-
Gastrointestinal Endoscopy Clinics of... Apr 2022Colorectal cancer is the second leading cause of cancer-associated mortality, with a lifetime risk of approximately 4% to 5%. Colorectal cancer develops from the... (Review)
Review
Colorectal cancer is the second leading cause of cancer-associated mortality, with a lifetime risk of approximately 4% to 5%. Colorectal cancer develops from the sequential acquisition of defined genetic mutations in the colonic epithelium. Tumorigenesis from normal tissue to cancer occurs largely through 3 pathways: the chromosomal instability pathway, the microsatellite instability pathway, and the sessile serrated pathway. Colorectal cancer incidence and mortality have decreased by approximately 35% since the beginning of screening programs in the 1990s, although other factors such as use of aspirin for coronary disease prevention and decreased smoking rates may also be important. In this review, we discuss the etiology, epidemiology, and histology of colorectal polyps and cancer.
Topics: Adenoma; Cell Transformation, Neoplastic; Colonic Polyps; Colorectal Neoplasms; Humans
PubMed: 35361330
DOI: 10.1016/j.giec.2021.12.001 -
World Journal of Gastroenterology May 2020In recent years, the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway.... (Review)
Review
In recent years, the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway. Colorectal serrated polyps are histopathologically classified into hyperplastic polyps (HPs), sessile serrated lesions, and traditional serrated adenomas; in the serrated neoplasia pathway, the latter two are considered to be premalignant. In western countries, all colorectal polyps, including serrated polyps, apart from diminutive rectosigmoid HPs are removed. However, in Asian countries, the treatment strategy for colorectal serrated polyps has remained unestablished. Therefore, in this review, we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions ≥ 6 mm in size, and traditional serrated adenomas of any size.
Topics: Adenoma; Clinical Decision-Making; Colectomy; Colon; Colonic Polyps; Colorectal Neoplasms; Humans; Hyperplasia; Intestinal Mucosa; Narrow Band Imaging; Practice Guidelines as Topic; Precancerous Conditions; Proctectomy; Rectum; Treatment Outcome
PubMed: 32476792
DOI: 10.3748/wjg.v26.i19.2276 -
Journal of Gastroenterology Apr 2021The Japanese Society of Gastroenterology (JSGE) published ''Daicho Polyp Shinryo Guideline 2014'' in Japanese and a part of this guideline was published in English as... (Review)
Review
BACKGROUND
The Japanese Society of Gastroenterology (JSGE) published ''Daicho Polyp Shinryo Guideline 2014'' in Japanese and a part of this guideline was published in English as "Evidence-based clinical practice guidelines for management of colorectal polyps" in the Journal of Gastroenterology in 2015. A revised version of the Japanese-language guideline was published in 2020, and here we introduce a part of the contents of revised version.
METHODS
The guideline committee discussed and drew up a series of clinical questions (CQs). Recommendation statements for the CQs were limited to items with multiple therapeutic options. Items with established conclusions that had 100% agreement with previous guidelines (background questions) and items with no (or old) evidence that are topics for future research (future research questions: FRQs) were given descriptions only. To address the CQs and FRQs, PubMed, ICHUSHI, and other sources were searched for relevant articles published in English from 1983 to October 2018 and articles published in Japanese from 1983 to November 2018. The Japan Medical Library Association was also commissioned to search for relevant materials. Manual searches were performed for questions with insufficient online references.
RESULTS
The professional committee created 18 CQs and statements concerning the current concept and diagnosis/treatment of various colorectal polyps, including their epidemiology, screening, pathophysiology, definition and classification, diagnosis, management, practical treatment, complications, and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumors/carcinomas).
CONCLUSIONS
After evaluation by the moderators, evidence-based clinical practice guidelines for management of colorectal polyps were proposed for 2020. This report addresses the therapeutic related CQs introduced when formulating these guidelines.
Topics: Colonic Polyps; Disease Management; Evidence-Based Practice; Guidelines as Topic; Humans; Japan
PubMed: 33710392
DOI: 10.1007/s00535-021-01776-1 -
American Journal of Physiology.... Jan 2018We examined the role of macrophages in inflammation associated with colorectal cancer (CRC). Given the emerging evidence on immune-microbiota interactions in CRC, we...
