Colon cancer screening, surveillance, prevention, and therapy
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| Sprache: | English |
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Philadelphia [u.a.]
Saunders
2008
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| Schriftenreihe: | Gastroenterology clinics of North America
37,1 |
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| 245 | 1 | 0 | |a Colon cancer screening, surveillance, prevention, and therapy |c guest ed. Mitchell S. Cappell |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2008 | |
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| 490 | 1 | |a Gastroenterology clinics of North America |v 37,1 | |
| 650 | 4 | |a Colon (Anatomy) |x Cancer | |
| 650 | 4 | |a Colon (Anatomy) |x Cancer |x Prevention | |
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| adam_text | CONTENTS VOLUME 37 « NUMBER 1 » AAARCH 2008
Preface xi
MitcheU S. Cappell
Pathophysiology, Clinical Presentation,
and Management of Colon Cancer 1
Mitchell S. Cappell
Colon cancer is believed to arise from two types of precursor polyps via
two distinct pathways: conventional adenomas by the conventional
adenoma-to-carcinoma sequence and serrated adenomas according to
the serrated adenoma-to-carcinoma theory. Conventional adenomas
arise from mutation of the APC gene; progression to colon cancer is
a multistep process. The fundamental genetic defect in serrated
adenomas is unknown. Environmental factors can increase the risk
for colon cancer. Advanced colon cancer often presents with symptoms,
but early colon cancer and premalignant adenomatous polyps
commonly are asymptomatic, rendering them difficult to detect and
providing the rationale for mass screening of adults over age 50.
Sporadic and Syndromic Hyperplastic Polyps and
Serrated Adenomas of the Colon: Classification,
Molecular Genetics, Natural History, and Clinical
Management 25
James E. East, Brian P. Saunders, and Jeremy R. Jass
There is now strong evidence for an alternative pathway of colorectal
carcinogenesis implicating hyperplastic polyps and serrated adenomas.
This article briefly reviews the evidence for this serrated padiway,
provides diagnostic criteria for clinically significant hyperplastic polyps
and allied serrated polyps, and suggests how this information may be
translated into safe, effective guidelines for colonoscopy-based colon
cancer prevention. Consideration also is given to the definition and
management of hyperplastic polyposis syndrome. The currently pro¬
posed management plan for serrated polyps is tentative because of
incomplete knowledge of the nature and behavior of these polyps. This
article highlights key areas warranting further research.
v
Syndromic Colon Cancer: Lynch Syndrome
and Familial Adenomatous Polyposis 47
Tusar Desai and Donald Barkel
Colon cancer, the third leading cause of mortality from cancer in the
United States, afflicts about 150,000 patients annually. More than 10%
of these patients exhibit familial clustering. The most common and well
characterized of these familial colon cancer syndromes is hereditary
nonpolyposis colon cancer syndrome (Lynch syndrome), which
accounts for about 2°/o to 3% of all cases of colon cancer in the United
States. We review the current knowledge of familial cancer syndromes,
with an emphasis on Lynch syndrome and familial adenomatous
polyposis.
Prevention of Colorectal Cancer: Diet,
Chemoprevention, and Lifestyle 73
James R. Marshall
This article focuses on preventing die initiation and promotion of
neoplastic growth in colon cancer, particularly with dietary measures.
A goal of dietary epidemiology is to identify chemopreventive agents
and strategies. The effects of diet are analyzed by observational
approaches and experimental dietary, nutritional, or chemopreventive
interventions. Short-term trials that alter intermediate biomarkers diat
are more sensitive than the adenoma to interventions may be necessary.
The same logic needs to be applied to chemoprevention. Nonsteroidal
anti-inflammatory drugs, calcium, and selenium have some individual
effects that could be potentiated if added together. The current evidence
is that the combined effect of all three agents is modest, compared with
the effects of screening, or even those of smoking cessation.
Implementation of Colon Cancer Screening:
Techniques, Costs, and Barriers 83
Anthony B. Miller
Colorectal cancer and breast cancer are the only cancer sites for which
evidence on the efficacy of screening is available from randomized trials.
