Benign Neoplasms of the Colon and Rectum
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
Hofstad et al. (47) prospectively studied the growth of colorectal polyps. Colonoscopy was performed in 58 subjects. Polyps ≥10 mm were removed; polyps < 5 mm, and 5 to 9 mm were left behind for a follow-up study. Colonoscopy was followed-up by one investigator once a year. On the third year, polyps were removed by snare or hot biopsy. The measurement of the polyps was performed by a measuring probe plus photography. On the third year, 7 of 58 patients had only hyperplastic polyps. Twenty-nine individuals had one adenoma, 17 individuals had two to three adenomas, 5 individuals had four to five adenomas. Twenty-five percent of all the adenomas were unchanged in size whereas 40% displayed growth and 35% showed regression or shrinking in size. Adenomatous polyps < 5 mm showed a tendency to growth, while the adenomas 5 to 9 mm showed a tendency to reduction in size. The hyperplastic polyps showed a similar pattern. There was a tendency to increase growth in the adenomatous polyps in the younger age groups reaching significance from initial examination to the third year and from the first to the second year of re-examination. Moreover, in the patients with four to five adenomas at the initial examination, the polyps showed larger growth than the polyps in patients with only one or two to three adenomas. There were no differences in polyp growth between the sexes. A similar prospective study by Bersentes et al. (48) on adenomas of the upper rectum or sigmoid colon, size 3 to 9 mm, showed no regression or consistent linear growth rates with a 2 year follow-up.
The Large Bowel and the Anal Canal
E. George Elias in CRC Handbook of Surgical Oncology, 2020
The stools guaiac test is relatively simple and inexpensive. It has an overall positivity of about 2%. Of these, 15 to 30% will have colorectal polyps or cancers, usually in an early stage.26 This technique tests a large number of the population, at low cost, for occult blood, then evaluates them for potential colorectal cancers. The disadvantages include a high false negative rate — which can be as high as 30% for invasive carcinoma and 60% for benign polyps — and a high false positive rate. However, controlled clinical trials are now on the way to find out if such an approach can reduce the mortality rate from colorectal cancer in the screened population. Digital rectal examination is good in detecting tumors at mid-rectum or below. Colonoscopy is ideal but is it expensive, has low yield in screening, and has poor compliance from the population.
Colorectal Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Colorectal polyps may be classified according to their architecture and degree of dysplasia, or their origin: epithelial (adenomatous and hyperplastic), hamartomatous (e.g., Peutz–Jeghers and juvenile polyps), inflammatory, lymphoid, and mesenchymal (e.g. lipomas) polyps. The commonest polyps reported by pathologists are adenomatous and hyperplastic lesions. Adenomatous polyps are dysplastic by definition. Whereas many polyps are stalked, some are sessile lesions. Tubular adenomas are composed of greater than 75% tubular glands, villous lesions greater than 50% villous architecture, and tubulovillous adenomas 25–50% villous pattern.15 The degree of dysplasia is classified as mild, moderate, or severe, based on the cytological features of the lining epithelial cells and an assessment of the neoplastic architecture. Thus, severely dysplastic adenomas show loss of polarity, nuclear enlargement, prominent nucleoli, numerous mitoses, and an often complex branching and cribriform pattern of the glands.16
Investigate the role of PIK3CA gene expression in colorectal polyp development
Published in Egyptian Journal of Basic and Applied Sciences, 2023
Ameer Ali Imarah, Rana Ahmed Najm, Haider Ali Alnaji, Saleem Khteer Al-Hadraawy, Abbas F. Almulla, Hussein Raof Al-Gazali
A polyp is a mass that protrudes into the lumen of a hollow duct or organ. Colorectal polyps are classified according to histological properties as neoplastic (malignant potential) or non-neo-plastic, including hyperplastic, inflammatory, or hamartomatous polyps. As with any disease in the human body, when diagnosed at the early stages of development, the treatment protocol becomes easy and simple also, with low side effects when compared with the final stages of diseases development, therefore it so important to diagnose the neoplastic polyps in the early stage of development [18]. Thus, the current study attempted to show the role of PIK3CA expression in colorectal polyp development. The patient group was divided into three age groups (50–59 years), (60–69 years), and (70–80 years), including 35 patients, 7 patients, and 24 patients, respectively. In general, age classification in the current study agrees with a study that found a high prevalence of colorectal polyp cases diagnosed in the age above 50 years. The current study is compatible with the results of recent studies [19,20]. The variations of cases in each age group may occur due to many causes; colorectal polyps diagnosed accidentally through colonoscopy screening make the diagnosis don’t have a specific standard. A possible second cause may be the small sample size, which can reflect a nonspecific and real representation of the distribution according to age group.
