scholarly journals A single-centre analysis of post-colonoscopy colorectal cancer

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
R Aerts ◽  
C Severi ◽  
G Van Roey ◽  
R Harlet ◽  
M T’Syen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Colonoscopy ◽  
Colorectal Cancers ◽  
Average Period ◽  
Right Colon ◽  
Single Centre ◽  
The World ◽  
Important Quality ◽  
The Mean ◽  
The Right

Patients and methods : A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. Results : 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. Conclusions : The data of our centre are in line with the data of the literature from which can be concluded that most post-colonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).

scholarly journals The Detection of Proximal Colon Polyps and Its Importance in Screening Colonoscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 219-223
Author(s):  
Răzvan Opaschi ◽  
Simona Bățagă ◽  
Ioan Macarie ◽  
Imola Török ◽  
Anca Negovan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sigmoid Colon ◽  
Histopathological Examination ◽  
Proximal Colon ◽  
Screening Colonoscopy ◽  
Colon Polyps ◽  
Tubular Adenoma ◽  
Right Colon ◽  
Multiple Biopsies ◽  
The Right

Abstract Background: Colon polyps are precursors of colorectal cancer (CRC), therefore their endoscopic detection is very important. A shift of in the localization of colorectal polyps toward the proximal colon has been recently observed in Western countries. Aim: The aim of this paper was to establish the most important clinical and endoscopic aspects of right colon polyps and to correlate them with their histopathological types, with an emphasis on sessile serrated adenomas/polyps (SSA/Ps). Material and method: We perfomed a retrospective study on a series of consecutive patients who underwent colonoscopy in the Gastroenterology and Endoscopy Unit of the County Emergency Clinical Hospital of Tîrgu Mureș between January 1, 2010 – December 31, 2014, comparing the results with those of patients who underwent colonoscopy between January 1, 2005 – December 31, 2009. In all cases with abnormal aspects at endoscopy, multiple biopsies were taken for histopathological examination. Only cases where the diagnosis of colon polyp was confirmed by the Histopathology Department were included in the study. Results: In the 2010–2014 period there were 871 patients diagnosed with colon polyps (1,038 polyps), with a mean age of 62.28 years. The most frequent histopathological form was tubular adenoma in 55.97% of cases (n = 581). SSA/Ps were found in 66 patients (75 polyps). Considering all polyps, the most frequent localization was in the sigmoid colon in 32.36% of cases (n = 336), but for SSA/Ps the most common localization was the ascending colon in 24% of cases (n = 18), followed by the sigmoid colon in 21.33% of cases (n = 16). Compared with patients investigated between 2005 and 2009, we found an increasing localization in the right colon, from 10.43% (n = 67) in 2005–2009 to 15.41% (n = 160) in 2010–2014. SSA/Ps were found in the right colon in 5.97% of cases (n = 4) in the first period compared with 11.25% of cases (n = 18) in the second period. Conclusions: In the last years we found an increasing localization of colon polyps in the right colon. These findings underscore the importance of high quality colonoscopy to maximize protection against colorectal cancer.

EP.TU.660The rate of interval colorectal cancer within 5 years of a negative colonoscopy at a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Abdullah Alqallaf ◽  
Aimee Grant ◽  
Corina Lavelle ◽  
Palanichamy Chandran
Keyword(s):  
Colorectal Cancer ◽  
Short Interval ◽  
Interval Cancer ◽  
District General Hospital ◽  
Colorectal Cancers ◽  
Right Colon ◽  
Adenoma Detection ◽  
Technical Factors ◽  
Interval Colorectal Cancer ◽  
Repeat Procedures

Abstract Aims Interval colorectal cancer is defined as cancer that has developed within a short interval of a diagnostic test that did not detect a cancer. Many authors define this interval as five years, though more complex definitions of interval cancer have been proposed. Our aim was to determine what percentage of colorectal cancers diagnosed at our hospital had a negative colonoscopy within the 5 years prior to their diagnosis. Methods We obtained details of all colorectal cancers diagnosed between 2017-2019 at our department. We then surveyed the endoscopy system to detect the patients who had a negative colonoscopy within the 5 years prior to their diagnosis, to calculate what percentage of cancers diagnosed within that period were interval cancers. Results Between 2017-2019, 539 patients were diagnosed with colorectal cancer. Age at diagnosis varied widely from 21 to 107, and 310 (57.5%) of patients were male. Seventeen patients had a negative colonoscopy within 5 years (though two of these were planned repeat procedures within a few months of the index ‘negative’ colonoscopy). We can therefore calculate the rate of interval cancer at 3.1% between 2017-2019. Conclusions The aetiology of interval colorectal cancer has been attributed to patient/tumour factors (right colon and female sex) and technical factors (adenoma detection and caecal intubation rate). Though the rate of interval cancer at our department seems pleasingly low compared to the literature, we plan to investigate the risk factors that might be at play: are biological factors to blame or can our endoscopy service be improved?

