Early Diagnosis Of Colorectal Cancer Research Articles

Serum Levels of BDNF in Patients with Adenoma and Colorectal Cancer.

The present study is aimed at examining the serum levels of brain-derived neurotrophic factor (BDNF) and investigating its role in differential diagnosis of colorectal cancer (CRC). Materials and Methods. In a Chinese population, we conducted a case-control study to compare the diagnostic performance of serum levels of BDNF and carcinoembryonic antigen (CEA) for CRC. We enrolled 61 healthy controls, 31 patients with adenomas, and 81 patients with CRC. We explored the correlation between serum levels of BDNF and several pathological features, such as tumor differentiation and TNM staging. Results. The serum levels of BDNF were significantly (p < 0.0001) higher in patients with CRC (10.64 ± 3.84, n = 81) than in the healthy controls (4.69 ± 1.69 ng/mL, n = 61). Serum BDNF also correlated with tumor size, tumor differentiation, and TNM staging (p < 0.05). For early diagnosis, the combination of BDNF (AUC 0.719; 95% CI, 0.621–0.816) and CEA (AUC 0.733; 95% CI, 0.632–0.909) slightly improved the diagnostic performance for CRC (AUC 0.823; 95% CI, 0.737-0.909). Conclusions. Combined detection of serum BDNF and CEA may thus have the potential to become a new laboratory method for the early clinical diagnosis of CRC.

Symptom Perceptions and Help-Seeking Behaviours of Omani Patients Diagnosed with Late-Stage Colorectal Cancer: A Qualitative Study.

Objective: Colorectal cancer (CRC) is the fourth leading cause of mortality in Oman, with most patients diagnosed at advanced stages. Early diagnosis of CRC improves prognosis and survival rate. The aim of this study was to explore the symptom perceptions and help-seeking behaviours (HSBs) of Omani patients diagnosed with late-stage CRC. Methods:Semi-structured individual interviews were conducted with 16 patients. Results:Four main themes emerged, including normalisation and ignorance (patients felt healthy, perceived symptoms as not being serious and related to dietary habits, concealed them or prioritised work and family commitments), self-empowerment and self-management (patients were stubborn, employed ‘wait and see’ approach, used symptomatic or herbal treatments), disclosure and seeking help (patients disclosed symptoms to family members or friends, sought medical help only when symptoms worsened, visited faith healers or travelled abroad for treatment) and healthcare professionals (patients attributed treatment or diagnosis delays to lack of continuity of care, loss of trust in doctors or delays in referral).Conclusion:Patients attributed delays in CRC diagnosis to several factors based on their perceptions of symptoms. Most HSBs driven by sociocultural and emotional causes. Increased awareness of CRC symptoms and modifying HSBs can encourage early diagnosis. Prompting patients to disclose CRC-related symptoms may aid referral decisions.

Urinary 8-iso PGF2α and 2,3-dinor-8-iso PGF2α can be indexes of colitis-associated colorectal cancer in mice

Early diagnosis of colorectal cancer is needed to reduce the mortal consequence by cancer. Lipid mediators play critical role in progression of colitis and colitis-associated colon cancer (CAC) and some of their metabolites are excreted in urine. Here, we attempted to find novel biomarkers in urinary lipid metabolite of a murine model of CAC. Mice were received single administration of azoxymethane (AOM) and repeated administration of dextran sulfate sodium (DSS). Lipid metabolites in their urine was measured by liquid chromatography mass spectrometry and their colon was collected to perform morphological study. AOM and DSS caused inflammation and tumor formation in mouse colon. Liquid chromatography mass spectrometry-based comprehensive analysis of lipid metabolites showed that cyclooxygenase-mediated arachidonic acid (AA) metabolites, prostaglandins, and reactive oxygen species (ROS)-mediated AA metabolites, isoprostanes, were predominantly increased in the urine of tumor-bearing mice. Among that, urinary prostaglandin (PG)E2 metabolite tetranor-PGEM and PGD2 metabolite tetranor-PGDM were significantly increased in both of urine collected at the acute phase of colitis and the carcinogenesis phase. On the other hand, two F2 isoprostanes (F2-IsoPs), 8-iso PGF2α and 2,3-dinor-8-iso PGF2α, were significantly increased only in the carcinogenesis phase. Morphological study showed that infiltrated monocytes into tumor mass strongly expressed ROS generator NADPH (p22phox). These observations suggest that urinary 8-iso PGF2α and 2,3-dinor-8-iso PGF2α can be indexes of CAC.

