Cancer Polyps Research Articles

Low prevalence of dysplastic polyps in patients with ulcerative colitis

Patients with ulcerative colitis (UC) are prone to colorectal cancer and dysplastic polyps and also have sporadic adenomas. There is scant information, however, relating the prevalence of sporadic adenomas in UC patients compared with normal subjects. The aim of this study was to assess the prevalence of all dysplastic lesions in UC and compare the prevalence of adenomas to that in the general population. A single-center retrospective study, in which all patients with diagnosed UC were followed during a ten-year period. The incidence of polyps and colorectal cancers were recorded and compared to that of an age-matched group in the general population who had screening colonoscopy. A total of 229 UC patients were included compared with 450 age-matched subjects who underwent a single colonoscopy. The average number of colonoscopies per UC patient was 3. The rate of sporadic adenomas among UC patients (9.6%), as well as the rate of all dysplastic polyps (11.2%) in these patients, were significantly lower than the rate of adenomas among the control population (24%; OR 0.33-0.44; P<0.0001). Despite this, the rates of colon cancer were comparable between the groups (2.1% vs. 1.5%, P=0.55). In spite of the observed lower rate of dysplastic polyps in UC patients, this should not preclude tight surveillance in this high-risk population.

An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS)

ObjectivesColorectal polyp cancers present clinicians with a treatment dilemma. Decisions regarding whether to offer segmental resection or endoscopic surveillance are often taken without reference to good quality evidence. The aim...

Immune analysis of expression of IL-17 relative ligands and their receptors in bladder cancer: comparison with polyp and cystitis

BackgroundBladder cancer, cystitis and bladder polyp are the most common urinary system diseases all over the world. Our former research results show that IL-17A and IL-17 F contribute to the pathogenesis of benign prostatic hyperplasia (BPH) and prostate cancer (Pca) while IL-17E interacting with IL-17RB might have an anti-tumor effect.ResultsUsing imunohistochemistry, we systemically compared immunoreactivity of ligands (IL-17A, E and F) and receptors (IL-17RA, IL-17RB and IL-17RC) of IL-17 family, infiltration of inflammatory cells and changes of structural cells (fibroblast cells, smooth muscle and vascular endothelial cells) in sections of bladder tissues from subjects with bladder cancer, cystitis and bladder polyp. Compared with subjects with cystitis, immunoreactivity for IL-17A, IL-17 F and IL-17RC was significantly elevated in the group of bladder cancer (p < 0.01), while immunoreactivity of IL-17E, IL-17RA and IL-17RB, and the infiltrating neutrophils were decreased (p < 0.05). The numbers of infiltrating lymphocytes and phagocytes and CD31+ blood vessels and immunoreactivity of CD90+ fibroblasts were also elevated in patients with bladder cancer compared with those of cystitis. The patterns of IL-17 ligands and receptors, and inflammatory cells and structural cells varied in cystitis, bladder polyp and bladder cancer. In bladder cancer, immunoreactivity of IL-17E and IL-17 F was positively correlated with smooth muscles and lymphocytes, respectively. In addition, immunoreactivity of IL-17A and IL-17E was positively correlated with their receptors IL-17RA and IL-17RB respectively.ConclusionsThe data suggest that changed patterns of expression of the IL-17 cytokine family ligands and receptors might be associated with infiltration of inflammatory cells and structural cells (CD90+ fibroblasts and CD31+ blood vessels), which might also contribute to occurrence and development in bladder cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12865-016-0174-8) contains supplementary material, which is available to authorized users.

Development and Clinical Validation of a Blood Test Based on 29-Gene Expression for Early Detection of Colorectal Cancer.

