Frequency of advanced neoplasia in the proximal colon without an index polyp in the rectosigmoid

Early-Onset Colorectal Cancer Is Associated with a Lower Risk of Metachronous Advanced Neoplasia than Traditional-Onset Colorectal Cancer

BACKGROUND

Colorectal cancer (CRC) incidence in the USA has increased in adults under age 50. Current CRC surveillance guidelines do not consider age at diagnosis, and there are limited data available on outcomes from surveillance colonoscopies in early-onset CRC (EO-CRC) to guide recommendations on surveillance intervals.

AIMS

To compare surveillance outcomes between EO-CRC and traditional-onset colorectal cancer (TO-CRC).

METHODS

In a retrospective cohort study in a large tertiary care academic medical center, we collected data on patients with a diagnosis of CRC between 2000 and 2014 who received surgery with curative intent. We used log-rank test and inverse probability of treatment weighted Cox regression analysis to compare the development of metachronous advanced neoplasia (MAN) in patients with EO-CRC (diagnosed ages 18-49) and TO-CRC (diagnosed ages 50-75).

RESULTS

Patients with EO-CRC (n = 107) were more likely to present with advanced-stage disease (62% versus 35%, p < 0.0001), rectal tumors (45% versus 27%, p < 0.01), and a family history of CRC (30% versus 16%, p = 0.02) compared to those with TO-CRC (n = 139). Patients with EO-CRC had lower risk of MAN (adjusted HR 0.44, 95% CI 0.22-0.88) than TO-CRC patients. The 5-year event rate for MAN was lower for patients with EO-CRC compared to patients with TO-CRC (5.8% vs. 16.1%, p = 0.07). The presence of synchronous neoplasia or history of diabetes was also predictive of MAN.

CONCLUSIONS

EO-CRC was independently associated with a lower risk of developing MAN compared to TO-CRC. Shorter surveillance intervals may not be warranted in EO-CRC; however, large prospective studies are needed.

Association between family history of malignant neoplasm with colorectal adenomatous polyp in 40s aged relative person

PURPOSE

We assessed the association between a family history of malignancy and risk of colorectal adenoma among individuals aged 40-49 years.

METHODS

The study population consisted of subjects, aged in their 40s, who underwent colonoscopy. Their family histories of cancer were collected with a self-administered questionnaire. A logistic regression model was used to assess the association between a family history of cancer and the risk of colorectal polyp.

RESULTS

In total, 2275 participants were included in the study. Univariate analysis showed that old age, male sex, current cigarette smoking, BMI>25 kg/m(2), and a family history of colorectal cancer (CRC) were risk factors for the development of sporadic colorectal adenomatous polyps in these patients. A multivariate analysis showed that a family history of CRC or kidney cancer was associated with adenoma development. A family history of CRC was also a risk factor for advanced and multiple adenoma.

CONCLUSIONS

This study shows that a family history of CRC is a risk factor for advanced and multiple colorectal adenoma in people in their 40s. These results support earlier screening for colorectal neoplasms in individuals with a family history of CRC.

Incidence and risk factors of metachronous colorectal neoplasm after curative resection of colorectal cancer in Korean patients

OBJECTIVE

Early detection and endoscopic removal of metachronous neoplasms are important preventive strategies for patients with colorectal cancer (CRC) after curative tumor resection. We aimed to determine the incidence of and the risk factors for metachronous colorectal neoplasms after curative resection for CRC.

METHODS

We retrospectively reviewed clinical data of patients who underwent curative resection for CRC at the National Cancer Center, Korea, from July 2004 to July 2007 and were followed up for a mean duration of 40.7 months. The incidence of and the risk factors for developing metachronous neoplasms were analyzed.

RESULTS

A total of 1049 patients were included in this study. A follow-up colonoscopy showed that 454 (43.3%) patients developed metachronous neoplasms, including 46 (4.4%) with advanced adenoma or cancer. Univariate analyses revealed that age ≥ 60 years, male gender, diabetes mellitus, hypertension, synchronous adenoma, synchronous multiple adenoma and synchronous advanced adenoma were associated with the development of metachronous neoplasms. Baseline risk factors associated with metachronous advanced neoplasm were age ≥ 60 years, synchronous multiple adenoma and synchronous advanced adenoma. Multivariate analysis showed that age ≥ 60 years, synchronous adenoma and diabetes mellitus were risk factors for the development of metachronous neoplasms. The cumulative incidence of metachronous neoplasms was higher in patients with these risk factors than in those without.

CONCLUSIONS

Elder age, synchronous adenoma and diabetes mellitus are risk factors for developing metachronous neoplasia. Therefore, careful surveillance colonoscopy are necessary for these patients.

Screening colonoscopy for colorectal cancer prevention: results from a German online registry on 269000 cases

BACKGROUND

The efficacy of screening colonoscopy in general use remains to be determined. Here we report data over a 39-month study period collected in a nationwide online registry.