The trials on colon cancer screening in the United States and Europe
used die fecal occult blood test as die primary screen, but randomized
trial data are not yet available on endoscopy (flexible sigmoidoscopy to
60 cm), and no randomized, controlled trials of colonoscopy as
a screening test are in progress. This article reviews colorectal cancer
screening from an epidemiologist s perspective to provide the theoretic
evidence-based underpinning for the role of die gastroenterologist in
colorectal screening.
Screening for Colorectal Cancer 97
Jack S. Mandel
Although there are several methods available for colon cancer
screening, none is optimal. This article reviews methods for screening,
including fecal occult blood tests, flexible sigmoidoscopy, colonoscopy,
CT colonography, capsule endoscopy, and double contrast barium
enema. A simple, inexpensive, noninvasive, and relatively sensitive
screening test is needed to identify people at risk for developing
advanced adenomas or colorectal cancer who would benefit from
colonoscopy. It is hoped mat new markers will be identified diat
perform better. Until then we fortunately have a variety of screening
strategies that do work.
Implementation of Colonoscopy for Mass Screening
for Colon Cancer and Colonic Polyps: Efficiency
with High Quality of Care 117
Susan L. Mihalko
As awareness of colon cancer by the public continues to increase,
screening colonoscopy procedures will proportionately increase. There
is much written on die design of new ambulatory gastroenterology
clinics, but litde practical information about high-volume, mass
colonoscopic screening of patients in die hospital outpatient setting.
Many institutions struggle widi inefficient endoscopy units diat cannot
always meet die dual needs of high quality and efficient performance of
screening endoscopy. The patient undergoing screening colonoscopy
seeks an efficient unit widi state-of-die-art equipment, highly skilled
physicians, highly competent staff, accurate case documentation,
comfortable surroundings, and consumer-friendly follow-dirough of
care. Optimizing these factors in existing spaces may require revision of
an endoscopy unit s operations and, possibly, renovation of die
endoscopy suite.
Reducing the Incidence and Mortality of Colon Cancer:
Mass Screening and Colonoscopic Polypectomy 129
Mitchell S. Cappell
Most colon cancers arise from conventional adenomatous polyps
(conventional adenoma-to-carcinoma sequence), while some colon
cancers appear to arise from the recendy recognized serrated
adenomatous polyp (serrated adenoma-to-carcinoma dieory). Because
conventional adenomas and serrated adenomas are usually asymptom¬
atic, mass screening of asymptomatic patients has become die
cornerstone for detecting and eliminating diese precursor lesions to
reduce die risk of colon cancer. Colonoscopy has become die primary
screening test because of its high sensitivity and specificity, and die
ability to perform polypectomy. Odier screening tests include guaiac
tests or fecal immunochemical tests (FIT) for fecal occult blood, and
vii
flexible sigmoidoscopy. A minimal colonoscopic withdrawal time of 6
minutes is important to maximize polyp detection at colonoscopy.
Chromoendoscopy is an experimental technique used to highlight
abnormal colonic areas to identify neoplastic tissue and to potentially
determine the histology of colonic polyps at colonoscopy based on
superficial pit anatomy.
CT Colonography: Current Status and Future Promise 161
Susan Summerton, Elizabeth Little, and Mitchell S. Cappell
CT colonography (CTC) is an innovative technology that entails CT
examination of the entire colon and computerized processing of the raw
data after colon cleansing and colonic distention. CTC could potentially
increase the screening rate for colon cancer because of its relative safety,
relatively low expense, and greater patient acceptance, but its role in
mass colon cancer screening is controversial because of its highly
variable sensitivity, the inability to sample polyps for histologic analysis,
and lack of therapeutic capabilities. This article reviews the CTC
literature, including imaging and adjunctive techniques, radiologic
interpretation, procedure indications, contraindications, risks, sensitiv¬
ity, interpretation pitfalls, and controversies.
Surveillance of Patients at Increased Risk of Colon
Cancer: Inflammatory Bowel Disease and Other
Conditions 191
Amulya Konda and Michael C. Duffy
Colorectal cancer (CRC) is the second most common cause of cancer-
related mortality in the United States. Colonoscopic screening with
removal of adenomatous polyps in individuals at average risk is known
to decrease the incidence and associated mortality from colon cancer.
