RESUMEN
BACKGROUND AND STUDY AIM: Valid tissue sampling of colorectal adenomas is crucial for their management in terms of treatment and follow-up. The aim of this study was to assess the validity of a cold biopsy sample as representative for the whole polypectomy specimen, with regard to histopathological features. PATIENTS AND METHODS: As part of the Norwegian Colorectal Cancer Prevention trial, 442 participants (60% men) who fulfilled the criterion of colonoscopic recovery of adenoma that had been biopsied at flexible sigmoidoscopy, had their adenomas subsequently removed by polypectomy (snare resection) at colonoscopy. Logistic regression analysis was used to determine which variables contributed to the histopathological discrepancy between cold biopsy and polypectomy specimens. RESULTS: Among the 532 colorectal adenomas biopsied at flexible sigmoidoscopy and removed by colonoscopy, the assessment of intraepithelial neoplasia (dysplasia) status was changed in 51 adenomas (10%), and 38 (7%) of them had been underestimated at biopsy compared with polypectomy. Likewise, the assessment of villousness was changed in 45 adenomas (9%), being upgraded in 26 (6%) at polypectomy compared with biopsy. In a multivariate model, the diameter of neoplasia at polypectomy was positively associated with increased risk of the underestimation of intraepithelial neoplasia and/or villousness influencing a diagnosis of advanced colorectal neoplasia, when cold biopsy and polypectomy specimens were compared ( Ptrend=0.01). Among 56 cases of advanced neoplasia, 35 (63%) showed only low-grade intraepithelial neoplasia on biopsy. CONCLUSIONS: Biopsy-based diagnosis underestimated histopathological diagnosis in about 10% of colorectal adenomas detected by flexible sigmoidoscopy screening, but advanced neoplasia was underestimated in more than 60%. Efforts must be made to obtain polypectomy specimens to secure precise diagnosis.
Asunto(s)
Adenoma/patología , Biopsia con Aguja/métodos , Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Endoscopía/métodos , Adenoma/diagnóstico , Adenoma/cirugía , Adulto , Anciano , Estudios de Cohortes , Colectomía/métodos , Pólipos del Colon/diagnóstico , Pólipos del Colon/cirugía , Colonoscopía/métodos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/cirugía , Reacciones Falso Negativas , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Sistema de Registros , Medición de Riesgo , Sensibilidad y Especificidad , Sigmoidoscopía/métodos , Resultado del TratamientoRESUMEN
The objective of this study was to evaluate the potential beneficial effects of non-steroidal anti-inflammatory drugs (NSAIDs) and/or acetylsalicylic acid (ASA) and hormone replacement therapy (HRT) on colorectal neoplasia, and to compare their effects with those of lifestyle-related risk factors in 12 960 individuals who underwent flexible sigmoidoscopy screening examination. The association between these factors and colonic neoplasia was assessed by logistic regression analysis. NSAIDs and/or ASA intake were associated with decreased risk of distal low grade adenoma (DLGA) (adjusted odds ratio (OR) 0.80, P trend=0.02) in men. The duration of HRT was inversely related to the risk of DLGA (OR 0.89, P trend=0.08). Current smoking increased the risk of DLGA and distal advanced neoplasia (DAN) in both men (OR 2.50, P<0.01) and women (OR 2.30, P<0.01). There was a significant positive trend for increasing risk of DLGA (OR 1.16, P<0.01) and DAN (OR 1.20, P=0.02) with increasing use of alcohol among men, but not among women. Prescription of NSAIDs and/or ASA for chronic conditions may not be expected to have a substantial preventive effect on colorectal neoplasia in comparison with the adverse effect of smoking and alcohol. This may be explained by an increased risk of colorectal neoplasia for patients with conditions for which NSAIDs or ASA are being prescribed.
