INITIAL MANAGEMENT AND FOLLOW-UP SURVEILLANCE OF PATIENTS WITH COLORECTAL ADENOMAS (original) (raw)
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Prevalence of adenomas among young individuals at average risk for colorectal cancer
The American journal of gastroenterology, 2005
We evaluated the prevalence and characteristics of adenomas in a young population not genetically predisposed for the development of colorectal cancer (CRC). The databases of the Dutch Hereditary Colorectal Cancer Registry were used. The study population included patients (n = 444) who had regular endoscopy until mutation analysis revealed they did not carry the (Adenomatous Polyposis Coli (APC)/Mismatch Repair) gene defect identified in their family. At first colonoscopy (n = 342; 50% males, mean age 37 yr) a total of 19 adenomas (10 males, mean age 50 yr, range 24-91 yr) and two CRCs (2 males, age 49 and 72 yr) were identified, and at first sigmoidoscopy (n = 102; 53% males, mean age 29 yr) three adenomas (2 males, age 8, 40, and 41 yr) were found. A second colonoscopy was performed in 14 patients with, and in 162 patients without an adenoma. Three of 14 patients (21%) developed a new adenoma (all >50 yr) and 8 of 162 (5%) patients developed their first adenoma during follow-up...
Risk Factors for Advanced Colorectal Adenomas A Pooled Analysis
Cancer Epidemiology Biomarkers Prevention, 2002
Although most colorectal cancers arise from adenomatous polyps, most adenomas do not progress to invasive cancer. Understanding the epidemiology of advanced adenomas, specifically those with severe dysplasia, carcinoma in situ, or intramucosal carcinoma, is crucial to uncovering why some adenomas progress and some do not. Using data from four colonoscopy-based adenoma case-control studies, we compared two case groups: subjects with advanced adenomas (those with severe dysplasia, carcinoma in situ, or intramucosal carcinoma; n ؍ 119) and subjects with nonadvanced adenomas (those with none, mild, or moderate dysplasia; n ؍ 441) to a polyp-free control group (n ؍ 1866) in regard to frequently studied risk factors for colorectal neoplasia. All of the cases were newly diagnosed and had no prior history of adenomas. We used an unordered polytomous logistic model to calculate multivariate odds ratios for advanced and nonadvanced adenoma cases relative to polyp-free controls. Among women, ever use of hormone replacement therapy was more strongly associated with reduced risk of advanced adenomas relative to polyp-free controls [odds ratio (OR), 0.4; 95% confidence interval (CI), 0.2-0.9] than with reduced risk of nonadvanced adenomas (OR, 0.7; 95% CI, 0.4-1.0). Among men, increased physical activity (>2 h/week) was more strongly associated with reduced risk for advanced adenomas (OR , 0.4; 95% CI, 0.2-1.0) than with reduced risk for nonadvanced adenomas (OR, 0.8; 95% CI, 0.5-1.2). Apart from these differences, most other risk factors, including body size and cigarette smoking were similar in their association with advanced and nonadvanced adenomas, suggesting that many risk factors for colorectal neoplasia may be important to adenoma formation but not to dysplasia per se.
Increased risk of colonic neoplasia in patients with sporadic duodenal adenoma
Gastroentérologie Clinique et Biologique, 2009
Background. -Recent studies have shown an increased risk of colorectal neoplasia in patients with duodenal neoplasia. The aim of this retrospective case-control study was to confirm this risk. Patients and methods. -Rate of colorectal neoplasia in 29 patients with one or more duodenal adenomas were compared with controls matched for gender and age, but without duodenal adenomas (one case to two controls). Patients with neoplasia of the ampulla, familial adenomatous polyposis or other known hereditary conditions of the digestive tract were excluded. Indications for upper and lower gastrointestinal endoscopy in controls were abdominal pain or changes in bowel habits. Controls with anemia or digestive bleeding were not included. Neoplastic lesions found at colonoscopy were classified as adenomas, advanced adenomas (size ≥ 10 mm, villous component, high-grade dysplasia), cancers and advanced neoplasia (cancers and advanced adenomas). Comparison between groups was by Fisher's exact test or Student's t test. Odds-ratios (OR) and 95% confidence intervals were calculated, if the difference was significant.