The tumorigenic and therapeutic functions of exosomes in colorectal cancer: Opportunity and challenges.

Most cells release extracellular vesicles (EVs) mediating intercellular communication via transferring various biomolecules including proteins, nucleic acids, and lipids. A subset of EVs is exosomes that promote tumorigenesis. Different tumour cells such as colorectal cancer (CRC) cells produce exosomes that participate in the progression of CRC. Exosomes cargo including proteins and miRNAs not only support proliferation and metastasis of tumour cells but also mediate chemoresistance, immunomodulation and angiogenesis. In addition, as exosomes are present in most body fluids, they can hold the great capacity for clinical usage in early diagnosis and prognosis of CRC. Exosomes from CRC (CRC-Exo) differentially contain proteins and miRNAs that make them a promising candidate for CRC diagnosis by a simple liquid-biopsy. Despite hopeful results, some challanges about exosomes terminology and definition remains to be clarified in further experiments. In addition, there are little clinical trials regarding the application of exosomes in CRC treatment, therefore additional studies are essential focusing on exosome biology and translation of preclinical findings into the clinic. The present study discusses the key role of exosomes in CRC progression and diagnosis. Furthermore, it describes the opportunity and challenges associated with using exosomes as tumour markers.

Four circulating exosomal miRNAs as novel potential biomarkers for the early diagnosis of human colorectal cancer

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. Our study aimed to identify novel circulating miRNAs as early diagnostic biomarkers of CRC. The Gene Expression Omnibus (GEO) datasets were analyzed by using the online tool GEO2R. Isolated exosomes were verified by using the transmission electron microscope (TEM), Nanosight, and western blot. qRT-PCR was implemented to examine miRNA expression. The diagnostic value of circulating exosomal miRNAs was identified by using the receiver operating characteristic curve (ROC). In this study, we found that serum exosomal miRNAs are more suitable for diagnosing CRC when compared to serum miRNAs. Furthermore, we identified four exosomal miRNAs (miR-126, miR-1290, miR-23a, and miR-940) in the serum of CRC patients as novel potential biomarkers for the early diagnosis of CRC because they showed high diagnostic values to differentiate CRC patients at TNM stage I from healthy controls (HCs). In addition, our data suggested that CRC cells may secrete miRNAs into the extracellular environment through exosomes regardless of intracellular miRNA expression. In conclusion, we identified serum exosomal miR-126, miR-1290, miR-23a, and miR-940 as novel potential biomarkers for the early diagnosis of CRC.

Evaluation Changes in Indicators of Oncological Service in Colorectal Cancer in East Kazakhstan Region

