DOCSLIB.ORG

Surveillance Colonoscopy in Prior Polyps/IBD/Inherited Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Surveillance Colonoscopy in Prior Polyps/IBD/Inherited Disorders Surveillance colonoscopy in: Prior polyps/IBD/Inherited disorders AshutoshAshutosh Barve,Barve, M.D.,M.D., Ph.D.Ph.D. Gastroenterology/HepatologyGastroenterology/Hepatology FellowFellow UniversityUniversity ofof LouisvilleLouisville University of Louisville Colonoscopy AsymptomaticAsymptomatic SymptomaticSymptomatic ScreeningScreening SurveillanceSurveillance University of Louisville Screening ScreeningScreening refersrefers toto examinationsexaminations thatthat areare performedperformed inin anan asymptomaticasymptomatic populationpopulation inin anan attemptattempt toto identifyidentify preclinicalpreclinical diseasedisease andand alteralter itsits naturalnatural historyhistory soso asas toto reducereduce morbiditymorbidity andand mortalitymortality University of Louisville GastroenterologyGastroenterology-- 20032003 (Vol.(Vol. 124,124, IssueIssue 2:2: 18651865--18711871 )) ColorectalColorectal cancercancer screeningscreening andand surveillance:surveillance: ClinicalClinical guidelinesguidelines andand rationalerationale——UpdateUpdate basedbased onon newnew evidenceevidence SidneySidney Winawer,Winawer, RobertRobert Fletcher,Fletcher, DouglasDouglas Rex,Rex, JohnJohn Bond,Bond, RandallRandall Burt,Burt, JosephJoseph FerrucciFerrucci ,, TheodoreTheodore Ganiats,Ganiats, TheodoreTheodore Levin,Levin, StevenSteven Woolf,Woolf, DavidDavid Johnson,Johnson, LynneLynne Kirk,Kirk, ScottScott Litin,Litin, CliffordClifford SimmangSimmang forfor thethe U.S.U.S. MultisocietyMultisociety TaskTask ForceForce onon UniversityColorectalColorectal of CancerCancer Louisville Screening algorithm University of Louisville Gastroenterology- 2003 (Vol. 124, Issue 2: 1865-1871) Surveillance SurveillanceSurveillance isis thethe examinationsexaminations thatthat areare performedperformed inin aa patientpatient withwith knownknown previousprevious diseasedisease inin anan attemptattempt toto modifymodify andand addressaddress futurefuture riskrisk University of Louisville Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, Smith RA, Lieberman DA, Burt RW, Levin TR, Bond JH, Brooks D, Byers T, Hyman N, Kirk L, Thorson A, Simmang C, Johnson D, Rex DK University of Louisville Why new guidelines? LargeLarge numbernumber ofof patientspatients withwith adenomasadenomas identifiedidentified SurveillanceSurveillance isis aa hugehuge burdenburden onon medicalmedical resourcesresources NeedNeed forfor increasedincreased efficiencyefficiency ofof surveillancesurveillance colonoscopycolonoscopy DecreaseDecrease cost,cost, riskrisk andand overuseoveruse ofof resourcesresources University of Louisville Differences From Prior Postpolypectomy Guidelines 1.1. IdentifyIdentify predictorspredictors ofof subsequentsubsequent advancedadvanced adenomasadenomas andand cancerscancers toto stratifystratify patientspatients intointo lowerlower-- andand higherhigher--riskrisk groupsgroups 2.2. RiskRisk stratificationstratification usedused toto encourageencourage aa shiftshift fromfrom intenseintense surveillancesurveillance toto surveillancesurveillance basedbased onon riskrisk –– freefree upup endoscopicendoscopic resourcesresources forfor screening,screening, diagnosis,diagnosis, andand appropriateappropriate surveillancesurveillance University of Louisville Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Differences From Prior Postpolypectomy Guidelines 3.3. HighHigh--qualityquality baselinebaseline colonoscopycolonoscopy isis emphasizedemphasized 4.4. CompletenessCompleteness ofof polypectomypolypectomy atat baselinebaseline isis emphasizedemphasized –– particularlyparticularly inin thethe