Vojnosanitetski pregled, 2018
Background/Aim. In recent years, many studies have demonstrated a proximal shift in the distribution of adenomas and colorectal cancers. The aim of this study was to investigate whether there are differences in the incidence and anatomical distribution of adenomas and colorectal cancers spanning a 20 year time gap. Methods. We performed a retrospective observational study of colorectal adenomas and cancers diagnosed during total colonoscopy in a high volume tertiary care facility in two 1-year periods of time ? 1990 and 2010. Results. During the analyzed period, 4,048 colonoscopies were performed, 1,148 were performed in 1990 and 2,900 were done in 2010. The study included 466 patients with adenomas and 121 patients with colorectal cancers. Frequency of proximal adenoma changed from 16.5% to 32.7% (p < 0.001). By analyzing colonoscopies in 2010, an increase in the incidence of adenomas compared to 1990 was noticed. The number of adenomas sized 0?5 mm rose from 32.8% to 56.9% (p &...
Patients With Non-Colorectal Cancers May Be at Elevated Risk of Colorectal Neoplasia
American Journal of Gastroenterology, 2019
Background: Screening for colonic neoplasia has decreased the incidence of colorectal cancer in the United States in the past two decades. Whether personal history of noncolorectal cancer is a risk factor for colonic neoplasia has not been well studied. We assessed the risk of colorectal neoplasia in noncolorectal cancer survivors. Methods: We conducted a retrospective study of patients who had undergone colonoscopy for any indication between 2009 and 2018. Colonic adenoma detection rate and multivariate logistic regression were conducted to assess for the primary outcomes of the study. Results: The study included 9408 cancer patients and 3295 control patients. Colonic adenomas were detected in 4503 cancer patients (48%) and 950 cancer-free patients (29%). Histologic examination of these adenomas revealed tubulovillous features in 620 patients (5%) and villous in 153 (1%). High-grade dysplasia was detected in 1611 patients (13%). Invasive colorectal adenocarcinoma was detected in 455 patients (12%); this rate was highest in patients with multiple myeloma (14%). Multivariate analysis revealed that a personal history of noncolorectal cancer was associated with increased risk of adenoma (Odd ratio, 2.04; 95% CI, 1.84-2.26; P<0.001). The adenoma detection rate was 30% in patients younger than 40 years (n=1211), 32% in patients between 41 and 50 years (n=812), 47% in patients between 51 and 60 years (n=2892), and 55% in patients older than 60 years (n=4493). Conclusions: The adenoma detection rate in patients with a personal history of noncolorectal cancer is higher than the reported rate of the general population and our control group.
International Journal of Cancer, 2018
Our study aimed to evaluate the relevance of genetic susceptibility in the development of colorectal adenomas (CRA) and its relationship with the presence of family history of colorectal cancer (CRC). Genomic DNA from 750 cases (first degree relatives of patients with CRC) and 750 controls (subjects with no family history of CRC) was genotyped for 99 single nucleotide polymorphisms (SNPs) previously associated with CRC/CRA risk by GWAS and candidate gene studies by using the MassArray™ (Sequenom) platform. Cases and controls were matched by gender, age and histological lesion. Eight hundred and fifty-eight patients showed no neoplastic lesions, whereas 288 patients showed low-risk adenomas, and 354 patients presented high-risk adenomas. Two SNPs (rs10505477, rs6983267) in the CASC8 gene were associated with a reduced risk of CRA in controls (log-additive models, OR: 0.67, 95%CI:0.54-0.83, and OR:0.66, 95%CI:0.54-0.84, respectively). Stratified analysis by histological lesion revealed the association of rs10505477 and rs6983267 variants with reduced risk of low-and high-risk adenomas in controls, being this effect stronger in low-risk adenomas (log-additive models, OR:0.63, 95% CI:0.47-0.84 and OR:0.64, 95%CI:0.47-0.86, respectively). Moreover, 2 SNPs (rs10795668, rs11255841) in the noncoding LINC00709 gene were significantly associated with a reduced risk of low-risk adenomas in cases (recessive models, OR:0.22, 95%CI:0.06-0.72, and OR:0.08, 95%CI:0.03-0.61) and controls (dominant models, OR:0.50, 95%CI:0.34-0.75, and OR:0.52, 95%CI:0.35-0.78, respectively). In conclusion, some variants associated with CRC risk (rs10505477, rs6983267, rs10795668 and rs11255841) are also involved in the susceptibility to CRA and specific subtypes. These associations are influenced by the presence of family history of CRC.