About 3.15 million new cases of colorectal cancer (CRC) are predicted and it is expected that about 1.62 million human will die from this pathology, according to the forecasts of the International Agency for Research on Cancer in 2040. To this aim, an analysis studying studying the indicators of the oncological service for CRC also makes it possible to evaluate the ongoing anti-cancer measures in East Kazakhstan region. Aim. Evaluate some indicators of the oncological service at CRC in East Kazakhstan region in 2009 to 2018. Materials and methods. The research material was data from the Ministry of Health of the Republic of Kazakhstan – annual form No. 7 and 35 regarding CRC (ICD 10 – C18-21) for 2009-2018 in East Kazakhstan region – incidence, mortality, early diagnosis, neglect, morphological verification. A retrospective study using descriptive and analytical methods of biomedical statistics was used as the main method. Results and discussion. For 2009-2018, 3,661 new cases of CRC were registered in East Kazakhstan region for the first time. The incidence of CRC was 25.30/0000 and in dynamics tended to increase from 21.90/0000 (2009) to 25.70/0000 in 2018, the difference was statistically significant (t=1.99 and p=0.047). The mortality rate from CRC tended to decrease from 15.50/0000 to 14.70/0000 (p=0.591), and the average annual mortality rate from CRC was 15.60/0000. The indicators of early diagnosis (the proportion of patients with stage I-II) improved from 58.8% (2009) to 62.3% in 2018, and, accordingly, the indicators of the proportion of neglected patients significantly decreased with stage III (from 25.5% to 20.8%), while with stage IV (from 15.7% to 16.9%) there is a slight increase. The indicators of morphological verification in CRC improved from 90.5% to 98.6% during the studied years. Conclusion. An improvement in the indicators of morphological verification and early diagnosis of CRC was found. The obtained results are recommended to be used for monitoring anti-cancer measures in the region. Keywords: colorectal cancer, incidence, mortality, early diagnosis, neglect, morphological verification.

Quantitative detection of SRY-Box 21 (SOX21) gene promoter methylation as a stool-based noninvasive biomarker for early diagnosis of colorectal cancer by MethyLight method.

In recent years, the study of potential epigenetic biomarkers in feces has been an attractive research approach for the noninvasive diagnosis of colorectal cancer (CRC). The aim of this study was to evaluate the stool-based DNA methylation potential of SRY-Box 21 (SOX21) gene promoter as an appropriate candidate biomarker for differentiating CRC patients and healthy individuals for the first time. The MethyLight method was performed to analyze the methylation status of SOX21 gene promoter in fecal samples from 40 patients with CRC and 40 healthy controls. In addition, the diagnostic efficiency of measuring the hypermethylated SOX21 gene in the feces to the fecal occult blood test (FOBT) was compared. The percentage of methylated reference (PMR) values in the stool of CRC patients (median 1.44) was higher than those of healthy individuals (median 0.00) (P < 0.001). A sensitivity of 72.5% and specificity of 100% were obtained for SOX21 gene promoter methylation status and 29 of the patients were considered as positive in methylation status. There was no significant association between PMR values and demographic/clinicopathological features (P > 0.05). The results of the present study demonstrated that the stool-based assay of SOX21 gene promoter methylation has a relatively high sensitivity and specificity and it may serve as a noninvasive biomarker for early detection of CRC. However, more studies with a wide range of samples are required to further confirm the role of hypermethylation of SOX21 in the early CRC diagnosis.

The Regulatory Network of MicroRNA in the Metabolism of Colorectal Cancer.

Colorectal cancer (CRC) is the third most common malignant tumor in the world. During the progression of CRC, the entire metabolic network undergoes reprogramming, including marked changes in the regulation of glucose, lipid and amino acid metabolism. Although microRNAs (miRNAs) account for only 1% of the entire human genome, they play an important role in almost all physiological and pathological processes in the body. MiRNAs can react directly with key enzymes in the metabolic processes. MiRNAs also interact with other ncRNAs, as a member of non-coding RNA (ncRNA), to form their own regulatory network in various oncogenic pathways of CRC metabolism. The progression of colorectal cancer is closely related to the intestinal flora, where miRNAs act as important mediators. Understanding how miRNAs act in the regulatory network of CRC metabolism is helpful to elucidate the characteristics of tumor occurrence, proliferation, metastasis and drug resistance. This review summarizes the role of miRNAs in the metabolism of CRC and how miRNAs interact with key enzymes, ncRNA and intestinal flora to further discuss how miRNAs affect CRC and realize some new strategies for the early diagnosis and treatment of CRC.

