Flat Colon Lesions Identified And Removed Using Colonoscopy
March 7, 2008
A study released this week from researchers at the Veterans Affairs Palo Alto Healthcare System in California shows that non-polypoid colorectal neoplasms or flat colon lesions, are more common in Americans than previously thought and may have a greater association with cancer compared to polypoid neoplasms or the more commonly diagnosed colorectal polyp. The study appears in the March 5 issue of the Journal of the American Medical Association. Researchers identified these flat lesions through colonoscopy.
“This study is very significant, as these flat lesions are more difficult to detect than the typical polyp during colorectal cancer screening,” said Grace H. Elta, MD, FASGE, president of the American Society for Gastrointestinal Endoscopy (ASGE). “Researchers identified these lesions in their study through colonoscopy, which has the ability to detect lesions of all sizes and is the only procedure that allows for the removal of lesions and polyps. Studies have shown that other imaging methods are ineffective at identifying even small polyps and miss flat lesions entirely. This study highlights the importance of quality colonoscopy screening. ASGE, as the standard-setting society for endoscopy, has issued quality indicators for colorectal cancer screening that define measures for improving quality in colonoscopy.”
Flat lesions are challenging to detect because subtle findings through examination can be difficult to distinguish from the normal mucosa. As compared with the surrounding normal mucosa, the flat lesions appear to be slightly elevated, completely flat or slightly depressed.
The study examined data from a group of 1,819 patients, almost all men with an average age of 64, from July 2003 to June 2004 undergoing elective colonoscopy to estimate the prevalence of non-polypoid colorectal neoplasms (NP-CRNs), or flat lesions, and to characterize their association with colorectal cancer. Patients were divided into three groups; screening, surveillance and a group of patients with symptoms for colorectal cancer. Flat lesions were found in 170 people, approximately 10 percent. The surveillance group had the highest incidence with more than 15 percent who had flat lesions. Approximately six percent of the screening and symptoms groups had flat lesions. Researchers found that the flat growths were five times more likely to be cancerous than polyps.
“Experts in gastrointestinal endoscopy will need to be more vigilant than ever in encouraging their patients to take their bowel prep as directed before the colonoscopy. Proper bowel prep is important so that the physician can clearly see the colon. This study also highlights the importance of not withdrawing too soon during the procedure, allowing the physician enough time to thoroughly examine the colon. According to ASGE quality indicators, withdrawal time should be six minutes or more. ASGE will continue to provide training and education to physicians to ensure that patients are receiving the highest quality of care possible,” said Elta.
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About Colonoscopy
Colonoscopy is a common and very safe procedure that examines the lining of the lower intestinal tract called the colon or large intestine. Colonoscopy means “to look inside the colon.” Physicians specially trained in the procedure use a flexible tube that has a light and miniature TV camera on the tip. This instrument, often referred to as the “scope,” is placed in the rectum and advanced through the colon. It is connected to a television monitor that the physician watches while performing the test. Various miniaturized tools can be inserted through the scope to obtain biopsies (samples) of the colon and to perform a wide range of maneuvers for diagnosis and treatment. When used as a colon cancer prevention method, colonoscopy can find potentially precancerous conditions before they turn into cancer. Colonoscopy is the only procedure that visualizes the entire colon and allows for the detection and removal of lesions and polyps before they turn into cancer.
About Colorectal Cancer
Each year nearly 150,000 people are diagnosed with colon cancer and almost 50,000 die from the disease annually in the United States. Colorectal cancer, also known as colon cancer, is the third most commonly diagnosed cancer in men and women and the second leading cause of cancer-related deaths in the United States. Many of those deaths could be prevented with earlier detection. The five-year relative survival rate for people whose colon cancer is treated in an early stage is greater than 90 percent. Unfortunately, only 39 percent of colon cancers are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the five-year relative survival rate decreases dramatically.
Colorectal cancer screening’s effect on early detection and prevention through polypectomy (performed during colonoscopy) has been identified as a main contributing factor for the declining rates of colorectal cancer incidence and deaths from the disease.
About the American Society for Gastrointestinal Endoscopy
Founded in 1941, the mission of the American Society for Gastrointestinal Endoscopy is to be the leader in advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 10,000 physician members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit http://www.asge.org/ and http://www.asge.org/ for more information.