A blood test for early detection of colorectal cancer is a valuable tool for testing asymptomatic individuals and reducing colorectal cancer-related mortality. The objective of this study was to develop and validate a novel blood test able to differentiate patients with colorectal cancer and adenomatous polyps (AP) from individuals with a negative colonoscopy. A case-control, multicenter clinical study was designed to collect blood samples from patients referred for colonoscopy or surgery. Predictive algorithms were developed on 75 controls, 61 large AP (LAP) ≥1 cm, and 45 colorectal cancer cases and independently validated on 74 controls, 42 LAP, and 52 colorectal cancer cases (23 stages I-II) as well as on 245 cases including other colorectal findings and diseases other than colorectal cancer. The test is based on a 29-gene panel expressed in peripheral blood mononuclear cells alone or in combination with established plasma tumor markers. The 29-gene algorithm detected colorectal cancer and LAP with a sensitivity of 79.5% and 55.4%, respectively, with 90.0% specificity. Combination with the protein tumor markers carcinoembryonic antigen (CEA) and CYFRA21-2 resulted in a specificity increase (92.2%) with a sensitivity for colorectal cancer and LAP detection of 78.1% and 52.3%, respectively. We report the validation of a novel blood test, Colox®, for the detection of colorectal cancer and LAP based on a 29-gene panel and the CEA and CYFRA21-1 plasma biomarkers. The performance and convenience of this routine blood test provide physicians a useful tool to test average-risk individuals unwilling to undergo upfront colonoscopy. Clin Cancer Res; 22(18); 4604-11. ©2016 AACR.

CT colonography for population screening of colorectal cancer: hints from European trials

CT colonography (CTC) is a minimally invasive radiological investigation of the colon. Robust evidence indicates that CTC is safe, well tolerated and highly accurate for the detection of colorectal cancer (CRC) and large polyps, which are the targets of screening. Randomized controlled trials were carried out in Europe to evaluate CTC as the primary test for population screening of CRC in comparison with faecal immunochemical test (FIT), sigmoidoscopy and colonoscopy. Main outcomes were participation rate and detection rate. Participation rate for screening CTC was in the range of 25-34%, whereas the detection rate of CTC for CRC and advanced adenoma was in the range of 5.1-6.1%. Participation for CTC screening was lower than that for FIT, similar to that for sigmoidoscopy and higher than that for colonoscopy. The detection rate of CTC was higher than that of one FIT round, similar to that of sigmoidoscopy and lower than that of colonoscopy. However, owing to the higher participation rate in CTC screening with respect to colonoscopy screening, the detection rates per invitee of CTC and colonoscopy would be comparable. These results justify consideration of CTC in organized screening programmes for CRC. However, assessment of other factors such as polyp size threshold for colonoscopy referral, management of extracolonic findings and, most importantly, the forthcoming results of cost-effectiveness analyses are crucial to define the role of CTC in primary screening.

Surgical Treatment of a Common Bile Duct Polyp and Synchronous Gastric Cancer: A Case Report

Surgical Treatment of a Common Bile Duct Polyp and Synchronous Gastric Cancer: A Case Report

Automated visibility map of the internal colon surface from colonoscopy video.

Optical colonoscopy is a prominent procedure by which clinicians examine the surface of the colon for cancerous polyps using a flexible colonoscope. One of the main concerns regarding the quality of the colonoscopy is to ensure that the whole colonic surface has been inspected for abnormalities. In this paper, we aim at estimating areas that have not been covered thoroughly by providing a map from the internal colon surface. Camera parameters were estimated using optical flow between consecutive colonoscopy frames. A cylinder model was fitted to the colon structure using 3D pseudo stereo vision and projected into each frame. A circumferential band from the cylinder was extracted to unroll the internal colon surface (band image). By registering these band images, drift in estimating camera motion could be reduced, and a visibility map of the colon surface could be generated, revealing uncovered areas by the colonoscope. Hidden areas behind haustral folds were ignored in this study. The method was validated on simulated and actual colonoscopy videos. The realistic simulated videos were generated using a colonoscopy simulator with known ground truth, and the actual colonoscopy videos were manually assessed by a clinical expert. The proposed method obtained a sensitivity and precision of 98 and 96% for detecting the number of uncovered areas on simulated data, whereas validation on real videos showed a sensitivity and precision of 96 and 78%, respectively. Error in camera motion drift could be reduced by almost 50% using results from band image registration. Using a simple cylindrical model for the colon and reducing drift by registering band images allows for the generation of visibility maps. The current results also suggest that the provided feedback through the visibility map could enhance clinicians' awareness of uncovered areas, which in return could reduce the probability of missing polyps.