Asunto(s)
Adenoma/prevención & control , Quimioprevención/métodos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Estilo de Vida , Adenoma/epidemiología , Adenoma/fisiopatología , Distribución por Edad , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Estudios de Cohortes , Neoplasias Colorrectales/fisiopatología , Intervalos de Confianza , Femenino , Terapia de Reemplazo de Hormonas/métodos , Humanos , Incidencia , Modelos Logísticos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Noruega/epidemiología , Probabilidad , Medición de Riesgo , Distribución por Sexo , Sigmoidoscopía/métodos , Análisis de SupervivenciaRESUMEN
BACKGROUND: Randomized controlled trials of sufficient power testing the long-term effect of screening for colorectal neoplasia only exist for faecal occult blood testing (FOBT). There is indirect evidence that flexible sigmoidoscopy (FS) may have a greater yield. The aim of this study was to determine the diagnostic yield of screening with FS or a combination of FS and FOBT in an average-risk population in an urban and combined urban and rural population in Norway. METHODS: 20,780 men and women (1:1), aged 50-64 years, were invited for once-only screening (FS only or a combination of FS and FOBT (1:1)) by randomization from the population registry. A positive FS was defined as a finding of any neoplasia or any polyp > or = 10 mm. A positive FS or FOBT qualified for colonoscopy. RESULTS: Overall attendance was 65%. Forty-one (0.3%) cases of CRC were detected. Any adenoma was found in 2208 (17%) participants and 545 (4.2%) had high-risk adenomas. There was no difference in diagnostic yield between the FS and the FS and FOBT group regarding CRC or high-risk adenoma. Work-up load comprised 2821 colonoscopies in 2524 (20%) screenees and 10% of screenees were recommended later colonoscopy surveillance. There were no severe complications at FS, but six perforations after therapeutic colonoscopy (1:336). CONCLUSIONS: The present study bodes well for future management of a national screening programme, provided that follow-up results reflect adequate proof of a net benefit. It is highly questionable whether the addition of once-only FOBT to FS will contribute to this effect.
Asunto(s)
Adenocarcinoma/diagnóstico , Adenoma/diagnóstico , Pólipos del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Tamizaje Masivo/métodos , Sangre Oculta , Sigmoidoscopía/métodos , Adenocarcinoma/terapia , Adenoma/terapia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Colectomía/métodos , Pólipos del Colon/terapia , Neoplasias Colorrectales/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Estudios Prospectivos , Población Rural , Población UrbanaRESUMEN
BACKGROUND: Some early genetic events in the development of colorectal adenomas are known, but their relationship to in vivo growth characteristics is uncertain. This study compared in situ size changes and other clinicopathological variables with selected genetic and protein markers. METHODS: 56 adenomas (< or = 10 mm) from 39 patients were analysed for APC, CTNNB1 and K-ras mutations, allelic imbalance on 1p and 18q, microsatellite instability and immunohistochemical expression of HLA-DR, BAX, BCL-2 and Ki-67. For 42 of the adenomas, in situ growth was measured over 3 years. The total number of polyps in each patient was recorded. RESULTS: K-ras was mutated in 8/56 adenomas. None of the regressing adenomas revealed such mutations, compared to 20% in those that maintained or increased their size. Multivariate linear regression analysis showed that tumour growth was higher in females compared to males, and was even higher in the presence of a K-ras mutation. APC mutations were found in 37/56 adenomas. CTNNB1 mutations were found in 2/19 adenomas without APC mutation. Deletions of 1p were found in 12/56 adenomas and, seemingly, most frequent in patients with few tumours. The most frequently expressed protein was BAX (33/41), but neither this nor the other proteins showed associations with an in situ growth pattern. CONCLUSION: The multivariate linear regression model showed that patient gender and the presence of K-ras mutation had significant effects on tumour growth. The lack of the proliferative stimulus resulting from a K-ras mutation may contribute to the process of adenoma regression.