settingsetting ofof piecemealpiecemeal removalremoval ofof largelarge sessilesessile polypspolyps University of Louisville Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Differences From Prior Postpolypectomy Guidelines 5.5. FollowFollow--upup surveillancesurveillance ofof hyperplastichyperplastic polypspolyps isis discourageddiscouraged (except(except inin hyperplastichyperplastic polyposis)polyposis) 6.6. TheThe importanceimportance ofof increasingincreasing awarenessawareness ofof hyperplastichyperplastic polyposispolyposis isis discusseddiscussed 7.7. TheThe useuse ofof FOBTFOBT duringduring surveillancesurveillance isis discourageddiscouraged atat present,present, butbut requiresrequires furtherfurther studystudy University(low(low PPV)PPV) of Louisville Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Differences From Prior Postpolypectomy Guidelines 8.8. FollowFollow--upup intervalsintervals afterafter removalremoval ofof 11 oror 22 smallsmall (<(< 11 cm)cm) adenomasadenomas havehave beenbeen lengthenedlengthened (5(5––1010 yearsyears oror averageaverage--riskrisk screeningscreening options)options) 9.9. EvolvingEvolving technologiestechnologies suchsuch asas chromoendoscopy,chromoendoscopy, magnificationmagnification endoscopy,endoscopy, andand CTCT colonographycolonography (virtual(virtual colonoscopy)colonoscopy) areare notnot yetyet establishedestablished asas surveillancesurveillance modalitiesmodalities University of Louisville Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Guideline endorsed by: ColorectalColorectal CancerCancer AdvisoryAdvisory CommitteeCommittee ofof thethe AmericanAmerican CancerCancer SocietySociety AmericanAmerican CollegeCollege ofof GastroenterologyGastroenterology AmericanAmerican GastroenterologicalGastroenterological AssociationAssociation AmericanAmerican SocietySociety forfor GastrointestinalGastrointestinal EndoscopyEndoscopy University of Louisville Literature reviewed ColonoscopyColonoscopy studiesstudies addressingaddressing relationshiprelationship betweenbetween baselinebaseline findingsfindings andand detectiondetection ofof advancedadvanced adenomaadenoma duringduring followfollow upup SigmoidoscopySigmoidoscopy studiesstudies withwith largelarge cohortscohorts andand followfollow--upup periodsperiods longerlonger thanthan 1010 yrsyrs addressingaddressing thethe relationshiprelationship betweenbetween baselinebaseline findingsfindings andand detectiondetection ofof advancedadvanced adenomasadenomas atat followfollow upup University 1515 studiesstudies werewere identifiedidentified of Louisville Advanced Adenoma (AA) SizedSized 1.01.0 cmcm oror largerlarger OROR AnyAny villousvillous componentcomponent (nontubular)(nontubular) OROR HighHigh gradegrade dysplasiadysplasia OROR InvasiveInvasive cancercancer SurrogateSurrogate biologicalbiological indicatorindicator ofof cancercancer riskrisk University of Louisville High-quality colonoscopy ReachesReaches cecumcecum LittleLittle fecalfecal residueresidue (good(good prep)prep) MinimumMinimum timetime ofof withdrawalwithdrawal fromfrom thethe cecumcecum ofof 66--1010 minutesminutes MeticulousMeticulous removalremoval ofof largelarge sessilesessile polypspolyps –– particularlyparticularly ifif piecemealpiecemeal polypectomypolypectomy usedused (repeat(repeat examexam ifif needed)needed) CriticalCritical forfor effectivelyeffectively reducingreducing coloncolon cancercancer riskrisk andand planningplanning appropriateappropriate Universitysurveillancesurveillance intervalsintervals of Louisville Predictors of Subsequent Advanced Adenomas MultiplicityMultiplicity SizeSize HistologyHistology LocationLocation OtherOther riskrisk factorsfactors –– age,age, sex,sex, historyhistory ofof polyps,polyps, familyfamily historyhistory ofof CRCCRC