Colonoscopy uptake for high-risk individuals with a family history of colorectal neoplasia: A multicenter, randomized trial of tailored counseling versus standard information.

Background:Colonoscopic screening is recommended for first-degree relatives of patients diagnosed with colorectal cancer (CRC) or colorectal adenomatous polyps (CAP) before the age of 60 years. This has the potential to reduce CRC-related morbidity and mortality, but uptake is currently inadequate.Methods:The aim of the study was to compare the effectiveness of standard information versus a nurse-led tailored intervention designed to promote uptake of colonoscopy screening by siblings of CRC or CAP patients. A randomized controlled trial was conducted. Digestive surgeons and gastroenterologists recruited index patients who developed CRC or CAP before the age of 60 years. All index patients received standard screening information for their siblings, in keeping with current guidelines. Centrally computerized randomization of index patients resulted in allocating all their siblings to the same group, intervention or control. The tailored intervention targeted the index patient first, to help them convey information to their siblings. The nurse then provided the siblings with tailored information based on their answers to a self-questionnaire which explored health behaviors, derived from psychosocial models of prevention. Then the siblings were given a personalized information leaflet to hand to their regular physician. The primary endpoint was the rate of documented colonoscopy performed in siblings within 1 year after diagnosis of the index patient. The intent-to-treat analysis included siblings who refused to participate in the study. Statistical analysis was adjusted for intrafamilial correlation.Results:A total of 304 siblings of 125 index patients were included: 160 in the intervention group and 144 in the control group. The rate of colonoscopy uptake among siblings was 56.3% in the intervention group and 35.4% in the control group (P = 0.0027). The respective rates after exclusion of refusals were 69.2% and 37.0% (P < 0.0001). More lesions were detected in the intervention group (1 invasive cancer and 11 advanced adenomas vs 5 advanced adenomas; P = 0.022).Conclusions:This study demonstrates the effectiveness of a nurse-led tailored intervention designed to promote colonoscopy screening uptake by siblings of patients diagnosed with CRC or CAP before age 60 years. Such tailored interventions that also involve physicians should help to reduce CRC-related mortality.

An audit of CT colonography – compliance with NICE guidelines

Background to the audit: Computed tomography (CT) colonography is an established means of identifying colorectal cancer and advanced polyps and has an important role in patients not suitable for colonoscopy. Since the introduction of faecal tagging we aim to audit the adequacy of bowel preparation and quality of reporting in accordance with the National Institute for Health and Care Excellence (NICE) guidelines.1

Hidden association of Cowden syndrome, PTEN mutation and meningioma frequency

Cowden syndrome (CS) is clinically presented by multiple hamartomas, often with mucocutaneous lesions, goiter, breast cancer and gastrointestinal polyps. CS is a genetic disorder of autosomal dominant inheritance and is one distinct syndrome of the phosphatase and tensin homolog on chromosome 10 (PTEN) hamartoma tumor spectrum. Noteworthy, PTEN germline mutations are related to a wide range of brain tumors. We performed a systematic analysis and review of the medical literature for Cowden syndrome and meningioma and additionally present the case of a 29-year- old CS patient diagnosed with multiple meningiomas. We found strong evidence for high incidence of brain tumors in CS patients. In particular meningiomas and gangliocytomas/Lhermitte-Duclos disease were often associated with 8% and 9% respectively in CS patients. Since aberrations in chromosome 10q are associated with meningiomas, it is likely that the underlying mutations in CS drive to a certain extent neoplastic meningioma growth. We propose to include meningiomas and brain tumors in the major criteria spectrum of CS-related disorders. This could warrant early diagnosis of brain lesions and close therapy, as well as better monitoring of patients with CS.

