Colon Polyps and Cancer

Screening for colorectal neoplasia still is the best method of reducing the mortality due to colorectal cancer, and it is to be hoped that fecal occult blood test programs will expand in the near future and be combined with appropriate endoscopy. There are substantial problems with compliance in large programs with occult blood tests as well as endoscopy. Colonography and DNA testing in feces are not yet suitable for population screening. Diagnostic strategies in symptomatic patients are becoming more selective, in the hope of avoiding many superfluous examinations without increasing the risk of missing cancers. New results have confirmed the preventive effect of long-term aspirin use on adenoma recurrence, but the most cost-effective dosage is not clear; the mechanism of action is also uncertain, but seems to involve cyclooxygenase-2. The risk of adenomas does not appear to be associated with low consumption of folate, but with low intake of fiber. A number of biomarkers have been evaluated in polyp patients, but so far surveillance is still based on endoscopic experience, which is less than optimal. Attempts have been made to restrict the number of surveillance endoscopies and reduce the pathologist’s workload. The place of argon plasma coagulation has been clearly defined in connection with piecemeal removal of large sessile adenomas.
Advances have been achieved in surgery and radiotherapy for rectal cancer, and acute surgery for colonic cancer with severe obstruction will be less common after the introduction of the metal stent.

References

• 1 Scholefield J H, Moss S, Sufi F. et al . Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial.  Gut. 2002;  50 840-844
• 2 Little J, Owen R W, Fernandez F. et al . Asymptomatic colorectal neoplasia and fecal characteristics: a case-control study of subjects participating in the Nottingham Fecal Occult Blood Screening Trial.  Dis Colon Rectum. 2002;  45 1233-1241
• 3 Starkey B J. Screening for colorectal cancer.  Ann Clin Biochem. 2002;  39 351-365
• 4 Young G P, St John J B, Winawer S J. et al . Choice of fecal occult blood tests for colorectal cancer screening: recommendations based on performance characteristics in population studies. A WHO and OMED Report.  Am J Gastroenterol. 2002;  97 2499-2507
• 5 Zhang B, Nakama H, Fattah A SMA. et al . Lower specificity of occult-blood test on stool collected by digital rectal examination.  Hepatogastroenterology. 2002;  49 165-167
• 6 Fludger S, Turner A M, Harvey R F. et al . Controlled prospective study of faecal occult blood screening for colorectal cancer in Bury, black pudding capital of the world.  BMJ. 2002;  325 1444-1445
• 7 Rasmussen M, Fenger C, Kronborg O. Diagnostic yield in a biennial Hemoccult-II screening program compared to a once-only screening with flexible sigmoidoscopy and Hemoccult-II.  Scand J Gastroenterol. 2003;  38 114-118
• 8 Segnan N, Senore C, Andreoni B. et al . Baseline findings of the Italian multicenter randomized controlled trial of ”once-only sigmoidoscopy” - SCORE.  J Natl Cancer Inst. 2002;  94 1763-1772
• 9 Blom J, Lidén A, Jeppsson B. et al . Compliance and findings in a Swedish population screened for colorectal cancer with sigmoidoscopy.  Eur J Surg Oncol. 2002;  28 827-831
• 10 Santavirta J. Screening sigmoidoscopy in persons aged 60 years.  Colorectal Dis. 2002;  4 184-188
• 11 Larsen I K, Grotmol T, Bretthauer M. et al . Continuous evaluation of patient satisfaction in endoscopy centres.  Scand J Gastroenterol. 2002;  37 850-855
• 12 Bretthauer M, Hoff G, Thiis-Evensen E. et al . Use of a disposable sheath system for flexible sigmoidoscopy in decentralized colorectal cancer screening.  Endoscopy. 2002;  34 814-818
• 13 Levin T R, Conell C, Shapiro J A. et al . Complications of screening flexible sigmoidoscopy.  Gastroenterology. 2002;  123 1786-1792
• 14 Cappel W H, de Vos tot Nederveen, Nagengast F M, Griffioen G G. et al . Surveillance for hereditary nonpolyposis colorectal cancer: a long-term study on 114 families.  Dis Colon Rectum. 2002;  45 1588-1594
• 15 Zubarik R, Ganguly E, Benway D. et al . Procedure-related abdominal discomfort in patients undergoing colorectal cancer screening: a comparison of colonoscopy and flexible sigmoidoscopy.  Am J Gastroenterol. 2002;  97 3056-3061
• 16 Cucino C, Buchner A M, Sonnenberg A. Continued rightward shift of colorectal cancer.  Dis Colon Rectum. 2002;  45 1035-1040
• 17 Mensink P BF, Kolkman J J, van Baarlen J. et al . Change in anatomic distribution and incidence of colorectal carcinoma over a period of 15 years: clinical considerations.  Dis Colon Rectum. 2002;  45 1393-1396
• 18 Nelson D B, McQuaid K R, Bond J H. et al . Procedural success and complications of large-scale screening colonoscopy.  Gastrointest Endosc. 2002;  55 307-314