Asunto(s)
Proteína de la Poliposis Adenomatosa del Colon/genética , Pólipos Adenomatosos/genética , Biomarcadores de Tumor/genética , Neoplasias Colorrectales/genética , Anciano , Cromosomas Humanos Par 1/genética , Cromosomas Humanos Par 18/genética , Proteínas del Citoesqueleto/genética , Femenino , Eliminación de Gen , Regulación Neoplásica de la Expresión Génica/genética , Genes ras/genética , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Mutación Puntual/genética , Proteínas Proto-Oncogénicas/genética , Factores Sexuales , Estadística como Asunto , Transactivadores/genética , beta CateninaRESUMEN
BACKGROUND: Familial history of colorectal cancer (FHCRC) is a recognised risk factor for sporadic CRC. The relationship to the growth rate of adenomas is largely unknown. Lifestyle related factors, which may also cluster in families, are also recognised risk factors for adenomas and CRC. AIMS: To study the relationships between FHCRC and family history of other cancers (FHOC) among first degree relatives in relation to occurrence, growth, and recurrence of adenomas. PATIENTS AND METHODS: Eighty seven patients with adenomas, participating in a double blind, three year, placebo controlled, endoscopic follow up and intervention study of growth and recurrence of polyps (50% men, 50-76 years). Polyps >9 mm were removed whereas the remainder and newly discovered polyps <10 mm were left in situ for three years before removal and histological diagnosis. Data were collected by means of dietary records, interviews, and questionnaires. RESULTS: The adenoma cases with FHCRC had a fourfold higher risk of adenoma growth. In contrast, no significant association was found for adenoma recurrence. FHOC was not significantly related to increased risk of growth or recurrence. Family history showed no significant association with the risk of baseline adenoma occurrence. Adjustment for CRC risk factors, also known to cluster in families, did not alter the results. CONCLUSIONS: FHCRC seems to be a strong risk factor for adenoma growth, but not for the earlier phases of CRC development such as the initiation of adenomas.
Asunto(s)
Adenoma/genética , Neoplasias Colorrectales/genética , Salud de la Familia , Neoplasias/genética , Adenoma/epidemiología , Anciano , Estudios de Cohortes , Neoplasias Colorrectales/epidemiología , Dieta , Método Doble Ciego , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias/epidemiología , Noruega/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND AND AIMS: The purpose of this study was to evaluate the utility of easily measured clinical variables at flexible sigmoidoscopy (FS) screening that might predict a proximal advanced neoplasm (PAN). METHODS: We studied 1833 subjects with biopsy verified adenomas at FS who subsequently underwent full colonoscopy. RESULTS: A total of 387 (21%) subjects had proximal colonic neoplasms (PCN) and 85 (5%) had PAN. In univariate comparison, the risk of PAN increased more than threefold in the presence of a distal adenoma measuring either > or =10 mm in diameter or containing villous components. Multiplicity of distal adenomas, severe dysplasia, or age > or =60 years increased the risk of PAN more than twofold. In the multivariate model, the presence of a distal adenoma > or =10 mm, villousness, and multiplicity maintained their significance as predictive variables for increased risk of proximal neoplasms, whereas sex and severe dysplasia lost their significance. By recommending colonoscopy only to individuals with multiple (>1) adenomas or any high risk adenoma at FS, we would have reduced the number of colonoscopies by 1209 (66%) but would have missed 32 (38%) participants with PAN and 217 (56%) with PCN. By using a 60 cm endoscope instead of an ordinary colonoscope at FS, nine (2%) participants with advanced neoplasms, including three patients with cancer, would have been missed. CONCLUSION: The present study supports the concept of defining "any adenoma" as a positive FS, qualifying for colonoscopy. We recommend the use of an ordinary colonoscope instead of a 60 cm sigmoidoscope for FS screening examinations.
Asunto(s)
Adenoma/patología , Neoplasias Colorrectales/diagnóstico , Endoscopios Gastrointestinales , Tamizaje Masivo/métodos , Sigmoidoscopía/métodos , Colonoscopía , Neoplasias Colorrectales/patología , Femenino , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo/instrumentación , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Derivación y Consulta , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: The Norwegian Colorectal Cancer Prevention study is an ongoing flexible sigmoidoscopy (FS) screening trial for colorectal cancer. Twenty-one thousand average-risk individuals, aged 50-64 years, living in two separate areas in Norway were randomly drawn from the Population Registry and invited to once-only screening flexible sigmoidoscopy. Examinations were performed over 3 years, at 2 centres, by 8 different endoscopists, using the same type of equipment. The aim of the present study was to investigate possible differences between endoscopists in detecting individuals with polyps, adenomas and advanced lesions (adenomas with severe dysplasia and/or villous components and/or size larger than 9 mm and carcinoma) in flexible sigmoidoscopy screening. METHODS: The present trial comprises data from 8822 individuals, aged 55-64 years, who have undergone a flexible sigmoidoscopy. In the study period, all lesions detected by the different endoscopists were registered. Tissue samples were taken from all lesions detected. RESULTS: Detection rates varied significantly between endoscopists, ranging from 36.4% to 65.5% for individuals with any polyp, from 12.7% to 21.2% for any adenoma and from 2.9% to 5.0% for advanced lesions. In a multiple logistic regression model, the performing endoscopist was a strong independent predictor for detection of individuals with polyps (P < 0.001 ), adenomas (P < 0.001) and advanced lesions (P = 0.01). CONCLUSION: Detection rates for colorectal lesions vary significantly between endoscopists in colorectal cancer screening. Establishing systems for monitoring performance in screening programmes is important. Supervised training and re-certification for endoscopists with poor performance should be considered.