We examined the role of macrophages in inflammation associated with colorectal cancer (CRC). Given the emerging evidence on immune-microbiota interactions in CRC, we also sought to examine the interaction between macrophages and gut microbiota. To induce CRC, male C57BL/6 mice ( n = 32) received a single injection of azoxymethane (AOM), followed by three cycles of dextran sodium sulfate (DSS)-supplemented water in weeks 1, 4, and 7. Prior to the final DSS cycle ( week 7) and twice weekly until euthanasia, mice ( n = 16/group) received either 200 μl ip of clodronate-filled liposomes (CLD) or phosphate-buffered saline (PBS) encapsulated liposomes to deplete macrophages. Colon tissue was analyzed for polyp burden, macrophage markers, transcription factors, and inflammatory mediators. Stool samples were collected, and DNA was isolated and subsequently sequenced for 16S rRNA. Clodronate liposomes decreased tumor number by ∼36% and specifically large (≥1 mm) tumors by ∼36% ( P < 0.05). This was consistent with a decrease in gene expression of EMR1 in the colon tissue and polyp tissue as well as expression of select markers associated with M1 (IL-6) and M2 macrophages (IL-13, IL-10, TGFβ, CCL17) in the colon tissue ( P < 0.05). Similarly, there was a decrease in STAT3 and p38 MAPK and ERK signaling in colon tissue. Clodronate liposomes increased the relative abundance of the Firmicutes phylum ( P < 0.05) and specifically Lactobacillaceae and Clostridiaceae families, which have been associated with reduced CRC risk. Overall, these data support the development of therapeutic strategies to target macrophages in CRC and provide support for further evaluation of immune-microbiota interactions in CRC. NEW & NOTEWORTHY We found that macrophage depletion during late-stage tumorigenesis is effective at reducing tumor growth. This was associated with a decrease in macrophage markers and chemokines in the colon tissue and a decrease in transcription factors that are linked to colorectal cancer. The macrophage-depleted group was found to have an increased abundance of Firmicutes, a phylum with documented anti-tumorigenic effects. Overall, these data support the development of therapeutic strategies to target macrophages in colorectal cancer.
Topics: Animals; Anticarcinogenic Agents; Azoxymethane; Biomarkers, Tumor; Cell Transformation, Neoplastic; Clodronic Acid; Colon; Colonic Polyps; Colorectal Neoplasms; Cytokines; Dextran Sulfate; Disease Models, Animal; Gastrointestinal Microbiome; Host-Pathogen Interactions; Inflammation Mediators; Liposomes; Macrophages; Male; Mice, Inbred C57BL; Signal Transduction; Time Factors; Tumor Burden
PubMed: 29025731
DOI: 10.1152/ajpgi.00229.2017 -
Ugeskrift For Laeger Aug 2021Colon capsule endoscopy (CCE) was introduced in 2006 as a novel way to visualise the colonic mucosa. Initially, CCE validity was limited by low completion rates (CR) and... (Review)
Review
Colon capsule endoscopy (CCE) was introduced in 2006 as a novel way to visualise the colonic mucosa. Initially, CCE validity was limited by low completion rates (CR) and poor image quality. Through technical progress and improved bowel preparations, CCE now offers an adjunct to diagnostic colonoscopy. As referred in this review, several studies have shown promising results regarding polyp detection rates by the use of CCE. Improvements in CR and quality of bowel preparation are needed for CCE to be on a par with conventional colonoscopy. Research in artificial intelligence is evolving to aid in diagnostics and staging using CCE.
Topics: Artificial Intelligence; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans
PubMed: 34477082
DOI: No ID Found -
Acta Clinica Croatica Aug 2022Colorectal juvenile polyp as a pathologic entity was first described by Verse. These non-neoplastic lesions are most commonly found in children and infants, while in...
Colorectal juvenile polyp as a pathologic entity was first described by Verse. These non-neoplastic lesions are most commonly found in children and infants, while in older children after the age of 14 and adults are a rare phenomenon. A 75-year-old female underwent colonoscopy. There was a pedunculated polyp in the transverse colon. Complete endoscopic electroresection of this polyp was performed and the polyp was sent for histopathologic analysis. Macroscopically, the polyp was described as a fragment of irregular round shape, size of about 2.5x2x1 cm, with fine-grained, reddish surface, showing dark red color on serial sections. Histologic examination of the polyp showed some irregularly distributed glands, some of which were cystically dilated. All glandular formations were coated with normal intestinal epithelium. The surface of the polyp was partially eroded and replaced by non-specific cellular granulation tissue. There were some signs of hemorrhagic infarction in the stroma of the polyp. Histopathologic examination indicated that histopathologic characteristics of this polyp corresponded to juvenile polyp. Juvenile polyps are very rarely found in adults. Therefore, we describe a case of this patient in her eighties with juvenile polyp localized in the transverse colon.
Topics: Child; Infant; Female; Humans; Adult; Aged; Colonic Polyps; Colonoscopy; Hamartoma
PubMed: 36818922
DOI: 10.20471/acc.2022.61.02.23 -
Revista de Gastroenterologia de Mexico... 2021"Serrated polyps" is the term used for epithelial lesions of the colon and rectum that have a "sawtooth" pattern on the polyp's surface and crypt epithelium. The... (Review)
Review
"Serrated polyps" is the term used for epithelial lesions of the colon and rectum that have a "sawtooth" pattern on the polyp's surface and crypt epithelium. The so-called serrated pathway describes the progression of sessile serrated adenomas and traditional serrated adenomas to colorectal cancer. Said pathway is well recognized as an alternative mechanism of carcinogenesis and accounts for 15-30% of the cases of colorectal cancer. It also explains a large number of the cases of interval colorectal cancer. Thus, due to their usually aggressive and uncertain behavior, serrated polyps are of the utmost importance in colorectal cancer screening. Our aim was to review the history, current nomenclature, pathophysiology, morphology, treatment, and surveillance of serrated polyps.