About Endoscopy
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system. In many cases, screening or treatment of conditions can be delivered via the endoscope without the need for further sedation, treatment or hospital stay.
Source: Anne Brownsey
American Society for Gastrointestinal Endoscopy
Recommendations On Colorectal Cancer Screening Updated By New Guidelines
March 7, 2008
A new guideline on colorectal cancer screening just released by an expert group representing a broad spectrum of health care organizations, including the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE) and the American Cancer Society (ACS), offers recommendations for various alternatives for colorectal cancer detection and states a strong preference for screening tests that can prevent colorectal cancer. The ASGE and the ACG are members of the U.S. Multi-Society Task Force on Colorectal Cancer and were participants in the guideline development process.
“What distinguishes these new guidelines is an emphasis on the importance and value of preventing colorectal cancer, which GI physicians applaud,” said Amy E. Foxx-Orenstein, D.O., FACG, president of the ACG.
“We know that 50 percent of Americans who should be getting screening for this largely preventable disease are not,” said Grace H. Elta, M.D., FASGE, president of the ASGE. “The data show that screening saves lives and efforts to increase colon cancer awareness and screening will help patients through earlier detection.”
Both the ASGE and the ACG want the public to be aware that the guideline’s stated preference for tests that prevent colorectal cancer supports the groups’ longstanding positions that colonoscopy is the preferred screening strategy for colorectal cancer. Because of its excellent sensitivity in detecting polyps and its potential for removing them and breaking the sequence of polyp to cancer in a single diagnostic and therapeutic intervention, colonoscopy is one of the most powerful preventive tools in clinical medicine.
Several tests are among the recommended alternatives including stool tests that detect colorectal cancer but not its precursor, colon polyps, and structural examinations of the colon by endoscopic procedures such as flexible sigmoidoscopy and colonoscopy, as well as radiological examinations by either barium enema or CT colonography, also known as “virtual colonoscopy.” The new guideline recognizes that for flexible sigmoidoscopy, barium enema and CT colonography, a follow-up colonoscopy will be required if anything suspicious is discovered.
Dr. Foxx-Orenstein of ACG added, “All of us on the front lines of battling colorectal cancer welcome this thorough review of the evidence regarding all the various screening modalities. While the evidence suggests that there are some limitations to all of the tests, the College sees significant strengths in the proven benefits of visualizing pre-cancerous growths and removing them in a single examination during colonoscopy.”
According ACG’s Dr. Foxx-Orenstein, “We congratulate the American Cancer Society and the other group participants on the publication of these guidelines which required so much collegiality and scientific exchange to navigate areas where clinically there still exists much controversy and uncertainty.”
Dr. Elta added, “It is our greatest hope that these new guidelines will contribute to the increased use of colorectal cancer screening tests to reduce the incidence of colorectal cancer, and thereby save lives.”
About Colorectal Cancer
Each year nearly 150,000 people are diagnosed with colon cancer and almost 50,000 die from the disease annually in the United States. Colorectal cancer, also known as colon cancer, is the third most commonly diagnosed cancer in men and women and the second leading cause of cancer-related deaths in the United States. Many of those deaths could be prevented with earlier detection. The five-year relative survival rate for people whose colon cancer is treated in an early stage is greater than 90 percent. Unfortunately, only 39 percent of colon cancers are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the five-year relative survival rate decreases dramatically.
About Colonoscopy
Colonoscopy utilizes direct visualization of the entire colon to detect pre-cancerous growths, including smaller polyps, even below 1 cm. This test allows removal of suspicious polyps without surgery at the time of the exam. Three studies have shown that colonoscopy prevents about 80 percent of colorectal cancers from developing by removing pre-cancerous polyps. Colorectal cancer screening’s effect on early detection and prevention through polypectomy has been identified as a main contributing factor for the declining rates of colorectal cancer incidence and deaths from the disease.
About CT Colonography
CT colonography technology requires the same cathartic bowel preparation and restricted diet as colonoscopy. The test requires insertion of a tube in the rectum and insufflation of the abdomen with air or gas while patients are awake. It does not provide the opportunity to remove polyps or suspicious lesions. There are unresolved questions about radiation risks and identifying small or flat polyps. CT colonography may be useful for those who refuse, who cannot undergo, or who have failed prior colonoscopy.
