Polyps of the Colon and Rectum

Jb, Kirsner; Ja, Rider; Hc, Moeller; Wl, Palmer; Ss, Gold

doi:10.1016/s0016-5085(19)35291-6

Cited by 53 publications

(1 citation statement)

References 2 publications

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“…The fact that 65 % of our patients had a single adenoma detected at the time of colonoscopy and that also one half of the adenomas were small and therefore theoretically of 'low risk' for the development of malignancy, may prompt the question 'Is follow-up necessary?'. The evidence is that these patients too are subsequently at greater risk for the development of further benign and malignant polyps (Rider et al, 1954;Kirsner et al, 1960).…”

Section: Discussionmentioning

confidence: 99%

Colonic adenomas--a colonoscopy survey.

Gillespie¹,

Chambers²,

Chan³

et al. 1979

Gut

153

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SUMMARY A colonoscopy survey of 620 patients with 1049 colon adenomas showed a predominantly left-sided distribution (77 %). Of these lesions 97 % were amenable to endoscopic removal or ablation. Sixty per cent of patients presented with rectal bleeding as their major symptom. There was agreement between radiology and colonoscopy in only 62 % of patients, as many of the studies were single contrast barium enemas, performed before referral. Forty-eight per cent of adenomas in our series were less than I 0 cm in diameter. Of the larger adenomas ( > 2-0 cm in diameter) 66 % were situated in the sigmoid colon, and of those containing invasive carcinoma (4-8 % of the total) an even higher percentage (94 %) were in the sigmoid and low descending colon. With increasing polyp size, there was a greater predominance of villous elements and this was associated with a higher risk of malignant change than the more frequent and generally smaller tubular adenoma. Local colonoscopic excision alone is sufficient treatment for adenomas with malignant change unless they are poorly differentiated histologically and providing adequate resection is demonstrated. Twenty-eight patients treated in this way are alive without recurrence at periods from six to 62 months. Although 65 % of patients had only one adenoma, and 90% three or less, there is a risk of developing other benign and malignant colon neoplasms and careful follow-up is required.It is now widely accepted that adenomas of the colorectum are premalignant (Grinnell and Lane, 1958;Kalus, 1972;Morson, 1974;Muto et al., 1975;Enterline, 1976), although only a small minority will develop into invasive carcinoma, and the risk for an individual adenoma is difficult to assess. Acceptance of the concept of the 'adenoma-cancer' sequence (Morson, 1974) means that removal of all colonic adenomas is desirable. Since the advent of fibreoptic colonoscopy polypectomy is now possible without the need to resort to abdominal surgery in the majority of patients except those with familial polyposis coli. Removal and histological examination allow for a clear separation between adenomas and other types of polyp, and enable the histopathologist to exclude the presence of malignancy and to assess the cancer risk factors for a particular adenoma and perhaps for the particular patient. The risk factors used are size (especially in excess of 1I0 cm in diameter), histological type (particularly where there is a villous pattern), and the presence of cellular atypia (Muto et al., 1975).Previous reports of adenoma distribution, size, and histopathology have largely been based on resected colon specimens obtained at necropsy or at Received for publication 2 October 1978 surgery (Grinnell and Lane, 1958;Blatt, 1961;Chapman, 1963;Arminski and McLean, 1964;Hughes, 1968). The purpose of this study is to present the clinical and pathological features of 1049 adenomas observed at colonoscopy in a symptomatic population of 620 patients over a five year period, and to outline the role of colonoscopy in their manage...

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Section: Discussionmentioning

confidence: 99%

Colonic adenomas--a colonoscopy survey.

Gillespie¹,

Chambers²,

Chan³

et al. 1979

Gut

153

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Asymptomatic Polyps of the Rectum and Colon

Drexler¹

1967

Arch Intern Med

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Experimentally induced cancer of the colon

Deschner¹

1974

Cancer

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1–2 Dimethylhydrazine (DMH) injected weekly at a dose of 20 mg/kg body weight induced colon cancer in CF1 mice with an incidence of over 90% by 186 days treatment. An unusual specificity was shown for the production of neoplasms in the distal colon. A tritiated thymidine‐labeling index curve, developed over nine treatment periods, demonstrated a marked elevation at 87 days. At this time, in addition to increased numbers of labeled epithelial cells, an expanded proliferative compartment closer to the luminal surface was noted. Focal atypias confined to one or two crypts were seen as early as 38 days. The frequency and size of these lesions within each animal increased with treatment time. Labeled indices of the focal atypias were often two to three times greater than that of the normal surrounding mucosa. A variable response among similarly treated animals indicated that multiple factors, i.e. physiological, genetic, and unknown, play a role in the induction of colon cancer.

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Polyps of the Colon and Rectum

Cited by 53 publications

References 2 publications

Colonic adenomas--a colonoscopy survey.

Colonic adenomas--a colonoscopy survey.

Asymptomatic Polyps of the Rectum and Colon

Experimentally induced cancer of the colon

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