Risk of cancer in small and diminutive colorectal polyps

The prevalence of cancer in small and diminutive polyps is relevant to “resect and discard” and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10mm and those with cancer or advanced histology (high-grade dysplasia or villous elements).Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions.There were 23,524 conventional adenomas <10mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5mm in size and 0.8% of adenomas 6–9mm in size. Of all conventional adenomas, 2.1% of those ≤5mm in size and 5.6% of those 6–9mm in size were advanced. Among 36,107 polyps ≤5mm in size and 6523 polyps 6–9mm in size, there were no cancers.These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.

Faecal calprotectin in patients with suspected colorectal cancer: a diagnostic accuracy study.

NICE guidance exists for the use of faecal calprotectin (FC) when irritable bowel syndrome or inflammatory bowel disease are suspected. Often, however, colorectal cancer is considered within the differential. Should FC have a high diagnostic accuracy for colorectal cancer, it may be applicable as a primary care screening test for all patients with lower gastrointestinal symptoms. To determine the negative and positive predictive value (NPV/PPV) of FC in patients referred from primary care with suspected colorectal cancer. A diagnostic accuracy study conducted at a single secondary care site Consenting patients referred with suspected colorectal cancer within the '2-week wait' pathway provided a stool sample for FC prior to investigation. FC levels were reconciled with end diagnoses: cancer, adenomatous polyps ≥10 mm, and all enteric organic disease. A total of 654 patients completed the evaluation; median age 69 years, female 56%. The NPV for colorectal cancer was 98.6% and 97.2% when including polyps ≥10 mm. The PPV for all organic enteric disease was 32.7%. The diagnostic yield for cancer based on clinical suspicion was 6.3%. By altering the FC cut-off to fix the NPV at 97.0%, the PPV for cancer increased from 8.7% to 13.3%. FC has a high NPV for colorectal cancer and significant polyps in patients with suspected cancer. In total, 27.8% of patients had a normal FC and could safely have been spared a '2-week wait' referral. The addition of FC testing into the current symptom-based assessment has the potential to increase colorectal cancer detection rate yet be clinically and cost effective.

PTU-039 Endoscopic Management of Complex Non Pedunculated Rectal Polyps

Introduction Complex NPRP (non pedunculated rectal polyp) is defined as the polyp which has an increased risk of malignancy, increased risk of incomplete resection/recurrence, increased risk of adverse event or SMSA level 4 polyp. 1 Complex rectal polyps are managed by endoscopic (EMR, ESD, hybrid ESD) techniques or by various surgical techniques (TEMS, TAMIS, TART, TASER), depending on the endoscopic lesion assessment and the local expertise. Methods The aim of this study was to describe the outcomes of the endoscopic management of complex rectal polyps in a large tertiary hospital (single operator). Results Over a period of 33 months (May 2013 to Jan 2016), 77 complex rectal polyps including 10 rectosigmoid polyps were encountered. The size of the polyp varied from 1 cm to 14 cms (median - 3.5 cm). The age of the patient varied from 50 to 92 (median age - 60). 29 polyps (37.6%) was confirmed to have cancer. The pre resection endoscopic accuracy of malignancy was 94%. Frank malignancy was suspected and confirmed in 7 cases and deemed not suitable for endoscopic resection. A small subpedunculated pT1 polyp cancer was resected enbloc, but was not suspected to be a cancer prior to resection.21 polyps were noted to have features suggestive of high risk of malignancy. All had attempted endoscopic resection, including EMR and/or hybrid ESD. Of these, 7 polyps was confirmed to have cancer. The surgery rate for complex rectal polyps (including lesions with endoscopic resections for cancer) is 4.2%. None of the benign polyps (including polyps with EMR/Hybrid ESD for recurrence at previous TEMS/EMR site, post surgery anastomosis site) had surgery. Of the data available for 54 polyps with post endoscopic resection, 46 polyps (85%) did not have any residual lesion at 3 months. Of the available data for 26 polyps at 12 months, no recurrence/residual lesion was noted. None of the resection had perforation. 2 polyp cancers had significant bleeding during attempted hybrid ESD and had surgical resection of the polyp cancer. Another benign polyp with hybrid ESD had significant bleeding controlled with haemospray. The average time of combined EMR/hybrid ESD procedures is 11.4 mins for every cm of polyp resected. Considering the age, co-morbidity, size, location and final histology, ESD or alternative micro surgical techniques would have made a difference to the final outcome in only one patient. Conclusion The pre resection endoscopic accuracy rate for malignancy is significantly high in a high volume centre. EMR and Hybrid ESD in experienced hands is an effective technique in managing complex rectal polyps. Reference 1 British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Disclosure of Interest None Declared