The Need to Follow-up Suspicious Findings
The management of any findings from stool tests, barium enema exams, or CT colonography is an important part of a screening program using these tests:
* For any of the stool tests, a positive finding will require a follow-up colonoscopy.
* For flexible sigmoidoscopy, patients who have adenomas discovered at sigmoidoscopy should undergo colonoscopy, based on evidence suggesting that patients who have an adenoma of any size in the distal colon (visible during the exam which only views part of the colon) are at increased risk for advanced neoplasia proximally (higher up in the colon beyond the reach of the sigmoidoscope.)
* For CT colonography, the new guideline reflects that the risk for patients whose largest polyps are smaller than 5 mm is low, but for polyps over 5 mm in size, a follow-up by colonoscopy is recommended.
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About the American College of Gastroenterology
Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 10,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients. To learn more about the College and its mission, visit http://www.acg.gi.org/.
About the American Society for Gastrointestinal Endoscopy
Founded in 1941, the mission of the American Society for Gastrointestinal Endoscopy (ASGE) is to be the leader in advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 10,000 physician members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit http://www.asge.org/ and http://www.screen4coloncancer.org/ for more information.
About Endoscopy
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system. In many cases, screening or treatment of conditions can be delivered via the endoscope without the need for further sedation, treatment or hospital stay.
Source: Anne-Louise Oliphant
American College of Gastroenterology
New Guidelines Favoring Tests That Prevent Colorectal Cancer Supported By AGA
March 6, 2008
New consensus colorectal cancer guidelines state for the first time that the primary goal of colorectal cancer screening is cancer prevention. Previous guidelines have given equal weight to tests for detecting cancer and preventing cancer. By removing polyps from the large bowel, colonoscopy is the only screening test that also prevents colorectal cancer.
“Colorectal cancer prevention should be the primary goal of screening,” said Nicholas LaRusso, MD, AGAF, president, American Gastroenterological Association (AGA) Institute. “Detection and removal of precancerous lesions is essential to improve the health of Americans.”
The guidelines, which represent the most current scientific evidence and expert opinion available, are a joint effort of the American Cancer Society, the American College of Radiology and the U.S. Multi-society Task Force (comprised of the American College of Gastroenterology, the American Gastroenterological Association (AGA) Institute and the American Society for Gastrointestinal Endoscopy).
“While the AGA Institute considers optical colonoscopy the definitive screening and treatment procedure for colorectal cancer, we support all clinically proven options for colorectal cancer screening. There are many tests available for screening and everyone age 50+ should talk with their physician about what test is available to them,” said John I. Allen, MD, MBA, AGAF chair of the AGA Institute Clinical Practice and Quality Management Committee.
The panel of experts representing the societies listed above added two new tests as options: stool DNA (sDNA) and CT colonography (CTC). The AGA Institute supports CTC as a promising screening test for colorectal cancer, which we believe will be in widespread clinical use in the near future.
The expert panel also concluded that any proposed colorectal screening test that has not been shown in the medical literature to detect the majority of cancers present at the time of testing should not be offered to patients for colorectal cancer screening, including some types of previously endorsed guiaic-based stool tests.
Based on a review of the historic and recent evidence, the following tests were deemed acceptable options for the early detection of colorectal cancer and adenomatous polyps for asymptomatic adults aged 50 years and older:
Tests That Detect Adenomatous Polyps and Cancer
* Flexible sigmoidoscopy every 5 years, or
* Colonoscopy every 10 years, or
* Double contrast barium enema (DCBE) every 5 years, or
* CT colonography (CTC) every 5 years
Tests That Primarily Detect Cancer
* Annual guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer, or
* Annual fecal immunochemical test (FIT) with high test sensitivity for cancer, or
* Stool DNA test (sDNA), with high sensitivity for cancer, interval uncertain.
The guidelines will appear in the May issue of Gastroenterology, May/June issue of CA: A Cancer Journal for Clinicians, and are published early online on CA First Look.
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About the AGA Institute
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is one of the oldest medical-specialty societies in the U.S. Comprised of two non-profit organizations - the AGA and the AGA Institute - our more than 16,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. For more information, please visit http://www.gastro.org/.