scholarly journals MALIGNANCY IN LARGE COLORECTAL LESIONS

2014 ◽  
Vol 51 (3) ◽  
pp. 235-239
Author(s):  
Carlos Eduardo Oliveira dos SANTOS ◽  
Daniele MALAMAN ◽  
Tiago dos Santos CARVALHO ◽  
César Vivian LOPES ◽  
Júlio Carlos PEREIRA-LIMA
Keyword(s):  
Invasive Carcinoma ◽  
Lesion Size ◽  
Primary Treatment ◽  
Left Colon ◽  
Right Colon ◽  
High Prevalence ◽  
Early Adenocarcinoma ◽  
The Mean ◽  
The Right ◽  
Low Rate

Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for deeper invasion Objectives To evaluate the malignancy of colorectal lesions ≥20 mm. Methods Between 2007 and 2011, 76 neoplasms ≥20 mm in 70 patients were analyzed Results The mean age of the patients was 67.4 years, and 41 were women. Mean lesion size was 24.7 mm ± 6.2 mm (range: 20 to 50 mm). Half of the neoplasms were polypoid and the other half were non-polypoid. Forty-two (55.3%) lesions were located in the left colon, and 34 in the right colon. There was a high prevalence of III L (39.5%) and IV (53.9%) pit patterns. There were 72 adenomas and 4 adenocarcinomas. Malignancy was observed in 5.3% of the lesions. Thirty-three lesions presented advanced histology (adenomas with high-grade dysplasia or early adenocarcinoma), with no difference in morphology and site. Only one lesion (1.3%) invaded the submucosa. Lesions larger than 30 mm had advanced histology (P = 0.001). The primary treatment was endoscopic resection, and invasive carcinoma was referred to surgery. Recurrence rate was 10.6%. Conclusions Large colorectal neoplasms showed a low rate of malignancy. Endoscopic treatment is an effective therapy for these lesions.

scholarly journals Segmental colonic length and mobility

2015 ◽  
Vol 97 (6) ◽  
pp. 439-444 ◽  
Author(s):  
M Phillips ◽  
A Patel ◽  
P Meredith ◽  
O Will ◽  
C Brassett
Keyword(s):  
Significant Proportion ◽  
Human Colon ◽  
Ascending Colon ◽  
Rectosigmoid Colon ◽  
Right Colon ◽  
Transverse Mesocolon ◽  
Anatomical Teaching ◽  
The Mean ◽  
The Right ◽  
Sigmoid Mesocolon

Introduction Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic colorectal procedures. The aim of this study was to refine anatomical understanding of the colon in terms of segmental length and mobility. Methods The colons of 35 cadavers were examined to determine lengths of caecum as well as ascending, transverse, descending and rectosigmoid colon, and to characterise colonic mobility at each location in terms of the mesenteric attachments. The presence of Jackson’s membrane (a congenital peritoneal band of the right colon) was also documented. Results The mean total colonic length was 131.2cm (standard deviation [SD]: 13.4cm). There was no correlation with height, age or sex; the best predictor of total colonic length was the length of the rectosigmoid segment. The mean height of the transverse mesocolon was 7.4cm (SD: 3.6cm) and that of the sigmoid mesocolon was 6.3cm (SD: 2.6cm). Two-thirds of the subjects had a mobile portion of the ascending colon and nearly one-third had a mobile descending colon. A mobile ascending colon was significantly more common in females. Jackson’s membrane was present in 66% of the subjects. Conclusions This cadaveric study suggests that rectosigmoid length accounts for most of the variability in total colonic length. The significant proportion of colons with mobility of the ascending and descending segments prompts revision of the traditional anatomical teaching of these segments as fixed and retroperitoneal. Mobility of the ascending colon may account for the anecdotal finding that colonoscopy is more challenging in female patients. Jackson’s membrane was identified in most colons.

scholarly journals Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial

2020 ◽  
Vol 8 (6) ◽  
pp. 725-735 ◽  
Author(s):  
Ma Henar Núñez Rodríguez ◽  
Pilar Díez Redondo ◽  
Fausto Riu Pons ◽  
Marta Cimavilla ◽  
Luis Hernández ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Screening Colonoscopy ◽  
Right Colon ◽  
Randomized Controlled ◽  
The Right

scholarly journals Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study

Gut ◽  
2016 ◽  
Vol 67 (2) ◽  
pp. 291-298 ◽  
Author(s):  
Chyke A Doubeni ◽  
Douglas A Corley ◽  
Virginia P Quinn ◽  
Christopher D Jensen ◽  
Ann G Zauber ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Mortality Risk ◽  
Left Colon ◽  
Screening Colonoscopy ◽  
Cancer Death ◽  
Right Colon ◽  
Community Based ◽  
Risk Of Death ◽  
Colon Cancers ◽  
Rectal Cancers