STUDY

Data from consecutive screening colonoscopies performed on asymptomatic patients in the practices of 280 participating gastroenterologists (age 55-99 years) were collected in an online registry. The number and histology of colorectal polyps and carcinomas, complication rates of colonoscopy and polypectomy were registered. Advanced adenoma was defined as an adenoma of >or= 10 mm in diameter, villous or tubulovillous in histology, or presence of high-grade dysplasia.

RESULTS

A total of 269 144 colonoscopies (male 44%) were evaluated. Tubular, villous/tubulovillous adenomas and invasive cancers were found in 15.6, 3.7, and 0.8%, respectively. Advanced adenomas amounted to 7.1%. In 95% of polyps greater than 5mm and less than 30 mm immediate polypectomy was performed. In 399 of the 575 carcinomas with complete tumor node metastasis stages, which were detected during colonoscopy, early stages dominated (UICC stages I and II in 43 and 27%, respectively). Complication rate was low and no fatalities were observed: cardiopulmonary complication in 0.10% of the colonoscopies, bleeding in 0.8% of polypectomies most of which were managed endoscopically (surgery in 0.03% of polypectomies). Perforation occurred in 0.02% of the colonoscopies and 0.09% of polypectomies.

CONCLUSION

Colonic neoplasias are detected in about 20% of patients most of which are immediately removed by polypectomy at a low risk. Polypectomy of adenomas and low UICC stages in cancer patients during screening colonoscopy may be tools for fighting colorectal cancer mortality.

Prospective comparison of contrast enhanced CT colonography and conventional colonoscopy for detection of colorectal neoplasms in a single institutional study using second-look colonoscopy with discrepant results

BACKGROUND

Colorectal cancer is the second leading cause of death from cancer in Western countries. Early detection by colorectal cancer screening can effectively cut its mortality rate. CT colonography represents a promising, minimally invasive alternative to conventional methods of colorectal carcinoma screening.

AIMS

The purpose of this prospective single institutional study was to compare the abilities of routine clinical CT colonography and conventional colonoscopy to detect colorectal neoplasms using second-look colonoscopy to clarify discrepant results.

PATIENTS AND METHODS

CT colonography was performed in 100 symptomatic patients using contrast enhanced multidetector CT followed by conventional colonoscopy on the same day. If results were discrepant, a second-look colonoscopy was performed after unblinding. CT colonographic findings were compared with those of conventional colonoscopy.

RESULTS

Conventional colonoscopy found 122 colorectal neoplasms in 49 patients. The overall sensitivity of CT colonography at detecting patients with at least one polyp 6 mm or larger was 76% and its specificity was 88%. Its by-patient sensitivity for polyps 10 mm or larger was 95% and its specificity was 98%. By-polyp sensitivities were 71% for polyps 10 mm or larger, and 61% for polyps 6 mm or larger. A second-look colonoscopy was performed in 19 patients and two initial false-positive findings of CT colonography were reclassified as true-positive. For conventional colonoscopy, this produced a by-polyp sensitivity of 94% for detection of lesions 6 mm and larger.

CONCLUSIONS

CT colonography had both a high by-patient sensitivity and specificity for detection of clinically important colorectal neoplasms 10 mm or larger. This suggests that CT colonography has the potential to become a valuable clinical screening method for colorectal neoplasms.

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

BACKGROUND

For colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data.

METHODS

Primary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma > or =1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal.

RESULTS

Neoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%.

CONCLUSIONS

A strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.

Virtual Colon Dissection with CT Colonography Compared with Axial Interpretation and Conventional Colonoscopy:Preliminary Results

OBJECTIVE

The aim of this study was to determine whether a new virtual colon dissection 3D visualization technique for CT colonography has a shorter analysis time and better sensitivity for detection of colonic polyps than interpretation of axial CT images. SUBJECTS AND METHODS. CT colonography was performed in 22 patients using 4-MDCT followed by conventional colonoscopy on the same day. The CT colonography data sets were analyzed by virtual colon dissection, which virtually bisects and unfolds the colon along its longitudinal axis to inspect the inner colonic surface for polyps. The same CT data sets were independently evaluated using axial interpretation. All data sets were independently interpreted by two radiologists in a blinded manner.

RESULTS

Conventional colonoscopy revealed 31 colonic lesions in 20 patients. Twenty two of the lesions were smaller than 10 mm; nine were 10 mm or larger. Two of the original 22 patients were excluded, one because of residual stool and fluid and the other because of an impassable stenosing rectal wall cancer. For virtual colon dissection, the per-lesion sensitivity was 42% for observer 1 and 68% for observer 2; for axial interpretation, the respective sensitivities were 48% and 61%. For polyps 10 mm or larger, the respective sensitivities were 67% and 89% for virtual colon dissection and 89% and 100% for axial interpretation. The average time for reconstruction and analysis of virtual colon dissection was 36.8 min versus 29.2 min for axial images. Virtual colon dissection was feasible in both the supine and the prone positions in 45.5% of colonic segments, in either the supine or the prone position in 24.5%, and in neither position in 30% of segments.