University of Louisville Multiplicity IncreasedIncreased numbernumber ofof adenomasadenomas atat baselinebaseline hashas beenbeen shownshown toto predictpredict subsequentsubsequent detectiondetection ofof advancedadvanced adenomaadenoma NationalNational PolypPolyp StudyStudy (RCT)(RCT) EuropeanEuropean fiberfiber andand calciumcalcium studystudy (RCT)(RCT) WheatWheat branbran studystudy (Martinez(Martinez etet al)al) (RCT)(RCT) AtkinAtkin etet alal (observational(observational cohort)cohort) University NoshirwaniNoshirwani etet alal (observational(observationalof Louisville cohort)cohort) Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Size LargerLarger adenomaadenoma sizesize waswas relatedrelated toto increasedincreased riskrisk forfor subsequentsubsequent AAAA oror CRCCRC WheatWheat branbran studystudy (RCT)(RCT) –– sizesize largerlarger thanthan 11 cmcm usedused 44 otherother RCTRCT diddid notnot findfind sizesize toto anan independentindependent predictorpredictor 77 outout ofof 88 observationalobservational cohortcohort studiesstudies showedshowed sizesize predictedpredicted futurefuture AAAA oror CRCCRC University of Louisville Gastroenterology- 2006 (Vol. 130, Issue 6: 1872-1885) Histology Overall,Overall, presencepresence ofof villousvillous componentcomponent and/orand/or highhigh gradegrade dysplasiadysplasia correlatedcorrelated withwith increasedincreased riskrisk ofof AAAA oror CRCCRC NoneNone ofof thethe RCTRCT showedshowed histologichistologic typetype ofof adenomaadenoma atat baselinebaseline toto bebe aa significantsignificant predictorpredictor ofof advancedadvanced neoplasianeoplasia ButBut severalseveral ofof thethe observationalobservational cohortcohort studiesstudies showedshowed thatthat advancedadvanced histologyhistology conferredconferred increasedincreased riskrisk ofof AAAA University of Louisville Location ProximalProximal
Load more

Recommended publications
  • Comparing Right Colon Adenoma and Hyperplastic Polyp
    Title: Comparing right colon adenoma and hyperplastic polyp miss rate in colonoscopy using water exchange and carbon dioxide insufflation: A prospective multicenter randomized controlled trial NCT Number: 03845933 Unique Protocol ID: EGH-2019 Date: Feb 16, 2019 頁 1 / 10 INTRODUCTION Colonoscopy is currently regarded as the gold standard to detect and prevent colorectal cancer (CRC) [1]. It estimated to prevent about 76%-90% of CRC [2], but post-colonoscopy CRCs (PCCRCs) still occur. Recent case-control studies consistently demonstrated that protection by colonoscopy against right-sided colon cancer, ranging from 40% to 60%, was lower than the 80% protection attained in the left colon [3-5]. Of all PCCRCs, 58% were attributed to lesions missed during examination [6]. In a systematic review of tandem colonoscopy studies, a 22% pooled miss-rate for all polyps was reported [7]. Colonoscopy maneuvers helping to reduce miss-rate for all polyps, particularly in the right colon, have the potential to decrease the incidence of PCCRCs. Water exchange (WE) colonoscopy is characterized by the gasless insertion to the cecum in clear water and maximizing cleanliness during insertion. WE colonoscopy has been shown to improve the overall adenoma detection rate (ADR), compared to air insufflation colonoscopy, in many prospective randomized controlled trials (RCTs) [8-13]. WE colonoscopy also has been shown to improve right colon ADR in RCTs [10-12] and meta-analyses [14,15]. In a pooled data from two multisite RCTs, WE also significantly increases right colon combined advanced and sessile serrated ADR as compared to air insufflation colonoscopy [16]. Decreased multitasking-related distraction from cleaning maneuvers has been the most recently identified explanation for the increase in ADR by WE [17].