Evaluation of cold snare polypectomy for small pedunculated (Ip) polyps with thin stalks: a prospective clinical feasibility study
Published in Scandinavian Journal of Gastroenterology, 2022
Jun Arimoto, Hideyuki Chiba, Jun Tachikawa, Kenji Yamaoka, Dai Yamazaki, Airi Higa, Naoya Okada, Takuma Suto, Naoya Kawano, Toshihiro Niikura, Hiroki Kuwabara, Michiko Nakaoka, Tomonori Ida, Taiki Morohashi, Tohru Goto
A standard or magnifying colonoscope was used in all cases (CF-HQ290ZI, PCF-Q260AZI, PCF-Q260AI, and PCF-H290ZI; Olympus Co., Tokyo, Japan), with carbon dioxide insufflation. A transparent attachment was placed on the tip of the endoscope. Cecum intubation was verified by identification of the appendiceal orifice and ileocecal valve. The location, size, and macroscopic type of all detected lesions were documented according to the Paris Classification [21,22]. Rectal retroflexion was routinely performed. Polyp resection was performed with a Snaremaster-Plus (Olympus) or Captivator II snare (Boston Scientific, Tokyo, Japan) in all cases. The widths of the sheaths were 2.6 mm and 2.4 mm, respectively. Endoscopists were instructed to measure the polyps using the size of the snare catheter or snare diameter. All detected colorectal polyps up to 10 mm in diameter, except for tiny hyperplastic polyps in the rectum and distal sigmoid colon, were resected.
Safety and efficacy of cold polypectomy compared to endoscopic mucosal resection and hot biopsy polypectomy
Published in Scandinavian Journal of Gastroenterology, 2019
Hideyuki Iwashita, Hidetoshi Takedatsu, Hiroyuki Murao, Sadahiro Funakoshi, Yasuhisa Kuniki, Satoshi Matsuoka, Shinji Tsukamoto, Masashi Yamaguchi, Satoshi Shakado, Teppei Kabemura, Shotaro Sakisaka
We retrospectively examined 1713 colorectal polyps (size 1–9 mm) in 731 patients; these polyps were resected in our hospital from April 2015 to July 2016. They were classified into the following three groups: CP group (476 lesions), EMR group (997 lesions), and HB group (240 lesions). The CP group comprised 288 CFP lesions and 188 CSP lesions. These lesions were compared with respect to the region, size, morphology, the presence of delayed bleeding, postoperative pathology, the presence of antithrombotic therapy (antiplatelet or anticoagulant), and polyp remnants. Delayed bleeding was defined as overt bleeding including melena or hematochezia, 24 h after operation. Procedure time was defined as the total time from detection of a polyp to resection and hemostasis. Antithrombotic drugs were discontinued or changed based on the guidelines established by the Japanese Gastroenterological Endoscopy Society. Briefly, we performed endoscopic treatment under taking aspirin and cilostazol. Thienopyridine was changed to aspirin or cilostazol 3–5 days prior to treatment. Other antiplatelet drugs were withdrawn from the day before endoscopic treatment. Direct oral anticoagulants, such as rivaroxaban and dabigatran, were discontinued only on the day of treatment. These antithrombotic drugs are resumed from the next day. All antithrombotic drugs were resumed from the day after treatment. This study was approved by Fukuoka City Medical Association Hospital ethics committee (approval data: February 7, 2018).