyp management with dedicated time for EMR, particularly for polyps over 3 cm. There is room for improvement, and this can be approached in a collaborative manner.
Topics: Humans; Colonic Polyps; Colonoscopy; British Columbia; Endoscopy, Gastrointestinal; Endoscopic Mucosal Resection; Colorectal Neoplasms
PubMed: 38097747
DOI: 10.1007/s00464-023-10631-8 -
Clinical and Translational... Feb 2024The identification of risk factors for precursor lesions of colorectal cancer (CRC) holds great promise in the context of prevention. With this study, we aimed to...
INTRODUCTION
The identification of risk factors for precursor lesions of colorectal cancer (CRC) holds great promise in the context of prevention. With this study, we aimed to identify patient characteristics associated with colorectal polyps (CPs) and polyp features of potential malignant progression. Furthermore, a potential association with gut microbiota in this context was investigated.
METHODS
In this single-center study, a total of 162 patients with CPs and 91 control patients were included. Multiple variables including information on lifestyle, diet, serum parameters, and gut microbiota, analyzed by 16S-rRNA gene amplicon sequencing and functional imputations (Picrust2), were related to different aspects of CPs.
RESULTS
We observed that elevated serum alkaline phosphatase (AP) levels were significantly associated with the presence of high-grade dysplastic polyps. This association was further seen for patients with CRC. Thereby, AP correlated with other parameters of liver function. We did not observe significant changes in the gut microbiota between patients with CP and their respective controls. However, a trend toward a lower alpha-diversity was seen in patients with CRC. Interestingly, AP was identified as a possible clinical effect modifier of stool sample beta diversity.
DISCUSSION
We show for the first time an increased AP in premalignant CP. Furthermore, AP showed a significant influence on the microbial composition of the intestine. Relatively elevated liver enzymes, especially AP, may contribute to the detection of precancerous dysplastic or neoplastic changes in colorectal lesions. The association between elevated AP, premalignant CP, and the microbiome merits further study.
Topics: Humans; Colorectal Neoplasms; Colonic Polyps; Bacteria; Feces; Gastrointestinal Microbiome; Hyperplasia
PubMed: 38088370
DOI: 10.14309/ctg.0000000000000660 -
Clinical Laboratory Dec 2023The aim was to investigate the value of blood Septin9, SRSF1, and PAX8 gene methylation detection techniques in early screening of colorectal cancer (CRC).
BACKGROUND
The aim was to investigate the value of blood Septin9, SRSF1, and PAX8 gene methylation detection techniques in early screening of colorectal cancer (CRC).
METHODS
A prospective cohort study enrolled 3,000 participants undergoing routine physical examination at Shizong County People's Hospital Health Management Center from December 2021 through November 2022, including 1,512 males and 1,488 females, ranging in age from 20 to 90 years, with a median age of 49 years. Fresh blood samples were collected and tested for Septin9, SRSF1, and PAX8 gene methylation. Positive or negative results were reported. Colonoscopy was recommended for positive results and telephone follow-up for negative results. A chi-squared test analyzed the positive rate of initial screening, colonoscopy compliance, and the detection rate of colorectal lesions. Finally, combined with the follow-up data, the screening effect of Septin9, SRSF1, and PAX8 methylation detection on CRC was evaluated.
RESULTS
Among 3,000 cases, 215 cases were preliminarily positive, with a positive rate of 7.1% (215/3,000). The positive rate of Septin9 gene methylation was the highest (6%, 180/3000), followed by SRSF1 (4.1%, 124/3000) and PAX8 (3.6%, 108/3000). The sensitivity of combined detection of Septin9, SRSF1, and PAX8 methylation in the diagnosis of CRC was higher than that of the three alone, and the specificity, positive predictive value, and negative predictive value of combined detection were higher than that of the single detection of blood Septin9, SRSF1, and PAX8 DNA methylation. In addition, the positive rate of initial screening increased with age (χ2 = 32.135, p < 0.001). A total of 150 cases underwent further colonoscopy, and the colonoscopy compliance rate was 69.8% (150/215). Among 150 cases who completed colonoscopy, 5 cases of CRC (3.4%), 25 cases of advanced adenoma (16.0%), 78 cases of non-advanced adenoma (52.0%), and 24 cases of non-adenomatous polyps (22.7%) were detected. The positive predictive value of Septin9, SRSF1, and PAX8 methylation was 94% (141/150) for all colorectal lesions, and 70.0% (105/150) for colorectal cancer and precancerous lesions.
CONCLUSIONS
Blood Septin9, SRSF1, and PAX8 gene methylation detection, combined with colonoscopy, can effectively detect colorectal cancer and precancerous lesions. This strategy may be an effective way to carry out large-scale colorectal cancer screening in the general risk population. Combined detection of the three genes can improve the detection rate of colorectal cancer, but Septin9 methylation is the most sensitive, which can be used for screening and efficacy evaluation of CRC.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; Adenoma; Colonoscopy; Colorectal Neoplasms; Cytoskeletal Proteins; DNA Methylation; Early Detection of Cancer; Mass Screening; PAX8 Transcription Factor; Physical Examination; Precancerous Conditions; Prospective Studies; Serine-Arginine Splicing Factors; Septins
PubMed: 38084698
DOI: 10.7754/Clin.Lab.2023.230426 -
Annual International Conference of the... Jul 2023Colorectal cancer (CRC) is one of the most common causes of cancer and cancer-related mortality worldwide. Performing colon cancer screening in a timely fashion is the...
Colorectal cancer (CRC) is one of the most common causes of cancer and cancer-related mortality worldwide. Performing colon cancer screening in a timely fashion is the key to early detection. Colonoscopy is the primary modality used to diagnose colon cancer. However, the miss rate of polyps, adenomas and advanced adenomas remains significantly high. Early detection of polyps at the precancerous stage can help reduce the mortality rate and the economic burden associated with colorectal cancer. Deep learning-based computer-aided diagnosis (CADx) system may help gastroenterologists to identify polyps that may otherwise be missed, thereby improving the polyp detection rate. Additionally, CADx system could prove to be a cost-effective system that improves long-term colorectal cancer prevention. In this study, we proposed a deep learning-based architecture for automatic polyp segmentation called Transformer ResU-Net (TransResU-Net). Our proposed architecture is built upon residual blocks with ResNet-50 as the backbone and takes advantage of the transformer self-attention mechanism as well as dilated convolution(s). Our experimental results on two publicly available polyp segmentation benchmark datasets showed that TransResU-Net obtained a highly promising dice score and a real-time speed. With high efficacy in our performance metrics, we concluded that TransResU-Net could be a strong benchmark for building a real-time polyp detection system for the early diagnosis, treatment, and prevention of colorectal cancer. The source code of the proposed TransResU-Net is publicly available at https://github.com/nikhilroxtomar/TransResUNet.
Topics: Humans; Colorectal Neoplasms; Early Detection of Cancer; Colonic Polyps; Colonic Neoplasms; Adenoma
PubMed: 38083589
DOI: 10.1109/EMBC40787.2023.10340572