Source: Aimee Frank
American Gastroenterological Association
Red Meat Consumption Linked To Colorectal Cancer: Experts Offer New Advice For Colorectal Cancer Awareness Month
March 4, 2008
For most Americans, meals tend to center around meat. To significantly decrease a person’s risks of developing colorectal cancer, experts at The University of Texas M. D. Anderson Cancer Center suggest a new approach to meal planning that focuses more on fruit and vegetable dishes.
According to recent findings issued by the American Institute for Cancer Research (AICR), consuming more than 18 ounces, or a little over a pound, of red meat (pork, beef, lamb and goat) each week can significantly increase a person’s risks for developing colorectal cancer. In addition, every ounce and a half of red meat a person eats over 18 ounces increases their risks by 15 percent.
March is Colorectal Cancer Awareness Month and National Nutrition Month, and nutritionists at M. D. Anderson Cancer Center are encouraging people to increase portion sizes of the vegetable, fruit, whole grain and/or bean dishes being served and decrease the portion size of meat.
Focus on Fruit and Vegetable Dishes
“Instead of asking what goes well with pork chops, ask what goes well with broccoli and sweet potatoes,” said Sally Scroggs, senior health education specialist in M. D. Anderson’s Cancer Prevention Center. “That way, your serving of meat becomes more of a side dish and not the center of the meal.”
“Red meat contains substances linked to colon cancer,” Scroggs said. “For example, some studies suggest that the heme iron (the compound that gives red meat its color) may increase the risk of developing colon cancer.”
AICR recommends that two-thirds of a meal consist of plant-based foods. Consuming less red meat and more plant-based foods can significantly decrease a person’s risks of developing colorectal cancer.
Don’t Eliminate Red Meat
Scroggs emphasizes that these recommendations are not meant to encourage people to completely eliminate red meat from their diet. “Consuming red meat in modest amounts is a valuable source of nutrients, including protein, iron, zinc and vitamin B12. Moderation is the key,” Scroggs said.
“According to the United States Department of Agriculture, Americans were eating an average of 36 ounces of red meat every week in 2007,” Scroggs said.
Scroggs recommends serving about three ounces (about the size of a deck of cards) of cooked red meat at meals. “If you follow this recommended serving size, you can include red meat in as many as six meals of your weekly diet.”
Avoid Processed Meats
AICR also recommends eating very little processed meat (meat preserved by smoking, curing, salting or adding chemical preservatives), such as ham, bacon, hot dogs, sausages, pastrami and salami. Every ounce and a half of processed meat eaten a day is thought to increase a person’s risks of developing colorectal cancer by 21 percent.
“It’s a good idea to avoid eating processed meats as much as possible,” Scroggs said. “Save that hot dog for special occasions, such as a family cookout or the ballpark.”
Colorectal cancer is the third most common cancer found in men and women in this country. The American Cancer Society estimates almost 150,000 new cases of colorectal cancer in the United States for 2008. Colorectal cancer is the second leading cause of cancer death among Americans but is considered a highly preventable disease.
For more information on colorectal cancer prevention strategies, visit http://www.mdanderson.org/cancerawareness.
University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd., Box 229
Houston, TX 77030
United States
http://www.mdanderson.org
Delay Of Aetna Sedation Restrictions Welcomed By AGA Institute
February 28, 2008
Aetna has announced that, based on input from the AGA Institute and discussions with a number of gastroenterologists, it will not implement Clinical Policy Bulletin 0740 on April 1, 2008, as planned. This policy would have restricted the use of an anesthesia professional in standard upper or lower endoscopic procedures, including colonoscopy, for average-risk patients.
Last month, we contacted Aetna on behalf of AGA members to express concern that this policy could negatively impact colorectal cancer screening rates, which are already discouragingly low. The AGA Institute commends Aetna for listening to our concerns. Aetna will now delay implementation until patient-friendly alternatives for sedation — which will not require an anesthesiologist — are approved by the FDA.
Along with our sister GI societies, we look forward to addressing concerns about payer sedation policies. Our goal is to ensure that payment policies do not pose a barrier to patients receiving medically necessary colorectal cancer screening and other endoscopic services.