Certain conditions, notably inflammatory bowel disease involving the
colon, a family history of polyps or cancer, a personal history of colon
cancer or polyps, and odier conditions such as acromegaly, ureter-
osigmoidostomy, and Streptococcus bovis bacteremia are associated with
an increased risk of colonic neoplasia. This article reviews the CRC
risks associated with these conditions and the currendy recommended
surveillance strategies.
Endoscopic Ultrasound in the Diagnosis, Staging
and Management of Colorectal Tumors 215
Manoop S. Bhutani
Endoscopic ultrasound (EUS) has evolved as a useful technique for
imaging and intervention in the colon and rectum. This article reviews
die clinical applications of EUS for imaging and intervention in
colorectal cancer, with an emphasis on the most recent clinical studies.
viii
Colonoscopic Polypectomy 229
Kevin A. Tolliver and Douglas K. Rex
Colonoscopic polypectomy is the most effective visceral cancer
prevention tool in clinical medicine. In general, risks associated with
the technique of polyp removal should match the likelihood that the
polyp will become or already is malignant (eg, low-risk technique for
low risk for malignant potential). Cold techniques are preferred for
most diminutive polyps. Polypectomy techniques must be effective and
minimize complications. Complications can occur even with proper
technique, however. Aggressive evaluation and treatment of complica¬
tions helps ensure die best possible outcome.
Surgical Therapy for Colorectal Adenocarcinoma 253
Neal Wilkinson and Carol E.H. Scott-Conner
Colorectal cancer (CRC) remains the second leading cause of cancer
mortality among men, and the third leading cause among women.
Worldwide, CRC is the fourth most common cancer with approx¬
imately 1 million new cases annually. Unfortunately, advanced disease
at diagnosis is still all too common. Locally advanced rectal cancer,
node-positive colon cancer, and metastatic disease still compose
a significant proportion of colon and rectal cancer. Surgery is the
mainstay of treatment, providing definitive management and potential
cure in early cases, and effective palliation in advanced cases.
Chemodierapy and, sometimes, radiodierapy are essential components
of effective treatment. This article briefly reviews die general principles
of surgical management and describes recent developments.
The Role of Radiation Therapy for Colorectal Cancer 269
John M. Robertson
Radiation dierapy (RT) has been used to treat cancers for more man
a century. Recent randomized trials have helped clarify die treatment
recommendations in die use of RT for colorectal cancers. This article
reviews these trials to illustrate key concepts, places diese trials in
perspective, and provides direction for future research.
Systemic Therapy for Colon Cancer 287
Timothy R. Asmis and Leonard Saltz
Colorectal cancer (CRC) is a common and frequendy fatal disease in
North America. A multidiscipunary approach to the prevention,
diagnosis, and treatment of this disease is essential. There have been
many advances in die surgical and medical treatment of CRC over the
last 10 years. This article reviews the indications, efficacy, and toxicity
of chemodierapy and targeted therapy for patients who have CRC.
Index 297
ix
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| series2 | Gastroenterology clinics of North America |
| spellingShingle | Colon cancer screening, surveillance, prevention, and therapy Gastroenterology clinics of North America Colon (Anatomy) Cancer Colon (Anatomy) Cancer Prevention |
| title | Colon cancer screening, surveillance, prevention, and therapy |
| title_auth | Colon cancer screening, surveillance, prevention, and therapy |
| title_exact_search | Colon cancer screening, surveillance, prevention, and therapy |
| title_full | Colon cancer screening, surveillance, prevention, and therapy guest ed. Mitchell S. Cappell |
| title_fullStr | Colon cancer screening, surveillance, prevention, and therapy guest ed. Mitchell S. Cappell |
| title_full_unstemmed | Colon cancer screening, surveillance, prevention, and therapy guest ed. Mitchell S. Cappell |
| title_short | Colon cancer screening, surveillance, prevention, and therapy |
| title_sort | colon cancer screening surveillance prevention and therapy |
| topic | Colon (Anatomy) Cancer Colon (Anatomy) Cancer Prevention |
| topic_facet | Colon (Anatomy) Cancer Colon (Anatomy) Cancer Prevention |
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