ObjectiveScreening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers.DesignWe conducted a nested case–control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55–90 years old on their colorectal cancer death date during 2006–2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures.ResultsWe analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).ConclusionsScreening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population.

scholarly journals Clinical and epigenetic features of colorectal cancer patients with somatic POLE proofreading mutations

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Takashi Kawai ◽  
Akihiro Nyuya ◽  
Yoshiko Mori ◽  
Takehiro Tanaka ◽  
Hiroaki Tanioka ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Methylation Status ◽  
Epigenetic Alterations ◽  
Right Colon ◽  
Partial Methylation ◽  
Methylation Score ◽  
Cd8 Cell ◽  
The Right ◽  
Colorectal Cancer Patients ◽  
Clinicopathological Variables

Abstract Background Mutations in the POLE gene result in an ultra-hypermutated phenotype in colorectal cancer (CRC); however, the molecular characterisation of epigenetic alterations remains unclear. We examined the genetic and epigenetic profiles of POLE-mutant CRC to elucidate the clinicopathological features of the associated genetic and epigenetic alterations. Results Tumour tissues (1,013) obtained from a cohort of patients with CRC were analysed to determine associations between the proofreading domain mutations of POLE with various clinicopathological variables, microsatellite instability (MSI) status, BRAF and KRAS mutations, and the methylation status of key regions of MLH1, MGMT, and SFRP2 promoters by calculating the methylation scores (range 0–6). Only four cases (0.4%) exhibited pathogenic POLE hotspot mutations (two p.P286R [c.857C > G], one p.V411L [c.1231G > C], and p.S459F [c.1376C > T] each), which were mutually exclusive to BRAF and KRAS mutations and MSI. CRC patients were divided into four subgroups: patients with POLE mutations (POLE, 0.4%, n = 4), patients with both MSI and extensive methylation in MLH1 (MSI-M, 2.9%, n = 29), patients with MSI but no extensive methylation in MLH1 (MSI-U, 3.6%, n = 36), and patients without MSI (non-MSI, 93.2%, n = 944). The POLE group was younger at diagnosis (median 52 years, P < 0.0001), with frequent right-sided tumour localisation (frequency of tumours located in the right colon was 100%, 93.1%, 36.1%, and 29.9% in POLE, MSI-M, MSI-U, and non-MSI, respectively; P < 0.0001), and was diagnosed at an earlier stage (frequency of stages I–II was 100%, 72.4%, 77.8%, and 46.6% in POLE, MSI-M, MSI-U, and non-MSI, respectively, P < 0.0001). The mean methylation score in POLE was not different from that in MSI-U and non-MSI, but the methylation signature was distinct from that of the other subgroups. Additionally, although the examined number of POLE-mutant tumours was small, the number of CD8-positive cells increased in tumours with partial methylation in the MLH1 gene. Conclusions CRC patients with POLE proofreading mutations are rare. Such mutations are observed in younger individuals, and tumours are primarily located in the right colon. Diagnosis occurs at an earlier stage, and distinct epigenetic alterations may be associated with CD8 cell infiltration.

Lymphoepithelioma-like Carcinoma of the Colon in a Patient With Hereditary Nonpolyposis Colorectal Cancer

1999 ◽  
Vol 123 (8) ◽  
pp. 720-724
Author(s):  
Giovanni De Petris ◽  
Robert Lev ◽  
Daniel M. Quirk ◽  
Paul R. Ferbend ◽  
Janet R. Butmarc ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Nasopharyngeal Carcinoma ◽  
Hereditary Nonpolyposis Colorectal Cancer ◽  
Right Colon ◽  
Carcinoma Of The Colon ◽  
Lymphoid Stroma ◽  
Hereditary Nonpolyposis ◽  
Malignant Lesions ◽  
Well Differentiated ◽  
The Right

Abstract Tumors with features similar to those of nasopharyngeal carcinoma, so-called lymphoepithelioma-like carcinomas, have been described in several organs but are extremely rare in the colon. We describe a patient with a family history consistent with hereditary nonpolyposis colorectal cancer who had 3 malignant lesions in the right colon, namely, a mucinous cancer, a lymphoepithelioma-like carcinoma, and a well-differentiated adenocarcinoma with prominent lymphoid stroma. To the best of our knowledge, lymphoepithelioma-like carcinoma has not been described previously in hereditary nonpolyposis colorectal cancer.

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