Predictive model using hemoglobin, albumin, fibrinogen, and neutrophil-to-lymphocyte ratio to distinguish patients with colorectal cancer from those with benign adenoma.

Colorectal cancer (CRC) is associated with inflammation, activation of coagulation, and mild anemia. Hematological parameters reflecting ongoing cancer may have the potency to be effective for early diagnostics of CRC. The aim of this study was to examine the validity and relationship between some biochemical and hematological parameters for the early diagnosis of CRC. We designed a prospective observational cohort study to analyze whether these laboratory markers have the potency to distinguish benign tumors from malignant before planned surgery. The clinical data were collected from 208 patients with suspected benign or malignant colorectal tumors who were eligible for elective surgery between September 2018 and January 2020. Blood samples were collected one day before surgery, examined parameters included: complete blood count, hemoglobin (HGB) concentration, albumin (ALB), C-reactive protein (CRP), interleukin-6 (IL-6), and fibrinogen (FG). Absolute neutrophil and lymphocyte counts were used for the calculation of the neutrophil-to-lymphocyte ratio (NLR). The diagnosis was confirmed by histopathological examination. The 197 patients were divided into the group of benign (B group = 52 patients) or malignant tumors (CRC group = 145 patients). ROC curves and cut-off values of NLR, HGB, FG, and ALB concentration, serum CRP and IL-6 levels. In the cohort of 197 adult patients submitted for the elective colorectal surgery, the complete blood samples drawn one day before surgery showed significant differences between patients with benign tumors and colorectal carcinoma: HGB (mean 139.9 g/l vs. 129.9; p<0.001), FG (mean 3.36 g/l vs. 3.94 g/l; p<0.001), ALB (mean 43.4 g/l vs. 41.1 g/l; p=0.001), NLR (mean 2.73 vs. 3.88; p=0.016), respectively. CRP (mean 2.9 mg/l vs. 4.4 mg/l; p=0.011), thrombocyte count (mean 235×109/l vs. 265×109/l; p<0.029). Differences in IL-6 concentrations were not significant (2.9 pg/ml vs. 4.15 pg/ml; p=0.052). Using multivariable logistic regression analysis, four valid parameters (HGB, FG, ALB, and NLR) were suitable for the construction of a diagnostic predictive model for the identification of CRC. In conclusion, a panel of routinely examined blood parameters like HGB, FG, ALB, and NLR has the potency to distinguish patients with benign tumors from malignant by applying a diagnostic predictive model for early laboratory detection of CRC.

Application of phototherapeutic-based nanoparticles in colorectal cancer.

Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second leading cause of cancer death, which accounts for approximately 10% of all new cancer cases worldwide. Surgery is the main method for treatment of early-stage CRC. However, it is not effective for most metastatic tumors, and new treatment and diagnosis strategies need to be developed. Photosensitizers (PSs) play an important role in the treatment of CRC. Phototherapy also has a broad prospect in the treatment of CRC because of its low invasiveness and low toxicity. However, most PSs are associated with limitations including poor solubility, poor selectivity and high toxicity. The application of nanomaterials in PSs has added many advantages, including increased solubility, bioavailability, targeting, stability and low toxicity. In this review, based on phototherapy, we discuss the characteristics and development progress of PSs, the targeting of PSs at organ, cell and molecular levels, and the current methods of optimizing PSs, especially the application of nanoparticles as carriers in CRC. We introduce the photosensitizer (PS) targeting process in photodynamic therapy (PDT), the damage mechanism of PDT, and the application of classic PS in CRC. The action process and damage mechanism of photothermal therapy (PTT) and the types of ablation agents. In addition, we present the imaging examination and the application of PDT / PTT in tumor, including (fluorescence imaging, photoacoustic imaging, nuclear magnetic resonance imaging, nuclear imaging) to provide the basis for the early diagnosis of CRC. Notably, single phototherapy has several limitations in vivo, especially for deep tumors. Here, we discuss the advantages of the combination therapy of PDT and PTT compared with the single therapy. At the same time, this review summarizes the clinical application of PS in CRC. Although a variety of nanomaterials are in the research and development stage, few of them are actually on the market, they will show great advantages in the treatment of CRC in the near future.