PTU-040 How Should Miss Rates for Cancer and Large Polyps Be Monitored at A Local Level? Retrospective Analysis of Repeat Colonoscopies at a District General Hospital

Introduction Caecal intubation and adenoma detection rates are key performance indicators (KPI) used to assess the quality of colonoscopy. Post-colonoscopy colorectal cancer (PCCRC) rates have recently been suggested as an additional KPI. Most studies estimate PCCRC rates by identifying the proportion of patients with diagnosed colorectal cancer (CRC) who have had a colonoscopy within 3 years of their diagnosis. This is labour intensive requiring evaluation of ≥2 databases. We describe a simplified method for estimating PCCRC rates. Aim To estimate the PCCRC rate using data from the endoscopy database alone. To identify all patients who had ≥2 colonoscopies over a 3 year period and those with CRC at the latest colonoscopy. To estimate the miss rate for larger (>20 mm) polyps. Methods We identified all patients on our endoscopy database (Adam, Fujifilm) who had a colonoscopy from 2010–12 and had a repeat colonoscopy within the next 3 years. We merged initial colonoscopy data with data of those patients found to have CRC and used conditional formatting to flag up duplicate procedures. Patients found to have CRCs or polyps >20 mm in the repeat procedure, not noted at their initial endoscopy, were identified. This data was used to calculate a ‘miss rate’ for these lesions. Results Between 2010 and 2012, 4961 colonoscopies were performed. In total 192 cancers were identified during this period. 237, 150, 225 and 128 repeat colonoscopies were performed within the same year and at 1, 2 and 3 years respectively. Of the 150 repeat procedures performed the following calendar year, indications included polyp surveillance (78), post-operative cancer surveillance (20), HNPCC or FAP (15), family history of CRC (8), anaemia (7), altered bowel habit (6) and other (16). In this group, 42 had polyps >20 mm and 6 had cancers. 3 of the cancers were in the ascending colon and the remaining three were missed at sites reported to have been examined in the previous study. This resulted in a missed polyp rate of 38.6%, a ‘missed cancer rate’ at one year of 6/150 patients (4%) and an overall ‘missed cancer rate’ of 0.12% or 1 in 827 colonoscopies. 2 cancers were found in patients who had a repeat colonoscopy after 2 years, both in the ascending colon. There were no missed cancers on repeat colonoscopy within the same calendar year or at three years. Conclusion Data readily obtainable from the endoscopy reporting system can be used to determine the rate of missed cancers. Our results are similar to that reported in other studies employing more complex and time-consuming methodology. This alternative approach can be used by units to confirm their local PCCRC rate, large polyp miss rates and potentially identify endoscopists whose miss rates are unacceptably high. Disclosure of Interest None Declared

PWE-109 Cytoplasmic Expression of HMGB1 is Associated with Early Colorectal Carcinogenesis