“Aetna has engaged in an exchange of information and viewpoints with our society regarding the possible public health impact of this policy,” said Joel V. Brill, MD, AGAF, chair of the American Gastroenterological Association (AGA) Institute practice management and economic committee. “The AGA Institute commends Aetna for listening to our concerns. We are dedicated to working with all stakeholders involved to provide clear recommendations to physicians, patients, purchasers and payers regarding the appropriate use of sedation for endoscopic procedures.”
As noted in the August 2007 AGA Institute Review of Endoscopic Sedation. the AGA encourages practitioners to develop a structured sedation protocol suited to the needs of their patients and practice. We are committed to ensuring patients have access to medically necessary technologies, pharmaceuticals and services delivered by appropriately trained health-care professionals. Patients should feel confident that they are undergoing colorectal cancer screening and other endoscopic procedures in an environment that promotes safety, patient comfort and quality of care. Ultimately a qualified health-care practitioner should be the decision maker regarding the use and administration of sedation agents in conjunction with the patient.
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Source: Aimee Frank
American Gastroenterological Association
A Novel HMSH2 Gene Mutation In Colorectal Cancer Patients?
February 26, 2008
About 20% CRC patients have a genetic component and HNPCC is the most common autosomal dominant hereditary syndrome. Some Chinese HNPCC pedigrees were recently reported in the World Journal of Gastroenterology because of their great significance for hereditary CRC. This article will undoubtedly bring comfort to many families.
The article describes how five independent Chinese kindreds of HNPCC fulfilled the classical Amsterdam Criteria, as collected by Prof. Yulong He and Dr. Changhua Zhang of Sun Yet-san University in China. The research group has constructed a CRC database since 1994 and the follow-up rate has always been above 90%. Eleven independent Chinese kindreds of HNPCC were collected by deep pedigree investigation until January, 2004 and five of them fulfilled the classical Amsterdam Criteria. To identify high-risk populations with HNPCC, the group tested hMSH2 and hMLH1 mutation in these classical kindreds.
A novel hMSH2 gene mutation was found in one HNPCC kindred. In the kindred, there were four colorectal carcinoma patients in two successive generations, and three of them were diagnosed before the age of 45. The proband developed endometrial carcinoma at the age of 61, bladder carcinoma at 66 and CRC at 72, while his father got bladder carcinoma at the age of 70. In addition, one proband’s daughter had CRC at the age of 34 and died of synchronous hepatic metastasis. In the kindred, gene testing was performed on ten family members and four of them were found to have a mutation in hMSH2 at position A1808G. The mutation sequence variant was in exon 12 of hMSH2 gene, which is a missense mutation. It was a single nucleotide substitution of c.1808A-G, which resulted in Asp 603 Gly of hMSH2 (NCBI Ref. Seq. NM 000251 and NP 000242 for mRNA and protein, respectively). Three of them with this mutation had developed CRCs and one had no colorectal disease and was still in follow-up.
The results of this study suggest molecular pathological tests should be performed to identify individuals with hereditary non-polyposis CRC and at-risk family members of HNPCC. Although the novel mutation reported by Prof. Yulong He and Dr. Changhua Zhang has not been confirmed as a germline mutation yet, it may be an important factor for CRC development in kindreds. Close follow-up and intensive surveillance should be performed for those high risk family members.
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Reference: Zhang CH, He YL, Wang FJ, Song W, Yuan XY, Yang DJ, Chen CQ, Cai SR, Zhan WH.
Detection of hMSH2 and hMLH1 mutations in Chinese hereditary non-polyposis colorectal cancer kindreds.
World J Gastroenterol 2008; 14(2): 298-302http://www.wjgnet.com/1007-9327/14/298.asp
Correspondence to: Professor Yu-Long He, Department of Gastrointestinopancreatic Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China.
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
Source: Jing Zhu
World Journal of Gastroenterology
Simple Ways To Judge The Efficacy Of 5-Fluorouracil In Colonic Neoplasm
February 26, 2008
5-fluorouracil (5-FU) is a common chemotherapeutical drug. It exerts its antitumor effect through competitive thymidylate synthase (TS) inhibition. Thymidylate synthase (TS) catalyses deoxyuridine-5′-monophosphate (dUMP) to 2′-deoxythymydine-5′-monophosphate (dTMP). It is the only de novo source of thymidylate, an essential precursor of DNA biosynthesis. In the 5-untranslated region of TS gene, there a unique tandem repeated sequence. There are three predominant genotypes of TS: (1) Homozygous with two tandem repeats (2R/2R); (2) homozygous with three tandem repeats (3R/3R); (3) heterozygous with both alleles (2R/3R). It was reported that TS genes with the triple repeats have higher expression activity than those with double repeats in vitro and in vivo.