    [Show full text]
  • Molecular Classification of Patients with Unexplained Hamartomatous and Hyperplastic Polyposis
    ORIGINAL CONTRIBUTION Molecular Classification of Patients With Unexplained Hamartomatous and Hyperplastic Polyposis Kevin Sweet, MS, CGC Context Significant proportions of patients with hamartomatous polyposis or with Joseph Willis, MD hyperplastic/mixed polyposis remain without specific clinical and molecular diagnosis Xiao-Ping Zhou, MD, PhD or present atypically. Assigning a syndromic diagnosis is important because it guides management, especially surveillance and prophylactic surgery. Carol Gallione, PhD Objective To systematically classify patients with unexplained hamartomatous or hy- Takeshi Sawada, MD, PhD perplastic/mixed polyposis by extensive molecular analysis in the context of central Pia Alhopuro, MD rereview of histopathology results. Sok Kean Khoo, PhD Design, Setting, and Patients Prospective, referral-based study of 49 unrelated patients from outside institutions (n=28) and at a comprehensive cancer center (n=21), Attila Patocs, MD, PhD conducted from May 2, 2002, until December 15, 2004. Germline analysis of PTEN, Cossette Martin, PhD BMPR1A, STK11 (sequence, deletion), SMAD4, and ENG (sequence), specific exon screen- Scott Bridgeman, BSc ing of BRAF, MYH, and BHD, and rereview of polyp histology results were performed. John Heinz, PhD Main Outcome Measures Molecular, clinical, and histopathological findings in pa- tients with unexplained polyposis. Robert Pilarski, MS, CGC Results Of the 49 patients, 11 (22%) had germline mutations. Of 14 patients with Rainer Lehtonen, BSc juvenile polyposis, 2 with early-onset disease had mutations in ENG, encoding endo- Thomas W. Prior, PhD glin, previously only associated with hereditary hemorrhagic telangiectasia; 1 had hemi- zygous deletion encompassing PTEN and BMPR1A; and 1 had an SMAD4 mutation. Thierry Frebourg, MD, PhD One individual previously classified with Peutz-Jeghers syndrome had a PTEN dele- Bin Tean Teh, MD, PhD tion.
    [Show full text]
  • Birt-Hogg-Dubé Syndrome with Simultaneous Hyperplastic
    Balsamo et al. BMC Medical Genetics (2020) 21:52 https://doi.org/10.1186/s12881-020-0991-8 CASE REPORT Open Access Birt-Hogg-Dubé syndrome with simultaneous hyperplastic polyposis of the gastrointestinal tract: case report and review of the literature Flávia Balsamo1, Pedro Augusto Soffner Cardoso1, Sergio Aparecido do Amaral Junior1, Therésè Rachell Theodoro2, Flavia de Sousa Gehrke1, Maria Aparecida da Silva Pinhal2, Bianca Bianco3* and Jaques Waisberg1 Abstract Background: Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant genodermatosis characterized by benign growth of the hair follicles, the presence of pulmonary cysts, spontaneous pneumothorax, and bilateral renal tumors that are usually hybrid oncocytic or multifocal chromophobe renal cell carcinoma. The diagnosis is confirmed by the presence of a pathogenic variant in the tumor suppressor folliculin (FLCN) gene mapped at 17p11.2. Although the dermatological lesions typical of BHDS are benign and only cause aesthetic concerns, and the pulmonary manifestations are controllable, the greater tendency of patients with this syndrome to present benign or malignant renal tumors, often bilateral and multifocal, makes the diagnosis of this syndrome important for the prognosis of the patients. The objective was to report the case of a patient with BHDS, without pulmonary manifestations and with hyperplastic polyposis of the gastrointestinal tract, and to perform a literature review. Case presentation: A 60-year-old man complained of abdominal pain and diarrhoea for 2 months. Physical examination was normal except for the presence of normochromic papules in the frontal region of the face associated with hyperkeratotic and hyperchromic papules in the dorsal region. The excisional biopsies of the skin lesions indicated trichodiscomas.
