Family History Of Colon Polyps Research Articles

Left Atrial Fibroma in Gardner Syndrome

Left Atrial Fibroma in Gardner Syndrome

Heterogeneity of colorectal adenomas, the serrated adenoma, and implications for screening and surveillance

Current algorithms for screening and surveillance for colon cancer are valuable, but may be limited by the underlying nature of the targeted neoplastic lesions. Although part of the success of adenoma removal relates to interruption of so-called "adenoma-carcinoma sequence", an alternate serrated pathway to colon cancer may pose difficulties with the ultimate results achieved by traditional colonoscopic methods. The endpoint carcinoma in this unique pathway may be derived from a dysplastic serrated adenoma. These tend to be located primarily in the right colon, especially in females, and are frequently associated with co-existent colon cancer. Unfortunately, however, there are few, if any, other identifiable risk factors, including age or family history of colon polyps or colon cancer. Moreover, this alternate serrated pathway may itself also be quite biologically heterogeneous as reflected in sessile serrated adenomas (SSA) with virtually exclusive molecular signatures defined by the presence of either BRAF or KRAS mutations. Screening algorithms in the future may need to be modified and individualized, depending on new information that likely will emerge on the natural history of these biologically heterogeneous lesions that differs from traditional adenomatous polyps.

Predictors of Colorectal Screening in Rural Colorado: Testing to Prevent Colon Cancer in the High Plains Research Network

Colorectal cancer is the second leading cause of cancer death in the United States, yet screening rates are well below target levels. Rural communities may face common and unique barriers to health care, particularly preventive health care. To establish baseline attitudinal, knowledge, belief, and behavior measures on colorectal cancer screening and to identify barriers to or predictors of colorectal cancer screening. As part of a controlled trial using a quasi-experimental, pretest, post-test design, we conducted a baseline telephone survey of 1,050 rural eastern Colorado residents aged 50 years and older. Smaller counties were over-sampled to ensure a minimum of 30 completed interviews per county. Seventy-seven percent reported they ever had a colorectal cancer screening test and 59% were up-to-date on at least 1 test. The most important independent predictors of being up-to-date were having visited a doctor or other health care practitioner for a checkup in the past year, having personal or family history of colon polyps or cancer, and having asked for a colorectal cancer screening test. Financial concerns were reported reasons for not obtaining fecal occult blood testing by 18% and colonoscopy by 21%. This study suggests that health care providers should be vigilant in counseling their patients 50 and older to have a colorectal cancer test. Community programs designed to promote colon cancer screening should encourage residents to have regular contact with their primary care physician and ask their doctor for a screening test. Additionally, programs should provide financial assistance for testing for low-income and uninsured patients.

Gastrointestinal Manifestations of Cowden Syndrome

Purpose: Cowden syndrome (CS) is an under diagnosed, under recognized, autosomal dominant inherited syndrome. CD is associated with germline mutations in the PTEN gene and exhibits an increase risk of breast, thyroid, and possibly other malignancies. Although various benign gastrointestinal lesions, including esophageal glycogenic acanthosis and hamartomatous polyps have been described, the colorectal cancer (CRC) risk remains poorly characterized. Methods: Nine patients (7 female, 2 males with a median age of 52.3) with a previous diagnosis of CS based on clinical criteria (International Cowden Consortium version 2000) and/or presence of a PTEN mutation were studied. All patients underwent colonoscopy, and four patients also underwent upper endoscopy. Results: One case was diagnosed with CRC at age 42. Four patients had a family history of CRC, three with affected first degree relatives (FDR). Two cases had a family history of colon polyps and CRC before age 45 years of age. One case had two FDR with CRC and a second degree relative with CRC at age 12. Two cases had FDR with CRC after age 45. Multiple colon polyps were observed in seven patients (78%). The polyps were mostly sessile, 1 to 4mm in size and universally distributed throughout the colon. Hamartomatous polyps were present in all cases with polyps. Three patients had adenomatous polyps. Inflammatory and hyperplastic polyps were also seen. Upper GI manifestations included esophageal acanthosis, and, multiple gastric and duodenal non-adenomatous polyps were seen. Conclusions: We found CRC in 1/9 (11%) patients with CS and three cases with first degree relatives with CRC. This study suggests further investigation of CS registries for prevalence of CRC and the potential contribution of CS to familial CRC. Endoscopic surveillance may be indicated in patients with CS.

Is histological investigation of polyps always necessary?

To assess whether polyp histological type can be predicted by patient characteristics and endoscopic polyp findings. 1681 polyps in 494 patients were categorized as advanced adenomas (villous component or severe dysplasia or early cancer) or insignificant polyps. Chi-squared tests were used to analyze whether polyp histological type could be predicted based on patient age (< 60 vs. > or = 60 years), gender, family history of colon polyps or cancer, presence of anemia, polyp size (< or = 5 mm vs. > 10 mm), and location (left- vs. right-sided). Insignificant polyp histology (n = 1337) correlated with patient age < 60 years (P = 0.0026), lack of anemia (P< 0.0001), polyp size < or = 5 mm (P < 0.0001), and right-sided location (P= 0.0058). Stepwise inclusion of these parameters demonstrated that the association of a < or = 5 mm right-sided polyp in a patient < 60 years yielded the highest combined predictive value (96.2%) for an insignificant polyp. Conversely, age > or = 60 years, presence of anemia, polyp size > 10 mm, or left-sided location, as single or combined parameters, demonstrated a maximum predictive value of only 75.4% for an advanced adenoma. A small right-sided polyp in a young patient is associated with a small risk (3.8 %) for advanced adenomatous tissue, indicating that histological investigation of such a polyp might not always be necessary. However, the recent recognition of flat adenomas and "mini" de novo colon carcinomas in the European population also may limit the usefulness of small polyp diameters in the exclusion of severe polyp histology.

4397 Polyp histology can be predicted by polyp size and site combined with patient age.

Aim: To assess whether polyp histology can be predicted on the basis of patient characteristics and endoscopic polyp findings. Methods: 2307 polyps from 1397 colonoscopies in 545 consecutive non-FAP patients were documented at the registry for colorectal polyps at the University Hospital of Zurich, Switzerland, over a 13 year period. Using Chi-square tests, patient age ( versus ≥ 60 years), gender, family history of colon polyps or cancer, presence of anemia, polyp size ( versus 5-10mm versus >10mm), polyp location (left-sided including splenic flexure versus rightsided), and total number of polyps (≤ versus >2) were assessed regarding a correlation with insignificant or significant polyp histology (villous component or severe dysplasia or carcinoma). Predictive values (PV) of these parameters for the polyp histology were calculated. Results: Insignificant polyp histology correlated with patient age 2 (p 2 polyps (36.9% versus 19.5%; p 10mm, leftsided location, nor total number of polyps ≤2 demonstrated a PV >75% for the presence of a significant adenoma. Conclusion: A diminutive (