The critical role of TS in nucleotide metabolism has made it an important target for cancer chemotherapy. Intratumoral TS protein expression before the chemoradiation treatment has been observed to inversely correlate with the response to 5-FU chemotherapy. Patients with low TS levels have better clinical outcome than those with high TS levels. Detecting the intratumoral TS levels is important for patients who are going to receive 5-FU-based chemotherapy, as these can be used to forecast the efficacy of chemotherapy. However, the classical assay for TS-activity determination (high-performance liquid chromatography with output monitored by radioactive flow detector) is tedious and expensive. A simple way to detect the TS levels is necessary. A research article to be published on January 28, 2008 in the World Journal of Gastroenterology addresses this question.
Immunoreactivity score (IRS) is a semiquantitative analysis for detecting the immunostaining results. Dr.Wei-Xing Wang and his colleagues used monoclonal antibody TS106 to detect the TS protein in the paraffin-embedded specimens. The samples came from 68 colonic neoplasms of Han Chinese patients. At the same time, the team also observed the link between TS genotype and IRS of TS. Three genotypes of TS were found: 2R/2R (n = 6), 2R/3R (n = 22) and 3R/3R (n = 40). Patients who were homozygous for triple-repeated (3R/3R) sequences showed significantly higher IRS of TS than patients who were homozygous for double-repeated (2R/2R) sequences or heterozygous patients (2R/3R), but no statistical significance of IRS in cancer tissues was observed between 2R/3R genotype and 2R/2R genotype. These results suggested TS genotype may be a genetic factor which can be used to predict the patient’s response to 5-FU-based chemotherapy. The data might offer an advantage for selection of Chinese cancer patients to receive fluoropyrimidines treatment.
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Reference: Kai-Huan Yu, Wei-Xing Wang, You-Ming Ding, et al. Polymorphism of thymidylate synthase gene associated with its protein expression in human colon cancer [J]. World J Gastroenterol 2008 January 28; 14(4): 617-621http://www.wjgnet.com/1007-9327/14/617.aspCorrespondence to: Wei-Xing Wang, Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei province, China.
About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
Source: Jing Zhu
World Journal of Gastroenterology
U.S. Cancer Deaths Down But Far Too Few Americans Screened For Colon Cancer
February 21, 2008
New data revealing decreasing trends in cancer deaths in the United States overall, and in colorectal cancer deaths in particular, highlight the remarkable benefits of colorectal cancer screening tests, but the lifesaving potential of these tests is unrealized for many Americans, according to experts from the American College of Gastroenterology. Racial minorities, uninsured Americans and even Medicare patients who should be tested are not being screening appropriately, and other recent studies reveal that they are diagnosed with more advanced cancers compared to patients with private insurance.
Today, the American Cancer Society reported a downward trend in cancer deaths between 2004 and 2007. Deaths from cancer of the colon and rectum decreased from 1998 to 2004 among both men and women, according to ACS. The report attributes early detection to this sharp decline in colon cancer deaths. Early detection of colorectal cancer, when it is most treatable, directly results in improved survival, exceeding 90 percent when detected at the earliest stage.
According to ACG President Amy E. Foxx-Orenstein, D.O., FACG, “The good news is that colorectal cancer deaths are down, but marked differences in the experience of colorectal cancer, its impact on quality of life, and death rates are seen between whites and blacks, and between the uninsured, and even those with health coverage under Medicare and Medicaid.” According to Dr. Foxx-Orenstein, “The American College of Gastroenterology is committed to national policy changes to improve access to colorectal screening and increased use of these proven prevention strategies, including reversing Medicare’s massive cuts to reimbursement for these tests since the benefit was first introduced, as well as to payments in ambulatory surgery centers where many screening tests are performed.”