Gastroenterología y Hepatología, 2006
AIM: to determine the frequency and malignancy risk of colonic flat adenomas among patients with colorectal polyps in a Spanish population. METHODS: 1300 consecutive colonoscopic examinations were reviewed; 640 polyps were detected and removed endoscopically in 298 patients. Chromoendoscopy with 0.2% indigo carmine was applied to clarify the macroscopical appearance of flat lesions. The following data was collected for flat and protruding polyps: size, location (proximal or distal to splenic flexure), histology (neoplastic or non neoplastic), high grade dysplasia (HGD) and submucosal invasive carcinoma (SIC) or beyond. RESULTS: 490 polyps (76.6%) were adenomas and 150 (23.4%) hyperplastic; 114 (23.3%) adenomas were flat (3 flat-depressed) whereas 376 (76.7%) were protruding. The diameter of flat and protruding adenomas was 9.2 ± 7.9. mm and 7.0 ± 5.9 mm, respectively (p < 0.001). A proximal location was more frequent for flat (63.1%) than for protruding adenomas (48.7%) (p = 0.003). The rate of HGD or SIC was significantly higher in flat than in protruding adenomas (7.0 vs 2.6%; p < 0.04). Two of the 3 flat-depressed lesions (both ≤ 10 mm in diameter) were carcinomas (T1 and T2, respectively). Flat adenomas had an increased risk for HGD or SIC (OR = 2,7; CI, 1,04-7,04; p < 0.05). CONCLUSIONS: In a Spanish population, flat adenomas represent nearly one quarter of all colorectal neoplastic polyps, their most frequent location being the right colon and they bear a higher risk of malignancy than protruding adenomas, especially for the flat depressed type. RIESGO DE DISPLASIA DE ALTO GRADO O CARCINOMA INVASIVO EN LOS ADENOMAS COLORRECTALES PLANOS EN POBLACIÓN ESPAÑOLA OBJETIVO: Determinar la frecuencia y el riesgo de malignidad de los adenomas colorrectales de tipo plano en pacientes españoles. MÉTODOS: Se revisaron 1.300 colonoscopias; se detectaron 640 pólipos en 298 pacientes, que fueron extirpados endoscópicamente. Se aplicó indigocarmín al 0,2% para clarificar el aspecto macroscópico de las lesiones planas. Se registraron las siguientes variables en las lesiones planas y en los pólipos protruidos: tamaño, localización (proximal o distal al ángulo esplénico), histología (neoplásico o no), presencia de displasia de alto grado, y existencia de carcinoma invasivo a submucosa o mayor. RESULTADOS: Un total de 490 pólipos (76,6%) fueron neoplásicos y 150 (23,4%) no neoplásicos; 114 (23,3%) adenomas fueron planos (3 planos-deprimidos) frente a 376 (76,7%) protruidos. El diámetro medio de los adenomas planos y protruidos fue de 9,2 ± 7,9 y 7,0 ± 5,9 mm, respectivamente (p < 0,001). La localización proximal fue más frecuente en los adenomas planos (63,1%) que en los protruidos (48,7%) (p = 0,003). La frecuencia de displasia de alto grado o carcinoma invasivo fue significativamente mayor en los adenomas planos que en los protruidos (el 7,0 frente al 2,6%; p < 0,04). Dos de las 3 lesiones planas-deprimidas) (ambas de ≤ 10 mm de diámetro) fueron carcinomas (T1 y T2, respectivamente). Los adenomas planos presentaron un riesgo superior de histología avanzada (displasia de alto grado o carcinoma invasivo) (odds ratio = 2,7; intervalo de confianza, 1,04-7,04; p < 0,05). CONCLUSIONES: En la población española los adenomas planos representan casi la cuarta parte de todos los pólipos This study was supported in part by Grants from the Instituto de Salud Carlos III (C03/02
Advanced colorectal adenomas in patients under 45 years of age are mostly sporadic
Digestive diseases and sciences, 2014
The presence of advanced adenomas in younger individuals is a criterion for Lynch syndrome (LS). However, the utility of screening advanced adenomas for loss of mismatch repair (MMR) protein expression to identify suspected LS remains unclear. Determine the prevalence of MMR defects to understand whether these patients harbor a defined genetic risk for CRC. The study cohort included adult patients ≤45 years of age with advanced adenomas (villous histology, ≥1 cm in diameter, ≥3 polyps of any size) endoscopically removed between 2001 and 2011. Clinical records were reviewed along with detailed pathological review and immunohistochemical MMR analysis. A total of 76 (40.1 % male, age 40.6 ± 5.4 years) patients met inclusion and exclusion criteria. Indications for colonoscopy were gastrointestinal (GI) bleeding 39 (51.3 %), CRC in a first-degree relative 17 (22.4 %) and somatic GI symptoms 20 (26.3 %). Index colonoscopy revealed a median of 1 adenoma (range 1-4), mean diameter of 12.9 ±...