Introduction High Mobility Group Box-1 (HMGB1) is a ubiquitous nuclear protein that regulates gene expression. When phosphorylated, it translocates to the cytoplasm and extracellular space to stimulate pro-inflammatory responses and influence epithelial cell behaviour. Our aim was to assess expression of HMGB1 in colorectal neoplastic progression. Methods Epithelial nuclear and cytoplasmic subcellular expression of HMGB1 was assessed immunohistochemically in a tissue microarray, representing 650 colorectal cancers and 50 paired normal colorectal mucosa samples, and 25 endoscopically resected paraffin embedded polyp cancer lesions (CaP), sourced from the Grampian Biorepository. Ethical approval was granted by the Grampian biorepository scientific committee. Intensity of HMGB1 expression (none, weak, moderate or strong) in all samples and proportion of positive cells/total CaP compartment (normal, adenoma, carcinoma) were double scored. Relative frequencies of staining across the tumour microarray were calculated and correlated to clinico-pathological data. In CaP, expression analysis used Fisher’s exact test of 2X2 contingency tables. Results Increased intensity of nuclear HMGB1 expression was correlated with increasing TNM tumour stage (p = 0.006) and Dukes stage (p = 0.016). Loss of nuclear HMGB1 intensity was identified at the early cancer stages compared to normal, followed by increased expression as the cancer progressed. No (p = 0.001) or low (p = 0.01) nuclear staining was associated with defective mismatch repair protein. Across the microarray, expression of cytoplasmic HMGB1 was significantly associated with malignancy (p Conclusion Dynamic subcellular localisation of HMGB1 expression is associated with colorectal neoplastic progression with cytoplasmic HMGB1 a feature of early carcinogenesis. The functional impact of this warrants further investigation and may reveal new insight into the pathogenesis of colorectal cancer. Disclosure of Interest None Declared

PWE-105 Management of The Malignant Colorectal Polyp: Changes in Practice and Outcomes in A Tertiary Referral Centre in London: Abstract PWE-105 Table 1

Introduction Screening colonoscopy has resulted in increasing identification rates of colorectal polyps which can be endoscopically removed. Almost 10% will histologically prove to be pT1 cancers. Factors associated with cancer recurrence post polypectomy have been described (ie lymphovascular invasion, poor differentiation, R1 Methods Patients with pT1 cancers that had either endotherapy+surgery or endotherapy alone between 2008–2014 were included in the study (n = 61). Endoscopic, histologic and surgery data, including complication rates from both modalities and overall/ cancer-free survival were recorded. Management was compared between two different periods (2008–11, 2012–14) in order to identify changes in practice. Results 38 (62%) patients were treated with endoscopic resection alone. 23 had a completion surgery, 15 (65%) due to R1 resection. Adenomatous tissue was found in 6 surgical specimens but only one had residual cancer. Major complications occurred in 2 (3%) patients post endoscopy versus 6 (26%) postoperatively (p = 0.044), 2 of whom died. There were no cancer relapses at mean follow up of 41±24 months. 17/31 (55%) patients treated prior to 2012 had surgery compared to 6/30 (20%, p = 0.008) treated in 2012–14. More than one risk factors were apparent in 8 (33%) patients treated with endoscopy only within the last 3 years compared to no one previously (p = 0.017). Out of the overall 38 patients with R1 resection, 14 (74%) had completion surgery between 2008–11 compared to 31% recently treated (p = 0.022). Conclusion Endoscopic resection of polyp cancers is a safe and successful therapy with minor complications and recurrence rates similar to surgery. Changing our practice recently in favour of endotherapy alone did not lead to increasing cancer relapses, suggesting that presence of risk factors should not be an absolute indication for surgery, but instead an individualised decision should be made based on combination of factors. Disclosure of Interest None Declared

Curcumin Induces Apoptosis of Colorectal Cancer Stem Cells by Coupling with CD44 Marker.