Auto-antibodies to p53 and the Subsequent Development of Colorectal Cancer in a U.S. Prospective Cohort Consortium.

Auto-antibodies to tumor suppressor p53 are found in a subset of patients with colorectal cancer. A recent prospective study in the United States has reported a significant 1.8-fold increased odds for colorectal cancer development with prediagnostic seropositivity to p53. In this study, we sought to examine this association in a U.S. colorectal cancer cohort consortium to evaluate the potential utility of p53 auto-antibodies as an early biomarker for colorectal cancer. Auto-antibodies to p53 were measured in prediagnostic blood samples of 3,702 incident colorectal cancer cases and 3,702 controls, matched by age, race, and sex, from 9 U.S. prospective cohorts. The association of seropositivity to p53 with colorectal cancer risk, overall and by time between blood draw and diagnosis, was determined by conditional logistic regression. Overall, 5% of controls and 7% of cases were seropositive to p53, resulting in a statistically significant 33% increased colorectal cancer risk [odds ratio (OR), 1.33; 95% confidence interval (CI), 1.09-1.61]. By follow-up time, the association was only significant with colorectal cancer diagnoses within 4 years after blood draw (OR, 2.27; 95% CI, 1.62-3.19), but not thereafter (OR, 0.97; 95% CI, 0.76-1.24). In this large consortium of prospective cohorts, we found that prediagnostic seropositivity to tumor suppressor p53 was significantly associated with an over 2-fold increased odds of developing colorectal cancer within 4 years after blood draw. Our finding suggests that p53 seropositivity may not be a useful predictor of long-term colorectal cancer risk; however, it might be considered as a marker to aid in the early diagnosis of colorectal cancer.

PICCOLO White-Light and Narrow-Band Imaging Colonoscopic Dataset: A Performance Comparative of Models and Datasets

Colorectal cancer is one of the world leading death causes. Fortunately, an early diagnosis allows for effective treatment, increasing the survival rate. Deep learning techniques have shown their utility for increasing the adenoma detection rate at colonoscopy, but a dataset is usually required so the model can automatically learn features that characterize the polyps. In this work, we present the PICCOLO dataset, that comprises 3433 manually annotated images (2131 white-light images 1302 narrow-band images), originated from 76 lesions from 40 patients, which are distributed into training (2203), validation (897) and test (333) sets assuring patient independence between sets. Furthermore, clinical metadata are also provided for each lesion. Four different models, obtained by combining two backbones and two encoder–decoder architectures, are trained with the PICCOLO dataset and other two publicly available datasets for comparison. Results are provided for the test set of each dataset. Models trained with the PICCOLO dataset have a better generalization capacity, as they perform more uniformly along test sets of all datasets, rather than obtaining the best results for its own test set. This dataset is available at the website of the Basque Biobank, so it is expected that it will contribute to the further development of deep learning methods for polyp detection, localisation and classification, which would eventually result in a better and earlier diagnosis of colorectal cancer, hence improving patient outcomes.

Circulating non-coding RNA cluster predicted the tumorigenesis and development of colorectal carcinoma.