    [Show full text]
  • Squamous Morules (Microcarcinoids) in Gastroesophageal Polyps; a Mimicker of Invasive Carcinoma Safia N Salaria1* and Elizabeth Montgomery2
    Salaria and Montgomery. Int J Pathol Clin Res 2015, 1:1 ISSN: 2469-5807 International Journal of Pathology and Clinical Research Review Article: Open Access Squamous Morules (Microcarcinoids) in Gastroesophageal Polyps; a Mimicker of Invasive Carcinoma Safia N Salaria1* and Elizabeth Montgomery2 1Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, USA 2Department of Pathology, The Johns Hopkins University School of Medicine, USA *Corresponding author: Safia N Salaria, MD, 1161 21st Avenue South, Medical Center North-C2104A, Nashville, TN 37232-2561, USA, Tel: 615-343-1949, Fax 615-936-7040, E-mail: [email protected] Abstract Introduction Colorectal lesions termed squamous morules or microcarcinoids Squamous morules and microcarcinoids (MC) are two among display predominantly squamous and variable endocrine numerous terms used to characterize lesions with varying amounts differentiation and are often found in colorectal adenomas with of squamous and neuroendocrine features. The literature describes high grade dysplasia thus mimicking invasion. Herein, we describe numerous associations of these lesions with dysplastic and invasive histopathologic, immunohistochemical classification and clinical processes distributed throughout various organs [1]. correlation of analogous lesions in the esophagus and stomach. We identified five cases (3 men, 2 women) from November More recently squamous morules have been described in 2004-March 2013 of gastric and gastroesophageal polyps with association with large colorectal polyps [2]. In the colon these lesions squamous morules. Four of the patients were white. The median have a predilection for high-risk adenomas, villous morphology age was 70 years (range 59-85 years). Two patients presented with and those with high grade dysplasia [2].
    [Show full text]
  • Appendiceal Hyperplastic Polyp: Case Report Apandikste Hiperplastik Polip: Olgu Sunumu
    DOI: 10.4274/tjcd.59320 Turk J Colorectal Dis 2017;27:155-157 CASE REPORT Appendiceal Hyperplastic Polyp: Case Report Apandikste Hiperplastik Polip: Olgu Sunumu Barış Tırman, İsmail Alper Tarım, Ayfer Kamalı Polat Ondokuz Mayıs University Faculty of Medicine, Department of General Surgery, Samsun, Turkey ABSTRACT Appendiceal hyperplastic polyps are morphologically analogous to those seen in the colorectum, but are very rare. In this case report, a 62-year- old woman with a 72-hour history of severe abdominal pain, nausea, vomiting, and anorexia presented to our clinic. On physical examination she was tender to palpation and there was direct rebound tenderness and involuntary guarding in the right lower quadrant. The patient was taken for emergency surgery with a diagnosis of acute abdomen. Appendectomy was performed after exploration findings revealed acute appendicitis. Pathological examination reported hyperplastic polyp of the appendix. A total colonoscopic examination was performed due to the association between appendiceal hyperplastic polyps and adenocarcinoma of the large bowel. Keywords: Appendicitis, serrated polyps, appendiceal hiperplastic polyps ÖZ Apandiks yerleşimli hiperplastik polipler kolorektal olanlara morfolojik açıdan benzerler, ancak nadir olarak görülmektedir. Bu olgu sunumunda 3 gündür olan karın ağrısı, bulantı, kusma, iştahsızlık şikayetleri ile merkezimize başvuran 62 yaşındaki kadın hastaya, fizik muayenesinde batında hassasiyet, sağ alt kadranda, rebound ve defans bulguları olması nedeniyle akut batın tanısıyla
    [Show full text]
  • High Frequency of K-Ras Mutations in Human Colorectal Hyperplastic Polyps Gut: First Published As 10.1136/Gut.40.5.660 on 1 May 1997
    660 Gut 1997; 40: 660-663 High frequency of K-ras mutations in human colorectal hyperplastic polyps Gut: first published as 10.1136/gut.40.5.660 on 1 May 1997. Downloaded from K Otori, Y Oda, K Sugiyama, T Hasebe, K Mukai, T Fujii, H Tajiri, S Yoshida, S Fukushima, H Esumi Abstract plastic polyps, we evaluated K-ras mutations Background-Hyperplastic polyps are and nuclear accumulation of p53 protein, common benign colorectal polyps, and are which are common in colorectal adenomas and thought to have little association with ma- adenocarcinomas. lignant tumours in the colorectum. How- ever, several reports suggest that some hyperplastic polyps may develop into Methods colorectal neoplasms. Aim-To clarify genetic alterations in PATIENTS AND SPECIMENS colorectal hyperplastic polyps. Twenty eight colorectal epithelial polyps were Methods-Twenty eight colorectal polyps resected from patients undergoing colon- having serrated components were re- oscopy during routine clinical practice at the sected from patients endoscopically. The National Cancer Center Hospital East from K-ras gene mutations in codons 12 and 13 1992 to 1995. All specimens were fixed with were analysed by PCR-RFLP. Intra- 10% buffered formalin. The specimens were nuclear p53 protein was immunostained stained with Carszzi's haematoxylin for light by the avidin-biotin complex method. stereomicroscopy. The pit patterns were classi- Results-A mutation of the K-ras gene fied according to Kudo's classification,'2 and was detected in nine (47%) of 19 hyper- then embedded in paraffin wax. Each specimen plastic polyps, and five (56%) of nine was cut into 3 ,u.m sections, and stained with adenomas.