This study investigated the effect of curcumin on colorectal cancer stem cells (CCSCs) and its possible mechanism. Comparison of the metabolic profiles of human adenomatous polyp (N = 61) and colorectal cancer (CRC) (N = 57) tissue found statistically significant differences (p < 0.05) in their composition of adenosine monophosphate (AMP), adenine, 5'-methythioadenosine, 3-hydroxybutyric acid, prostaglandin E2, threonine, and glutamine. Our cell culture model study found that curcumin treatment (50 μM for 48 h) did indeed increase apoptosis of CRC cells as well as of CCSCs, but at a significant level only in CD44(+) cells. Further metabolic profile studies of the CRC, CD44(+), and CD44(-) cells indicated that curcumin treatment increased glyceraldehyde and hydroxypropionic acid in CD44(-) cells but decreased glutamine content in both curcumin-treated CRC and CD44(+) cells. Based on our comparison of the metabolic profiles of human tissues and cancer cells, we suggest that curcumin might couple with CD44 and that curcumin-CD44(+) coupling at the cell membrane might have some blocking effect on the transport of glutamine into the cells, thus decreasing the glutamine content in the CD44(+) cells and inducing apoptosis.

New risk score for colorectal cancer, advanced polyps could guide screening tests

A new test developed by researchers at the Regenstrief Institute and the Indiana University School of Medicine, both in Indianapolis, may help physicians determine which patients should receive screening with colonoscopy and who can skip the test.1 Lead author Thomas Imperiale, MD, professor of medicine at the Indiana University School of Medicine, says he and his colleagues were primarily attempting to determine whether risk factors frequently associated with colorectal cancer and advanced precancerous polyps could be used in combination to stratify risk for advanced neoplasia in average-risk individuals. The research was conducted in average-risk patients (those with no high-risk familial cancer syndrome) aged 50 to 80 years who were undergoing initial screening colonoscopy in several Midwestern endoscopy units and practices. Investigators developed a risk assessment score that assigned points based on risk factors for both colorectal cancer and advanced precancerous polyps, including age, sex, family history of colorectal cancer, smoking history, and waist circumference. Participants were assigned one of the following scores: very low, low, intermediate, or high risk. Researchers found that there were fewer advanced neoplasms in the low-risk and very low-risk groups, indicating that less invasive tests such as sigmoidoscopies or fecal occult blood tests might be more appropriate for this population. However, participants in the high-risk groups might require colonoscopies. Dr. Imperiale says he hopes that knowing the risk of advanced neoplasia may make colorectal screening more “patient-centered” in terms of giving individuals the ability to choose a screening test. The biggest challenge, he adds, is making providers comfortable with using the scoring system and communicating the best screening test strategies to patients at both low and high risk.

Prevalence and Cost of Office Visits Prior to Colonoscopy for Colon Cancer Screening.

This study uses employer-sponsored private insurance claims data to determine the proportion of colonoscopies for colon cancer screening and polyp surveillance that were preceded by office visits and the associated insurance payments for those visits between 2010 and 2013.

Prevalence of Cytomegalovirus Infection in Patients With Colorectal Cancer by Using PCR Technique

Background: Colorectal cancer is the most common gastrointestinal cancer and the second leading cause of cancer deaths worldwide. Objectives: The purpose of this study is to investigate the prevalence of cytomegalovirus in patients with colorectal carcinomas and polyps in comparison with healthy people. Patients and Methods: In this analytical case-control study, 15 patients with colorectal cancer, 20 patients with colorectal polyps and also 35 patients without malignancy as controls were studied. Biopsy specimens were frozen under sterile conditions at -20oC. After DNA extraction, analysis of polymerase chain reaction (PCR) to detect CMV DNA in tissue samples was performed. Statistical analysis was performed with χ2 test. Results: CMV DNA were found in 8 (53.3%) of tumor samples, in 10 (50%) of polyp samples and 13 (37.1%) of the non-malignant control group. Statistical analysis showed no significant association between the prevalence of CMV and incidence colorectal cancer and polyps in comparison with the control group. Conclusions: The results of the present study has shown the presence of CMV sequences in differentiated cancer tissue, polyp and non-malignant by PCR method reflects the ability of the virus to infect of the different colon cells.