• 19 Imperiale T F, Wagner D R, Lin C Y. et al . Results of screening colonoscopy among persons 40 to 49 years of age.  N Engl J Med. 2002;  346 1781-1785
• 20 Pignone M, Rich M, Teutsch S M. et al . Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force.  Ann Intern Med. 2002;  137 132-141
• 21 Ko C W, Kreuter W, Baldwin L M. Effect of Medicare coverage on use of invasive colorectal cancer screening tests.  Arch Intern Med. 2002;  162 2581-2586
• 22 Frattini M, Balestra D, Pilotti S. et al . Tumor location and detection of k-ras mutations in stool from colorectal cancer patients.  J Natl Cancer Inst. 2003;  95 72-73
• 23 Kiran P R, Glass R E. Duration of symptoms and spread of colorectal cancer: a short history does not mean early disease.  Ann R Coll Surg Engl. 2002;  84 381-385
• 24 Fernandez E, Porta M, Malats N. et al . Symptom-to-diagnosis interval and survival in cancers of the digestive tract.  Dig Dis Sci. 2002;  47 2434-2440
• 25 Selvachandran S N, Hodder R J, Ballal M S. et al . Prediction of colorectal cancer by a patient consultation questionnaire and scoring system: a prospective study.  Lancet. 2002;  360 278-283
• 26 Eckardt V F, Schmitt T, Kanzler G. et al . Does scant hematochezia necessitate the performance of total colonoscopy?.  Endoscopy. 2002;  34 599-603
• 27 Arumugam P J, Joseph A, Sweerts M. et al . Severe dysplastic lesions in the colon: how aggressive should we be?.  Colorectal Disease. 2002;  4 345-347
• 28 Burton S, Eddy B, Li W Y. Reliability of preoperative biopsies in the histological grading of colorectal adenocarcinomas.  Ann R Coll Surg Engl. 2003;  85 23-25
• 29 Keller R, Winde G, Terpe H J. et al . Fluorescence endoscopy using a fluorescein-labeled monoclonal antibody against carcinoembryonic antigen in patients with colorectal carcinoma and adenoma.  Endoscopy. 2002;  34 801-807
• 30 Baron J A, Cole B F, Sandler R S. et al . A randomized trial of aspirin to prevent colorectal adenomas.  N Engl J Med. 2003;  348 891-899
• 31 Sandler R S, Halabi S, Baron J A. et al . A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer.  N Engl J Med. 2003;  348 883-890
• 32 Voskuil D W, Kampman E, Grubben M JAL. et al . Meat consumption and meat preparation in relation to colorectal adenomas among sporadic and HNPCC family patients in the Netherlands.  Eur J Cancer. 2002;  38 2300-2308
• 33 Chappel K S, Scott N, Path M RC. et al . Analysis of cyclooxygenase expression in human colorectal adenomas.  Dis Colon Rectum. 2002;  45 1316-1324
• 34 Flood A, Caprario L, Chaterjee N. et al . Folate, methionine, alcohol, and colorectal cancer in a prospective study of women in the United States.  Cancer Causes Control. 2002;  13 551-561
• 35 Peters U, Sinha R, Chatterjee N. et al . Dietary fiber and colorectal adenoma in a colorectal cancer early detection programme.  Lancet. 2003;  361 1491-1495
• 36 Bingham S A, Day N E, Luben R. et al . Dietary fiber in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study.  Lancet. 2003;  361 1496-1501
• 37 Torlakovic E, Skovlund E, Snover D C. et al . Morphologic reappraisal of serrated colorectal polyps.  Am J Surg Pathol. 2003;  27 65-81
• 38 Kanamaru T, Tanaka K I, Kotani J. et al . Telomerase activity and hTERT mRNA in development and progression of adenoma to colorectal cancer.  Int J Mol Med. 2002;  10 205-210
• 39 Freitas D, Goulão M H, Camacho E. et al . Clinical relevance of proliferation biomarkers and P53 expression in rectal mucosa and sporadic colonic adenomas: a prospective study.  Hepatogastroenterology. 2002;  49 1269-1274
• 40 Nusko G, Mansmann U, Kirschner T. et al . Risk related surveillance following colorectal polypectomy.  Gut. 2002;  51 424-428
• 41 Atkin W S, Saunders B P. Surveillance guidelines after removal of colorectal adenomatous polyps. British Society for Gastroenterology, Association of Coloproctology for Great Britain and Ireland.  Gut. 2002;  51 (Suppl 5) 6-9
• 42 Kronborg O. Screening for colorectal cancer.  Scand J Surg. 2003;  92 20-24
• 43 Konishi K, Kaneko K, Kurahashi T. et al . A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: a prospective study.  Gastrointest Endosc. 2003;  57 48-53
• 44 Parikshak M, Pawlak S E, Eggenberger J C. et al . The role of endoscopic colon surveillance in the transplant population.  Dis Colon Rectum. 2002;  45 1655-1660
• 45 Regula J, Wronska E, Polkowski M. et al . Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study.  Endoscopy. 2003;  35 212-218
• 46 Brooker J C, Saunders B P, Shah S G. et al . Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.  Gastrointest Endosc. 2002;  55 371-375
• 47 Dorudi S, Steele R JC, McArdle C S. Surgery for colorectal cancer.  Br Med Bull. 2002;  64 101-118
• 48 Keymling M. Colorectal stenting.  Endoscopy. 2003;  35 234-238
• 49 Brenner H. Long-term survival rates of cancer patients achieved by the end of the 20th century: a period of analysis.  Lancet. 2002;  360 1131-1135