Asunto(s)
Pólipos del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Tamizaje Masivo , Sigmoidoscopía , Competencia Clínica , Pólipos del Colon/epidemiología , Neoplasias Colorrectales/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Variaciones Dependientes del Observador , PrevalenciaRESUMEN
BACKGROUND: A randomized sample of 14,000 men and women, aged 55-64 years, resident in the City of Oslo and Telemark County, were drawn from the population registry to be offered a flexible sigmoidoscopy (FS) screening examination. A questionnaire was designed to modify routines and evaluate patient satisfaction. METHODS: Consecutive participants (4956) were given a questionnaire immediately after the FS to be filled in and returned by mail on the following day. Participants were asked questions about service, practical issues, and the level of pain during the FS and post-examination discomfort. They were also encouraged to give their comments in free text. RESULTS: Questionnaire replies were received from 4574 (92%) out of 4956 participants. The vast majority reported to have experienced no (70%) or slight (21%) pain during the examination. Women reported pain and post-examination discomfort more often than men. Pain was also associated with age of the patient and length of bowel examined, but not with total examination time. The proportion of painless examinations varied between endoscopists from 62% to 81%. For all endoscopists collectively, this improved during the study period, irrespective of past experience, but trainees seemed to adopt the score of their masters. CONCLUSIONS: The study demonstrated that the use of feedback information in an endoscopy screening unit may be useful in improving standards, including the performance of endoscopists. It is possible that the introduction of similar feedback systems in routine endoscopy laboratories may in the long run improve the reputation of gastrointestinal endoscopy.
Asunto(s)
Instituciones de Atención Ambulatoria/normas , Dimensión del Dolor/métodos , Satisfacción del Paciente , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Sigmoidoscopía/normas , Neoplasias Colorrectales/prevención & control , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Lifestyle-related variables are suggested to play a major role in the development of colorectal cancer (CRC). Within a 3-year follow-up and intervention study with calcium and antioxidants against growth and recurrence of colorectal polyps, supplementary studies were performed in which different aspects of lifestyle were examined. Instead of polypectomy at diagnosis, polyps <9 mm were left in situ in 116 polyp patients (50-76 years, 50% men). After 3 years, all polyps were removed and subjected to histology. Two different sets of control groups were included (all controls were age- and sex-matched and proven to be free of polyps). We applied two different methods in order to assess most exposure variables. Generally, in case-control studies, the validity of the study outcomes is high if they are similar regardless of choice of controls and methods, since bias due to these choices may affect the risk estimates. In contrast, the validity of the study outcomes is low if dependent upon these choices. Our preliminary data support the theory that different factors may be of importance in different stages of the neoplastive formation, and that lifestyle-related factors are likely to play a major role in CRC development.
Asunto(s)
Adenoma/terapia , Pólipos del Colon/terapia , Estilo de Vida , Recurrencia Local de Neoplasia/prevención & control , Adenoma/epidemiología , Adenoma/etiología , Adenoma/patología , Anciano , Pólipos del Colon/etiología , Pólipos del Colon/patología , Colonoscopía , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Noruega , Factores de RiesgoRESUMEN
BACKGROUND: Alcohol has been suggested as a promoter in the development of colorectal cancer (CRC). Our aim was to examine if alcohol intake was related to the presence and growth of colorectal adenomas <9 mm followed up in situ for 3 years. METHODS: We compared 87 adenoma cases to 35 'hospital' and 35 healthy controls (age- and sex-matched and proven to be polyp-free). These cases were participating in a 3-year intervention study against growth and recurrence of polyps. Alcohol data were obtained using a structured interview (I) and a 5-day dietary record by weighing (DR). RESULTS: The median intakes of alcohol were 5 g/day (I) and 6 g/day (DR). Increasing differences were found between I and DR with increasing alcohol intake. Increasing total alcohol intake showed a tendency to an inverse association with adenoma occurrence (ORs <0.5), in contrast to the tendency of a positive association with adenoma growth (ORs >5.8). No significant beverage-specific effects were observed at this low alcohol intake level. Those with an intake of >20 g alcohol/day (18%) had several indicators of an 'unhealthy' lifestyle that may also be independently associated with adenomas, and even CRC. CONCLUSION: A very low intake of alcohol (<5 g/day) did not increase the risk of presence and of growth of adenomas followed-up in situ for 3 years, but we cannot exclude that an increased intake may increase the risk of adenoma growth.