CONCLUSION

Although virtual colon dissection may facilitate detection of colonic polyps in isolated cases, its detection rate is not superior to axial interpretation, which is mainly attributable to failed rendering of insufficiently distended colonic segments or regions with residual feces. Virtual colon dissection is also the more time-consuming of the two procedures. With further improvement of path-finding and image segmentation, however, virtual colon dissection has the potential to be a useful interpretation tool for CT colonography.

Colon cancer: prevention, diagnosis, treatment

Colorectal cancer is the second leading cause of death from cancer in the United States. It is third leading cause of cancer death in men behind lung and prostate respectively, and behind lung and breast in cancer deaths among women. More than 130,000 cases are diagnosed each year with over 56,000 of those patients dying. Six percent of the United States population will develop colorectal cancer in their lifetime.

Screening sigmoidoscopy in persons aged 60 years

OBJECTIVE: To reduce mortality associated with colorectal cancer, an increased interest has focused in recent years on screening of colorectal cancer. No studies of colorectal cancer screening in Finland has been reported. A pilot study of screening sigmoidoscopy was started in 1994 and the results are presented in this paper.SUBJECTS AND METHODS: Between March 1994 and May 2000 all 1224 persons aged 60 years from four communities (population 15 400) were invited to screening sigmoidoscopy; 896 (73%) took part in this study. The screening procedure was flexible sigmoidoscopy to 60 centimetres. All the patients who had adenomas or cancers, were invited to have a double contrast barium enema (DCBE) or colonoscopy to investigate the proximal colon. To study the experience of persons undergoing screening sigmoidoscopy, a questionnaire was sent to 81 consecutive persons after the examination. Sixty persons (74%) returned the filled-in questionnaire.RESULTS: Hyperplastic polyps were found in 136 people (15.2% of the whole material). Hyperplastic polyps were more common in males than females (19.3% and 11.4%, respectively, P=0.0015). People with hyperplastic polyps had the same rate of neoplasia as people without. Neoplastic lesions were found in 65 people. Adenomas were found in 62 patients (6.9%). Twenty-five people (2.8%) had at least one advanced adenoma (>10 mm or villous component). The rate of advanced adenomas in males was 4.9% and in females 0.9% (P=0.0006). Three patients (0.3%) were found to have colorectal cancer. Of 43 diabetic patients, 7 (16.3%) had adenomas whereas 6.5% of the non-diabetic persons had adenomas (P=0.03). The proximal colon was investigated in 34 patients by DCBE and/or colonoscopy and the rate of proximal adenomas in patients with neoplastic findings in screening sigmoidoscopy was 5/34 (14.7%). Concerning the experience of screening sigmoidoscopy, 56 persons (93%) found bowel preparation easy and 4 unpleasant, 55 (92%) experienced either no or mild discomfort during the endoscopy whereas 5 found the examination painful; 59 people (98%) said that they would participate again in screening sigmoidoscopy.CONCLUSIONS: In this study of screening sigmoidosopy, the first published in Finland, adenoma rate was 6.9%, advanced adenoma rate was 2.8% and cancer rate was 0.3%. Males had more hyperplastic polyps and advanced adenomas than females. Diabetic people had more adenomas than non-diabetics. Experiences of the people screened were positive and nearly all said that they would participate again in screening sigmoidoscopy.

APACC, a French prospective study on aspirin efficacy in reducing colorectal adenoma recurrence: design and baseline findings

Colorectal cancer is the second most frequent cause of death from cancer in western countries. Many lines of evidence suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may offer chemoprevention against colorectal cancer. A multicentre, double-blind, randomized, controlled trial is underway to determine the efficacy of regular aspirin intake (160 or 300 mg/day) in reducing colorectal adenoma recurrence. We now report the baseline characteristics of subjects enrolled into the trial.

RESULTS

A total of 618 polyps were excised from 274 patients at the baseline colonoscopy. Men had on average (+/-SD) 2.5 +/- 1.8 polyps per subject and women had 1.7 +/- 1.2. Ninety-one (33.7%) had three or more adenomas and 183 (67.8%) had more than one adenoma measuring 10 mm or more in diameter. The mean (+/-SD) age of the subjects was 57.7 (+/- 9.4) years. Sixty-seven (24.9%) reported that they had previously had adenoma(s), 95 (35.2%) reported a family history of colorectal cancer and 41 (15.2%) a family history of colorectal adenomas.

PERSPECTIVE

All subjects will undergo a one-year clearance colonoscopy by February 2001. Clinical, molecular biological and dietary data will enable us to investigate other factors influencing the recurrence of adenomas in this group of high-risk subjects.