    [Show full text]
  • 急件 地 址： 100 台北郵政 84-310 信箱 日 期： 110 年 8 月 2 日 編 號： 癌登第 110003 號 收文者： 所有申報醫院 副本收文者：衛生福利部國民健康署、台灣癌症登記學會、資拓宏宇國際股份 有限公司
    台 灣 癌 症 登 記 中 心 通 知 發件人： 台灣癌症登記中心 電 話： 02-2341-6012 傳 真： 02-2351-1733 急件 地 址： 100 台北郵政 84-310 信箱 日 期： 110 年 8 月 2 日 編 號： 癌登第 110003 號 收文者： 所有申報醫院 副本收文者：衛生福利部國民健康署、台灣癌症登記學會、資拓宏宇國際股份 有限公司 主 題： 因應癌症登記實務作業之需求，請貴院依說明段辦理 急件 請檢閱 □請加註 □請回覆 □請回收 一、 本案係依衛生福利部國民健康署委託「台灣癌症登記工作計畫」辦理。 二、 因衛生福利部所屬資訊安全系統升級，使得近期「癌症篩檢與追蹤管理 資訊整合系統」中之癌症登記申報平台若單次上傳筆數過多而逾時，易 造成上傳失敗。故建議由登入系統開始到點選進行勘誤邏輯後產出勘誤 說明，整體執行時間請於 10 分鐘內完成；萬一過去經常申報筆數無法 順利完成上傳者，請以少量多批方式(約每批次 300-1000 筆內，此為大 部分醫院成功上傳筆數範圍)來進行申報，謝謝您的配合；若造成不便， 請見諒! 三、 依據 2021 年出版 WHO Classification of Tumours 第 5 版 Thoracic tumors，彙整最新病理組織型態編碼表(詳見附件)，適用於 2021 診斷年 以後個案。 台灣癌症登記中心 Taiwan Cancer Registry 附件 Updates to the International Classification of Diseases for Oncology, third edition (ICD-O-3) 2021.8.2 更新 Status ICD-O-3 Term New term 8010/3 Urachal carcinoma (C65.9, C66.9, C67._, C68._) New term 8013/3 Combined large cell neuroendocrine carcinoma (C57.9) Carcinoma, poorly differentiated, NOS (C51._) New term 8020/3 Poorly differentiated urothelial carcinoma (C65.9, C66.9, C67._, C68._) Anaplastic thyroid carcinoma (C73.9) New code and term 8023/3 NUT carcinoma (C30.0, C31._, C34._, C37.9) New term 8033/3 Carcinoma with sarcomatoid component (C18._, C19.9, C20.9) New term 8035/3 Squamous cell carcinoma with osteoclast-like giant cells (C44._) New term 8041/3 High‐grade neuroendocrine carcinoma (C54._, C55.9) New term 8041/3 Neuroendocrine carcinoma, poorly differentiated (C50._) New term 8041/3 Small cell carcinoma, pulmonary type (C56.9) Small cell carcinoma, hypercalcaemic type (C56.9) New term 8044/3 Small cell carcinoma,
    [Show full text]
  • The Genetics of Hereditary Colon Cancer
    Downloaded from genesdev.cshlp.org on October 1, 2021 - Published by Cold Spring Harbor Laboratory Press REVIEW The genetics of hereditary colon cancer Anil K. Rustgi1 Dapartment of Medicine (Gastrointestinal), Department of Genetics, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA The genetic basis of sporadic colorectal cancer has illu- families with hereditary forms of colorectal cancer. In minated our knowledge of human cancer genetics. This parallel fashion, an appreciation of the biological under- has been facilitated and catalyzed by an appreciation and pinnings of colorectal cancer has been transformed deep understanding of the forms of colorectal cancer that through mouse models and delineation of molecular harbor an inherited predisposition, including familial ad- pathways that were predicated upon how these pathways enomatous polyposis (FAP), hereditary nonpolyposis operate to foster different forms of hereditary colorectal colorectal cancer (HNPCC) or Lynch syndrome, the cancer. hamartomatous polyposis syndromes, and certain other In assessing the annual cases of colorectal cancer in rare