Asunto(s)
Adenoma/etiología , Consumo de Bebidas Alcohólicas/efectos adversos , Bebidas Alcohólicas/efectos adversos , Neoplasias Colorrectales/etiología , Adenoma/patología , Anciano , Consumo de Bebidas Alcohólicas/patología , Estudios de Casos y Controles , Colonoscopía , Neoplasias Colorrectales/patología , Conducta Alimentaria , Femenino , Estudios de Seguimiento , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de TiempoRESUMEN
High intake of fat and a low intake of foods rich in antioxidants and fibre are suggested to be associated with risk of colorectal adenomas. Inconsistency may, however, be due to dietary assessment problems or differences in the identification of cases and controls. We have compared 87 adenoma cases aged 50-76 years with 35 healthy controls and 35 'hospital' controls. All the controls were matched for sex and age (+/-5 years) and proven to be free of polyps. Current habitual diet was measured by a 5-day dietary record by weighing. Regarding the intakes of vegetable fat, protein, cholesterol, vitamin A, total vitamin D, edible fats, coffee and fish and fish products, the outcomes of the analysis depended upon the source of controls. However, an increased adenoma risk compared with either set of controls related to a low consumption of vegetables, cereals, iron, vitamin C and fibre and a high intake of total fat was found. This is suggestive of substantial differences, since bias due to abdominal symptoms, the dietary records or an inappropriate choice of controls, would have affected the estimations. The findings give further strength to the role of these dietary factors in the formation of precancerous lesions in the large intestine.
Asunto(s)
Adenoma/etiología , Neoplasias Colorrectales/etiología , Dieta/efectos adversos , Adenoma/epidemiología , Anciano , Estudios de Casos y Controles , Neoplasias Colorrectales/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
UNLABELLED: Fecal calprotectin (CPT) is elevated in the majority of patients with known colorectal cancer (CRC), but the specificity is not clarified. AIM: To evaluate if a CPT test (PhiCal ELISA) was more sensitive than Hemoccult II test in detecting colorectal neoplasia, and to obtain reference values in subjects with normal colonoscopy. To evaluate a possible relation between number and extent of dysplasia of adenomas in first degree relatives of patients with CRC and the stage of the carcinoma in the index casus. Further to study the prevalence of CRC and adenomas in the first degree relatives of patients operated for CRC. METHOD: In a multicenter study, 253 first degree relatives of patients with CRC, aged 50-75 years (mean age 60 years) underwent colonoscopy after having delivered stool samples and three Hemoccult II slides. RESULTS: In 237 first degree relatives from 148 patients with CRC, polyps were found in 118 (50%). Seventy three (31%) had adenomas and 17 had adenomas > or =10 mm. Five had asymptomatic cancers. The specificity of fecal CPT for adenomas at cut off levels
Asunto(s)
Adenoma/genética , Adenoma/patología , Antifúngicos/análisis , Pólipos del Colon/patología , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Heces/química , Glicoproteínas de Membrana/análisis , Moléculas de Adhesión de Célula Nerviosa/análisis , Sangre Oculta , Anciano , Colon/patología , Colon/cirugía , Pólipos del Colon/genética , Colonoscopía , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Complejo de Antígeno L1 de Leucocito , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Recto/patología , Recto/cirugía , Valores de Referencia , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Obesity is an increasing problem for industrialized nations. The incidence of colorectal cancer has also risen during the last decades. However, information is scarce about the association between the colorectal cancer precursors, adenomatous polyps, and body composition. Our aim was to find out if body fatness is related to the presence of polyps and of growth of adenomas of < or =9 mm observed in situ over 3 yr. METHODS: Twenty-eight outpatients with colorectal polyps and 50-75 yr of age were