Carcinoembryonic antigen (CEA) is the most significant plasma biomarker in colorectal cancer (CRC), which is mainly used to diagnose and monitor the recurrence of CRC. However, due to the low sensitivity of CEA, it is more recommended for postoperative surveillance rather than early diagnosis. It is necessary to find efficient biomarkers for CRC. In this study, the expression of plasma non-coding RNAs was confirmed in three independent cohorts with total 1201 participants. First, 12 non-coding RNAs were screened from 9 plasma samples by using microarray. The expression of selected non-coding RNAs was further validated by multiphase detection and risk score analysis. We found that miR-20b-5p, miR-329-3p, miR-374b-5p, miR-503-5p, XLOC_001120 and ENSG00000243766.2 were significantly elevated in CRC plasma, and the AUC in training and validation set was 0.996 and 0.954, respectively. Moreover, miR-20b-5p, miR-329-3p and miR-503-5p were found elevated in plasma from larger tumors (5 cm as the cutoff) in CRC patients, and the merged AUC in training and validation set was 0.896 and 0.881. In conclusion, a panel of 6 non-coding RNAs showed their important clinical value for the early diagnosis of CRC. Among, miR-20b-5p, miR-329-3p and miR-503-5p might be the potential markers for evaluating larger tumor size of CRC.

Re-engineering of peptides with high binding affinity to develop an advanced electrochemical sensor for colon cancer diagnosis

Colorectal cancer (CRC) develops from polyps in the inner large intestine or rectum and an increasing incidence and high mortality rate has been observed in humans. Currently, colonoscopy is the preferred modality for early CRC diagnosis. However, this technique has several limitations, such as high medical costs and intricate procedures, leading to increasing demands for the development of a new, simple, and affordable diagnostic method. In this study, an advanced electrochemical biosensor based on rationally designed affinity peptides was developed for discriminating adenoma to carcinoma progression. Amino acid-substituted and rationally designed synthetic peptides (BP3-1 to BP3-8) based on in silico modeling studies were chemically synthesized, and covalently immobilized onto a gold electrode using aromatic ring compounds through surface chemistry techniques. The binding performance of the developed sensor system was observed using square wave voltammetry (SWV). The peptide BP3-2 was selected depending on its relative binding affinity; SWV indicated the limit of detection of BP3-2 for LRG1 to be 0.025 μg/mL. This sensor could distinguish the adenoma-carcinoma transition with improved binding abilities (specificity and selectivity), and stability in plasma samples spiked with LRG1 and real samples from patients with CRC. These results indicate that this electrochemical sensor system can be used for early monitoring of the colorectal adenoma to carcinoma progression.

A study of colorectal cancer patients’ hair medulla by synchrotron radiation infrared microspectroscopy

Colorectal cancer seriously threatens life and health of human beings due to its high morbidity and mortality. At present, colonoscopy and biopsy are “the gold standard” for diagnosing colorectal cancer, however, they have several limitations. Since early diagnosis is very important for colorectal cancer treatment, it is of great urgency to develop new methods for detecting colorectal cancer early. As a place occuring metabolism, hair is closely related with human health status and genetic characteristics, etc. Synchrotron radiation infrared (SR-IR) microspectroscopy has the ability to gain IR spectra of hair medulla accurately. In this study, we applied SR-IR microspectroscopy to comparison of hair medulla from colorectal cancer patients and healthy persons. Peak-area ratios indicated that colorectal cancer might cause the changes of proteins, lipids and nucleic acids in hair medulla. Based on the above peak-area ratios, discriminant analysis obtained the sensitivity as 74.6%, the specificity as 83.8%, the positive predictive value as 88.7% and the accuracy as 78.0%. Principal component analysis (PCA) further displayed that colorectal cancer might alter proteins and nucleic acids in hair medulla significantly. In sum, the above results showed potential application value of hair medulla’s IR spectra in early diagnosis of colorectal cancer.