syndromes. Identification of germline mutations in the United States, it is clear that a distinction should be pivotal genes underlying the inherited forms of colorec- made for what is truly hereditary and what is in actuality tal cancer has yielded many dividends, including func- familial. The former connotes a distinct genetic basis tional dissection of critical molecular pathways that that has been defined, whereas the latter comprises an have been revealed to be important in development, cel- increased predisposition to cancer but without determi- lular homeostasis, and cancer; new approaches in che- nation, as of yet, as whether there is a hereditary basis moprevention, molecular diagnostics and genetic test- with discovery of pertinent tumor suppressor genes that ing, and therapy; and underscoring genotypic–pheno- are inactivated in the germline or whether the predispo- typic relationships.
    [Show full text]
  • Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: a Consensus Update by the US Multi-Society Task Force on Colorectal Cancer DAVID A
    GASTROENTEROLOGY 2012;143:844–857 AGA Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer DAVID A. LIEBERMAN,* DOUGLAS K. REX,‡ SIDNEY J. WINAWER,§ FRANCIS M. GIARDIELLO,ʈ DAVID A. JOHNSON,¶ and THEODORE R. LEVIN# *Oregon Health and Science University, Portland, Oregon; ‡Indiana University School of Medicine, Indianapolis, Indiana; §Memorial Sloan-Kettering Cancer Center, New York, New York; ʈJohns Hopkins University School of Medicine, Baltimore, Maryland; ¶Eastern Virginia Medical School, Norfolk, Virginia; and #Kaiser Permanente Medical Center, Walnut Creek, California Ն10 mm). They recommend that the high-risk group un- Podcast interview: www.gastro.org/gastropodcast. dergo surveillance at 1 year because of concerns about Also available on iTunes. missed lesions at baseline. US guidelines place emphasis on performing a high-quality baseline examination. In 2008, the MSTF published screening guidelines for CRC, which in- creening for colorectal cancer (CRC) in asymptomatic pa- cluded recommendations for the interval for repeat colono- Stients can reduce the incidence and mortality of CRC. In scopy after negative findings on baseline examination.5 the United States, colonoscopy has become the most com- New issues have emerged since the 2006 guideline, includ- monly used screening test. Adenomatous polyps are the most ing risk of interval CRC, proximal CRC, and the role of common neoplasm found during CRC screening. There is ev- serrated polyps in colon carcinogenesis. New evidence sug- idence that detection and removal of these cancer precursor gests that adherence to prior guidelines is poor. The task lesions may prevent many cancers and reduce mortality.1 How- force now issues an updated set of surveillance recommen- ever, patients who have adenomas are at increased risk for dations.