compared with 34 sex- and age-matched (+/-5 yr) polyp-free healthy controls. The polyp patients were randomly selected from a double blind 3-yr placebo-controlled endoscopic follow-up and intervention study against growth and recurrence of polyps among 116 polyp-bearing outpatients. Triceps skinfold thickness (TSF) was measured by a Harpenden caliper and total body fat percentage (BF%) by Futrex 5000. Dietary intake was calculated in a 5-day dietary record by weighing. Demograpic data, including smoking and alcohol habits, were registered by an interview and self-administrated questionnaires. Weight and height were measured. RESULTS: TSF and BF% ranked 66% of the individuals into the same quartiles, and 34% were ranked into the adjacent quartiles. The coefficient of correlation between TSF and BF% was highly significant (r = 0.90, p < 0.01, n = 62). TSF, BF%, and body mass index (kg/m2) did not differ between polyp patients and controls in either crude or adjusted analyses. Adenoma growth was, however, highly associated with increasing levels of TSF (p = 0.004), BF% (p = 0.02), and body mass index (p = 0.006). CONCLUSIONS: Our data suggest that high body fatness is a promoter of adenoma growth. Similar results were obtained with the caliper and Futrex 5000, which lends credibility to this study. For repeated documentation, a larger study population should be investigated. To our knowledge, this is the first case-control study to investigate the relationship between body composition and growth of adenoma by follow-up in situ over 3 yr.
Asunto(s)
Adenoma/etiología , Adenoma/patología , Neoplasias Colorrectales/etiología , Neoplasias Colorrectales/patología , Obesidad/complicaciones , Anciano , Composición Corporal , Estudios de Casos y Controles , Pólipos del Colon/etiología , Pólipos del Colon/patología , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Distribución Aleatoria , Factores de Riesgo , FumarRESUMEN
BACKGROUND: Dietary factors are known to be associated with initiation and development of colorectal cancer (CRC), and also with CRC's major precursor, the colorectal polyp. In long-term intervention studies on colorectal polyps, dietary changes may therefore affect potential effects of the study intervention. OBJECTIVE: To examine potential dietary changes among polyp-patients randomly selected from a 3 y intervention study after 1 y. DESIGN AND SUBJECTS: Of 116 polyp-bearing out-patients (50% men), aged 50-76 y, who participated in the double-blind 3 y placebo-controlled endoscopic follow-up and intervention study against growth and recurrence of polyps, 30 patients were randomised (strata: sex, age and polyp size) to perform a repeated 5 day dietary record by weighing after 1 y. The patients received a daily mixture of vitamin C (150 mg), alpha-tocopherol (75 mg), beta-carotene (15 mg), selenium (101 microg) and calcium (1.6 g) or placebo (lactose) for a period of 3 y with annual colonoscopic examinations and polyps size measurements to test if the mixture was able to reduce polyp growth and recurrence. Polyps of >9 mm were removed, whereas the remainders and new discoveries of polyps <9 mm were left in situ until the end of the study. RESULTS: Twenty-nine patients agreed to perform the repeated 5 day dietary record, and 86% performed the second record within 48-58 weeks after the first record. The results showed that, with the exception of vitamin D, milk and milk products, no significant differences were found between the two records. The median value of the Spearman's correlation coefficient for energy and energy-yielding nutrients was 0.66, for vitamins and minerals 0.58, and for foods 0.58. Individual differences between the records were found for most variables, but most of these were negligible. CONCLUSION: After 1 y, no major dietary changes were found which could be associated with a changed susceptibly for malignancy, and thereby affect potential effects of the study intervention. We may thus suggest that a potential changed susceptibility towards growth and recurrence of polyps, is due to the specific intervention, and not due to other major dietary changes.