An effective approach to the early diagnosis of colorectal cancer based on three-dimensional fluorescence spectra of human blood plasma

Colorectal cancer (CRC) is a common malignancy in the gastrointestinal tract, and its screening rates remain relatively low in the general population due to the lack of specific symptoms and effective methods. It is still in urgent need to develop rapid and reliable approach to the early diagnosis of CRC. Herein, based on the three-dimensional (3D) fluorescence spectra of human blood plasma, a combination strategy of Tchebichef image moments coupled with partial least squares-discriminate analysis (TM-PLS-DA) was proposed for the detection of CRC from three classes (CRC samples, adenomas samples and non-malignant findings). The established TM-PLS-DA classification model provided an 84 % correct classification for CRC prediction. Venetian blinds 10-fold cross validation was carried out. The error rates both in cross validation and test sets were less than 0.16. Sensitivity and specificity for CRC prediction were 0.95 and 0.88, respectively. At the same time, the diagnostic capacity of the proposed method was tested by receiver operating characteristics (ROC) analysis with area under the curve (AUC) of 0.94 for CRC diagnosis. These results demonstrate that the proposed TM-PLS-DA method based on the 3D fluorescence spectra of blood plasma has great advantage for the accurate CRC detection, which will provide a potential alternative approach for cancer diagnostics.

Factors Contributing to Delay in Specialist Care After Colorectal Cancer Diagnosis in Kentucky

BackgroundAbundant studies have associated colorectal cancer (CRC) treatment delay with advanced diagnosis and worse mortality. Delay in seeking specialist is a contributor to CRC treatment delay. The goal of this study is to investigate contributing factors to 14-d delay from diagnosis of CRC on colonoscopy to the first specialist visit in the state of Kentucky. MethodsThe Kentucky Cancer Registry (KCR) database linked with health administrative claims data was queried to include adult patients diagnosed with stage I-IV CRC from January 2007 to December 2012. The dates of the last colonoscopy and the first specialist visit were identified through the claims. Bivariate and logistic regression analysis was performed to identify factors associated with delay to CRC specialist visit. ResultsA total of 3927 patients from 100 hospitals in Kentucky were included. Approximately, 19% of patients with CRC visited a specialist more than 14 d after CRC detection on colonoscopy. Delay to specialist (DTS) was found more likely in patients with Medicaid insurance (OR 3.1, P < 0.0001), low and moderate education level (OR 1.4 and 1.3, respectively, P = 0.0127), and stage I CRC (OR 1.5, P < 0.0001). There was a higher percentage of delay to specialist among Medicaid patients (44.0%) than Medicare (18.0%) and privately insured patients (18.8%). ConclusionsWe identified Medicaid insurance, low education attainment, and early stage CRC diagnosis as independent risk factors associated with 14-d delay in seeking specialist care after CRC detection on colonoscopy.

Enabling the future of colonoscopy with intelligent and autonomous magnetic manipulation.

Early diagnosis of colorectal cancer significantly improves survival. However, over half of cases are diagnosed late due to demand exceeding the capacity for colonoscopy - the “gold standard” for screening. Colonoscopy is limited by the outdated design of conventional endoscopes, associated with high complexity of use, cost and pain. Magnetic endoscopes represent a promising alternative, overcoming drawbacks of pain and cost, but struggle to reach the translational stage as magnetic manipulation is complex and unintuitive. In this work, we use machine vision to develop intelligent and autonomous control of a magnetic endoscope, for the first time enabling non-expert users to effectively perform magnetic colonoscopy in-vivo. We combine the use of robotics, computer vision and advanced control to offer an intuitive and effective endoscopic system. Moreover, we define the characteristics required to achieve autonomy in robotic endoscopy. The paradigm described here can be adopted in a variety of applications where navigation in unstructured environments is required, such as catheters, pancreatic endoscopy, bronchoscopy, and gastroscopy. This work brings alternative endoscopic technologies closer to the translational stage, increasing availability of early-stage cancer treatments.