    [Show full text]
  • Gastrointestinal Pathology
    ANNUAL MEETING ABSTRACTS 161A Design: We performed a retrospective review of the pathology of 749 patients who negative mitotic fi gures (<10% of total mitotic cells). In 10 pulmonary grade 2 NET, 4 underwent thyroidectomy at our institution from 1/2010 to 7/2013. 297 cases with cases with distance metastasis (bone, liver) had higher PHH3 count (>10/10HPF, average chronic thyroiditis were identifi ed and 196 had either an anti-thyroglobulin or anti- 12/10HPF), raising the possibility that these tumors should be upgraded. thyroid peroxidase antibody testing done. 4 cases with malignancies other than PTC Conclusions: PHH3 is a rapid and reliable method assessing mitotic fi gures in grading were excluded. 192 cases were included, 102 had positive ATA. We compared the pulmonary and GI neuronendocrine neoplasms. fi nal histologic diagnoses according to the presence of ATA and the severity of CLI. Table 1. Mitotic count, Ki67 and PHH3 count in association with tumor grading Results: Our study demonstrated a higher rate of PTC in cases with CLT compared to PHH3/10HPF Mitotic count /10HPF Ki-67 benign thyroid disease (62% vs 38%, p<.0001). After comparing the cases according N Median P-value Median P-value Median P-value to the severity of CLI and presence of ATA, the results were not statistically signifi cant. Lung 0.001< 0.001< 0.001< G1 20 1.1 0.8 1.5 Table 1. Final diagnoses of cases with CLT, number (%) G2 10 8.5 6.2 14 With CLT Without CLT P G3 9 52 60 88 PTC 119 (62%) 170 (31%) <0.0001 GI 0.001< 0.001< 0.001< Benign thyroid 73 (38%) 387 (69%) G1 28 0.8 0.6 1.5 CLT=chronic lymphocytic thyroiditis G2 4 5.5 3.5 22.5 G3 7 22 23.5 48 Table 2.
    [Show full text]
  • DCLK1 Expression in Colorectal Polyps Increases with the Severity
    in vivo 32 : 365-371 (2018) doi:10.21873/invivo.11247 DCLK1 Expression in Colorectal Polyps Increases with the Severity of Dysplasia AKI TAKIYAMA 1, TOSHIAKI TANAKA 1, SHINSUKE KAZAMA 2, HIROSHI NAGATA 1, KAZUSHIGE KAWAI 1, KEISUKE HATA 1, KENSUKE OTANI 1, TAKESHI NISHIKAWA 1, KAZUHITO SASAKI 1, MANABU KANEKO 1, SHIGENOBU EMOTO 1, KOJI MURONO 1, HIROTOSHI TAKIYAMA 1 and HIROAKI NOZAWA 1 1Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan; 2Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan Abstract. Background: The expression of doublecortin-like (7), and colon (8-10). Previous research has postulated that kinase 1 (DCLK1) has been investigated in cancer; however DCLK1 expression is tightly associated with cancer growth, not in precancerous adenomatous polyps. Material s and epithelial-to-mesenchymal transition (EMT), and tumor Methods: Immunohistological expression of DCLK1 was metastasis (11-18). In addition, high expression of DCLK1 evaluated in various grades of adenomas, cancerous polyps, has been reported to correlate with poor prognosis in human and hyperplastic polyps in resected human tissue specimens. colorectal cancer (CRC) patients (10, 19, 20). Results: Ninety-two specimens were positive for DCLK1 and Compared to leucine-rich repeat-containing G-protein 134 were negative. Cancerous polyps showed a high DCLK1 coupled receptor 5 (LGR5) or CD133, which are known positivity rate compared to adenomas (68.4% vs. 36.8%; markers for both normal and tumor stem cells in the intestine p<0.01). The rate of DCLK1 positivity was not significantly (21, 22), DCLK1 is considered a marker of tumor stem cells, different among the three grades of adenomas (mild, although it is also expressed by normal stem cells.
    [Show full text]
  • Hyperplastic Polyp Or Sessile Serrated Lesion? the Contribution of Serial Sections to Reclassification Diana R
    Jaravaza and Rigby Diagnostic Pathology (2020) 15:140 https://doi.org/10.1186/s13000-020-01057-0 RESEARCH Open Access Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification Diana R. Jaravaza1* and Jonathan M. Rigby1,2 Abstract Background: The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections. Methods: Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed. Results: Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis. Conclusion: Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge.
    [Show full text]