Asunto(s)
Pólipos del Colon/prevención & control , Registros de Dieta , Conducta Alimentaria , Recurrencia Local de Neoplasia/prevención & control , Anciano , Ácido Ascórbico/administración & dosificación , Calcio/administración & dosificación , Colonoscopía , Dieta , Grasas de la Dieta/administración & dosificación , Susceptibilidad a Enfermedades , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Selenio/administración & dosificación , Vitamina E/administración & dosificación , beta Caroteno/administración & dosificaciónRESUMEN
A positive association between tobacco and colorectal adenomas has been suggested. Smoking is, however, also associated with 'poor' dietary habits, which in turn may be related to risk of adenomas. It is therefore of interest to study the relationship between smoking, diet and risk of colorectal adenomas in follow-up studies. We compared 87 adenoma cases to 35 'hospital' and 35 healthy controls (all controls were age- and sex-matched and proven to be free of adenomas). Smoking data were collected by an interview and a self-administrated questionnaire with a time interval of at least one month. After 3 years of follow-up, all polyps were removed. Our data indicate that smoking is associated with adenoma prevalence, but not necessarily with size, multiplicity, growth or recurrence of adenomas. Compared to both sets of controls, cases reported to have smoked more than 15 pack-years, or who are current smokers, had a fourfold increased frequency of adenomas (odds ratios 3.6-5.9). Smokers with adenomas had dietary habits that may also be associated with adenomas. The smoking estimates remained largely unchanged even after adjustments for dietary variables in multivariate analysis. This study lends support to the theory of an initiating role of tobacco smoke in neoplasia formation.
Asunto(s)
Adenoma/epidemiología , Neoplasias Colorrectales/epidemiología , Fumar/epidemiología , Adenoma/diagnóstico , Adenoma/etiología , Distribución por Edad , Anciano , Estudios de Casos y Controles , Estudios de Cohortes , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etiología , Comorbilidad , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Probabilidad , Valores de Referencia , Factores de Riesgo , Distribución por Sexo , Fumar/efectos adversos , Estadísticas no Paramétricas , Análisis de SupervivenciaRESUMEN
Faecal bile acids (FBA) have been implicated in colon carcinogenesis. The results of case-control studies of colorectal cancer and polyp patients are, however, conflicting. The aim of this study was to examine the influence of faecal bile acids on occurrence, growth and recurrence of colorectal polyps, and to see if a mixture of calcium and antioxidants might possibly act on cancer precursors through the effect on FBA. A total of 116 polyp-bearing patients were recruited from the outpatients department. Polyps < 10 mm in diameter were left in situ and measured by annual colonoscopy for 3 years. The patients received placebo or a mixture of antioxidants and calcium carbonate, 1.6 g calcium ion daily. Faecal samples were collected annually; the first, 1 month after start of intervention, freeze dried and subjected to bile acid profile analysis. Two age and sex matched control groups were recruited (n = 35), one from healthy volunteers (healthy controls) and one from the outpatients referred for colonoscopy, with no polyps (hospital controls). Twelve of 47 patients from the healthy volunteers had polyps (healthy polyp patients). One or more adenomas were found in 93 patients. The faeces of the hospital controls had significantly higher concentrations of total and secondary bile acids than did the healthy controls. There was no difference in FBA profile between the polyp group and the hospital controls, but significantly higher concentration of total and secondary faecal bile acids in the healthy polyp patients compared with the healthy control group (P < 0.05). No increased concentration of FBA were found in the polyp patients with multiple polyps (n = 21) or previous treatment for colorectal cancer (n = 7). No associations between FBA profile and growth or recurrence of colorectal polyps were found. The polyp patients receiving active medication had higher faecal concentrations of total and secondary bile acids in the beginning of the study than at the end, in spite of a good compliance. The present study does not support bile acids as being important markers of initiation or growth of small and medium sized colorectal adenomas. In the present study the calcium and antioxidants did not seem to affect the growth or recurrence of colorectal adenomas by increased TBA excretion in the faeces.