S1653 COVID Delays in Diagnosis and Treatment of Early Onset CRC

INTRODUCTION: This is a case of early onset Colorectal cancer (CRC) in which the COVID pandemic caused both diagnosis and treatment delays CASE DESCRIPTION/METHODS: A 31-year-old male with controlled Sickle Cell Anemia (no crises in over 10 years) presented to Emergency Department with 6 months of non-focal abdominal discomfort, 30lb weight loss and CT one month prior with 5 cm, Ascending Colon lesion [Img 1] Chief compliant was an expedited colonoscopy as COVID policies eliminated all outpatient and nonemergent case requests Labs were notable for hemoglobin 9 6 g/dL (down-trending since 2019, from baseline of 11-13 g/dL) and MCV 59 FL He denied upper gastrointestinal symptoms, family history of CRC or overt gastrointestinal bleeding He tested negative for COVID Outpatient colonoscopy, 4 days later, revealed a circumferential, ulcerated, firm ascending colon mass with malignant appearance [Img 2] Same day CT chest, abdomen and pelvis were negative for metastases Pre-surgical COVID testing returned positive Surgery was postponed until two negative COVID tests Ascending colon biopsies confirmed invasive, moderately, differentiated adenocarcinoma, CK 20 and CDX-2 positive Two weeks later, his COVID criteria was met and right hemi-colectomy was completed (tumor size: 8 × 5 × 1cm) Pathology confirmed invasive adenocarcinoma without any lymph nodes and negative margins Stains were negative for hereditary syndromes The patient did well after surgery DISCUSSION: This patient's immediate early onset CRC outcome was not complicated by COVID delays Research support delaying surgical intervention in cancer patients whether COVID negative or positive due to high risk for COVID specific mortality [1] Future research is needed to determine the 5-10-year impact of COVID delays on CRC detection, stage, treatment and mortality Further, prior studies have shown that colonoscopy delays of greater than 10 months from time of positive FIT led to increased detection of advanced stage CRC compared to colonoscopy within 3-6 months [2] Thus, in the next 3-6 months Gastroenterologists should prioritize outreach and completion of colonoscopies for patients suspected of malignancy in the pre-COVID era (Figure Presented)

S1720 COVID Delays in Diagnosis and Treatment of Early Onset CRC in Two Patients

INTRODUCTION: A case series of COVID-19 (C19) delays in diagnosis and treatment of early onset Colorectal cancer (CRC) CASE DESCRIPTION/METHODS: Case 1: A 31-year-old male with controlled Sickle Cell Anemia (no crises in over 10 years) presented to the emergency room (ER) with 6 months of non-focal, abdominal discomfort, 30lb weight loss and CT scan 1 month prior revealing a 5 cm, Ascending Colon lesion [Img 1] Chief complaint was an expedited colonoscopy as C19 policies eliminated all outpatient requests Labs noted worsening microcytic anemia Outpatient colonoscopy, 4 days later, revealed a circumferential, ulcerated, ascending colon mass, malignant appearing [Img 2] CT chest, abdomen and pelvis were negative for metastases Ascending colon biopsies confirmed invasive, moderately, differentiated adenocarcinoma (IAC), CK 20 and CDX-2 positive Right hemi-colectomy was completed (tumor size: 8 × 5 × 1cm, pathology confirmed IAC with negative lymph nodes, margins, and stains for hereditary syndromes) Case 2: An 18-year-old male with no past medical history presented to ER with 1 month of anorexia, 15lb weight loss as well as 3 days of generalized abdominal pain Labs showed microcytic anemia of 4 5 g/dL Primary team did not request inpatient endoscopies due to mis-perception that C19 policies were still in place Six weeks later, patient represented with same symptoms CT scan revealed thickening of right colon with ascites Colonoscopy showed large, erythematous, ulcerated, circumferential mass in the ascending colon [Img 3] Pathology and CT chest are still pending DISCUSSION: These cases reveal two of many ways that C19 has caused delays in the evaluation of CRC in general and early onset CRC specifically;both direct delays due to restrictions on endoscopies as well as indirect delays due to provider mis-perceptions Each case had at-least an one month delay in endoscopy from the time of presentation Thus, future research is needed to determine 1) the average delay to endoscopy compared to pre-C19 era;2) the most common causes of delay;and 3) the 5-10-year impact of C19 delays on CRC detection, stage, treatment, and mortality (Figure Presented)