Topics: Adenoma; Colonic Polyps; Colorectal Neoplasms; Humans; Rectum
PubMed: 34116964
DOI: 10.1016/j.rgmxen.2021.06.001 -
NPJ Biofilms and Microbiomes Aug 2022Colorectal cancer is the second most deadly and third most common cancer in the world. Its development is heterogenous, with multiple mechanisms of carcinogenesis. Two...
Colorectal cancer is the second most deadly and third most common cancer in the world. Its development is heterogenous, with multiple mechanisms of carcinogenesis. Two distinct mechanisms include the adenoma-carcinoma sequence and the serrated pathway. The gut microbiome has been identified as a key player in the adenoma-carcinoma sequence, but its role in serrated carcinogenesis is less clear. In this study, we characterized the gut microbiome of 140 polyp-free and polyp-bearing individuals using colon mucosa and fecal samples to determine if microbiome composition was associated with each of the two key pathways. We discovered significant differences between the microbiomes of colon mucosa and fecal samples, with sample type explaining 10-15% of the variation observed in the microbiome. Multiple mucosal brushings were collected from each individual to investigate whether the gut microbiome differed between polyp and healthy intestinal tissue, but no differences were found. Mucosal aspirate sampling revealed that the microbiomes of individuals with tubular adenomas and serrated polyps were significantly different from each other and polyp-free individuals, explaining 1-4% of the variance in the microbiome. Microbiome composition also enabled the accurate prediction of subject polyp types using Random Forest, which produced an area under curve values of 0.87-0.99. By directly sampling the colon mucosa and distinguishing between the different developmental pathways of colorectal cancer, our study helps characterize potential mechanistic targets for serrated carcinogenesis. This research also provides insight into multiple microbiome sampling strategies by assessing each method's practicality and effect on microbial community composition.
Topics: Adenoma; Carcinogenesis; Carcinoma; Colonic Polyps; Colorectal Neoplasms; Gastrointestinal Microbiome; Humans
PubMed: 36038569
DOI: 10.1038/s41522-022-00328-6 -
Revista Espanola de Enfermedades... Jul 2017The serrated pathway has been shown to be an alternative colorectal carcinogenetic route potentially accounting for up to one third of all CRCs. Serrated lesions,... (Review)
Review
The serrated pathway has been shown to be an alternative colorectal carcinogenetic route potentially accounting for up to one third of all CRCs. Serrated lesions, particularly SSPs, have been a focus of research during the past few years. They have well-established histological and molecular characteristics that account for their potential carcinogenetic risk through the accumulation BRAF, KRAS and methylator profile (CpG) mutations. Their endoscopic identification and resection represent a challenge because of their specific characteristics, and the need for an adequate specimen for histological diagnosis. Knowledge of these lesions is key, as is the adoption of established criteria for their endoscopic description and histological diagnosis. SPS is the maximum expression of involvement by serrated lesions, is associated with increased risk for CRC, and requires attentive endoscopic follow-up, as well as family screening. While the exact etiopathogenic mechanism remains unknown, current research will likely provide us with appropriate answers in the not too distant future.
Topics: Colonic Polyps; Colorectal Neoplasms; Endoscopy, Gastrointestinal; Humans; Syndrome
PubMed: 28530106
DOI: 10.17235/reed.2017.4065/2015 -
Histopathology Jun 2022The precursor lesion for the ~30% of colon carcinomas developing along the serrated pathway was first described in detail in 1996, and was named sessile serrated adenoma... (Review)
Review
The precursor lesion for the ~30% of colon carcinomas developing along the serrated pathway was first described in detail in 1996, and was named sessile serrated adenoma in 2003. Although the entity itself was controversial initially, over time the concept of a serrated pathway initiated by this lesion has become well accepted in the medical community. The name sessile serrated adenoma, however, has been controversial since the beginning and continues to be controversial. Alternative names, including serrated polyp with abnormal proliferation, sessile serrated polyp and, most recently, sessile serrated lesion, have been proposed. Despite the fact that the term sessile serrated lesion was adopted by the World Health Organization in 2019, none of these terms has received universal acceptance. In this article, arguments for and against adopting the term sessile serrated lesion are discussed in detail.
Topics: Adenoma; Colonic Neoplasms; Colonic Polyps; Colorectal Neoplasms; Humans
PubMed: 35040174
DOI: 10.1111/his.14618