Asunto(s)
Antioxidantes/administración & dosificación , Ácidos y Sales Biliares/análisis , Calcio/administración & dosificación , Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Ácidos y Sales Biliares/metabolismo , Pólipos del Colon/metabolismo , Pólipos del Colon/prevención & control , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/prevención & control , Heces , Humanos , RecurrenciaRESUMEN
BACKGROUND: Dietary calcium and antioxidants have been suggested as protective agents against colorectal cancer. This has been supported by animal experimental studies, case control and cohort studies. MATERIALS AND METHODS: In a prospective intervention study of colorectal adenomas, and intermediary stage in colorectal carcinogenesis, 116 polyp-bearing patients received a placebo-controlled daily mixture of beta-carotene 15 mg, vitamin C 150 mg, vitamin E 75 mg, selenium 101 microg, and calcium (1.6 g daily) as carbonate for a period of 3 years with annual colonoscopic follow-up to test if the mixture was able to reduce polyp growth or recurrence. All polyps of < 10 mm at enrollment or follow-up were left unresected until the end of the study. RESULTS: 87-91% of the patients attended the annual endoscopic follow-up investigations, and 19% of the patients dropped out of the medical intervention. The rest consumed 85% of the total amount of tablets over the 3 years. The fecal calcium concentration was 2.3-2.7 times higher in patients taking active medication compared to the placebo group. Diet registration showed that, when adding the intake of antioxidants and calcium from diet and intervention, there was a significant difference between the intake of these substances in the active and the placebo group. No difference was detected in the growth of adenomas between the active and the placebo group from year to year and for the total study period. Moreover, there was no effect on polyps of < 5 or 5-9 mm, or on polyps in the different colonic segments analyzed separately. A reduced growth of adenomas was found in patients <60 years of age taking active medication (n = 8) compared to those taking placebo (n = 6; mean difference 2.3 mm; 95% CI 0.26-4.36). There was a significantly lower number of patients free of new adenomas in the placebo group compared to those taking active medication as tested by logistic regression and Kaplan-Meier analysis (log-rank test p value 0.035). Subgroup analysis showed that only the group of patients with no family history of colorectal cancer, those with only one adenoma at inclusion, and those <65 years benefitted from the intervention medication. CONCLUSION: The study did not find an overall effect on polyp growth. Our data, however, may support a protective role of calcium and antioxidants on new adenoma formation.
Asunto(s)
Pólipos del Colon/tratamiento farmacológico , Neoplasias Colorrectales/tratamiento farmacológico , Adenoma/tratamiento farmacológico , Anciano , Antioxidantes/administración & dosificación , Antioxidantes/efectos adversos , Antioxidantes/uso terapéutico , Ácido Ascórbico/administración & dosificación , Calcio de la Dieta/administración & dosificación , Calcio de la Dieta/efectos adversos , Calcio de la Dieta/uso terapéutico , División Celular/efectos de los fármacos , Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Estreñimiento/inducido químicamente , Diarrea/inducido químicamente , Dieta , Método Doble Ciego , Dispepsia/inducido químicamente , Ingestión de Energía/efectos de los fármacos , Femenino , Estudios de Seguimiento , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Cooperación del Paciente , Pacientes Desistentes del Tratamiento , Estudios Prospectivos , Factores de Tiempo , Vitamina A/administración & dosificaciónRESUMEN
Malignancy potential of colorectal polyps increases with size. The growth rate and destiny of each polyp is virtually unknown. It was recently shown that polyps smaller than 10 mm left in situ may partly regress or partly increase in size, whereas one quarter of polyps are unchanged after 3 years. Polyps smaller than 5 mm show a mean increase in size, whereas polyps measuring 5 to 9 mm show a mean decrease in size. Methodologic problems with the measurement of polyps and cancer are discussed. More studies of polyp growth related to risk factors are warranted.
Asunto(s)
Neoplasias del Colon/patología , Pólipos del Colon/patología , Colonoscopía , Humanos , Factores de Riesgo , Factores de TiempoRESUMEN
It is claimed that the symptoms of cancer in different parts of the colorectum are varied. The aim of the study was to decide how well the "classical" symptoms are divided between left and right colonic and rectal adenocarcinomas. This was a retrospective study of 102 patients with colorectal cancer at Ullevål hospital in 1992. Red blood in the faeces (p = 0.001), and changes in stool pattern (p = 0.001), were left colonic and rectal cancer specific. Moreover tenesmus, mucous stools, and pain at defecation were specific of rectal cancer. All these findings agree with the textbooks. Melaena, diarrhoea (p = 0.23), weight-loss (p = 0.09), a feeling of general physical weakness (p = 0.13), and ileus/subileus were not found as localisation specific symptoms, contrary to the claims of several textbooks. Pain was always correlated to the affected side in left and right colonic cancer, while in rectal cancer the localisation of pain was non-specific, and it appeared rather often; (37%) in Dukes' A and Dukes' B. Only a few patients had anorexia, but the number was still significant for those with right colonic cancer (p = 0.04). With few exceptions, our results generally support the textbooks. The referring symptoms may help to decide the necessity for further examinations, when total colonoscopy is not obtained.