Recent Studies Reveal Underuse of Colorectal Screenings, Late Stage Cancer Diagnoses
An analysis published in ACS’ journal CANCER in January 2008 of over 150,000 Medicare beneficiaries revealed that only 25 percent received recommended screenings for colorectal cancer since Medicare started to cover preventive screening tests. This finding reflects a significant underuse of proven screening tests among Medicare patients, and echoes other recent findings that Medicaid patients and the uninsured generally are being diagnosed with colorectal cancer at later stages, when the prognosis is far worse.
A study by Halpern et al. published in The Lancet Oncology on February 18, 2008 found a correlation between insurance status and stage of cancer diagnosis. According to the Halpern analysis, uninsured patients were two to three times more likely to be diagnosed at late stages (Stage III or State IV) than at Stage I. The disparity was most pronounced among cancers that could be detected early through screening or symptom assessment including colorectal cancer. The analysis also looked at racial background and found late state diagnosis for ten of twelve cancers among African Americans compared to whites.
ACG Recommends Earlier Screening for African Americans: Begin at Age 45
African-Americans are diagnosed with colorectal cancer at a younger age than other ethnic groups, and African-Americans with colorectal cancer have decreased survival compared with other ethnic groups. Physician experts from the American College of Gastroenterology in 2007 issued new recommendations to healthcare providers to begin colorectal cancer screening in African-Americans at age 45 rather than 50. Colonoscopy is the preferred method of screening for colorectal cancer and data support the recommendation that African-Americans begin screening at a younger age because of the high incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancerous lesions in this population. The recommendations were published in the March 2007 issue of The American Journal of Gastroenterology.
Colorectal Cancer Screening Recommendations from the American College of GastroenterologyFor normal risk individuals, the American College of Gastroenterology recommends screening beginning at age 50 (age 45 for African-Americans). The preferred screening test according to the American College of Gastroenterology is colonoscopy every 10 years. An alternative strategy for average risk individuals is an annual stool test for blood, and a flexible sigmoidoscopic exam every 5 years. Unlike colonoscopy, this approach does not allow identification and removal of polyps in the entire colon.
For those with a family history of colorectal cancer, testing should begin at 40 years of age or 10 years younger than the age of the youngest affected relative at the time of colon cancer diagnosis, whichever is earlier. For both average and high risk individuals, all potential precancerous polyps should be removed.
About Colorectal Cancer
Colorectal cancer is the number two cancer killer in the United States, affecting men and women equally. However, with screening and early detection, many of these deaths can be prevented. Most colorectal cancers develop from polyps, which are abnormal growths in the colon. Left undetected and free to grow, some polyps may develop into cancer. Screening tests can find and remove pre-cancerous polyps before they turn into cancer.
About the American College of Gastroenterology
Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 10,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients.
American College of Gastroenterology (ACG)
6400 Goldsboro Rd., Ste 450
Bethesda, MD 20817
United States
http://www.acg.gi.org
The Facts African Americans Need To Know About Colon Cancer
February 16, 2008
Each year more than 150,000 people in the United States are diagnosed with colon cancer and over 50,000 will die from the disease. Death rates from colon cancer are higher among African Americans than any other population group in the U.S. The American Society for Gastrointestinal Endoscopy (ASGE), representing the specialists in colon cancer screening, advises African Americans to speak to their physician about getting screened for colon cancer.
“Colon cancer is preventable with regular screening and is curable when detected early,” said ASGE President Grace H. Elta, MD, FASGE. “All men and women are at risk for colon cancer and should begin screening for the disease at age 50. It concerns me that African Americans are being diagnosed with colon cancer at a higher rate than other populations. This disease does not discriminate against race or gender; your age is the single most important risk factor. I encourage African Americans to talk to their doctor about colon cancer screening.”
Colorectal cancer, also referred to as colon cancer, is cancer of the colon or rectum and is the second-leading cause of cancer deaths in the U.S. for men and women combined. Colorectal cancer is the third most common cancer among African American men and women, with more than 16,000 cases estimated to be diagnosed each year and approximately 7,000 deaths annually. Some people are at a higher risk for the disease because of age, lifestyle or personal and family medical history. People who are diagnosed at early stages have a 90 percent chance of a cure and surviving. That is why screening for prevention and early detection is so important. Some studies have shown that African Americans are more frequently diagnosed with colon cancer at a younger age, leading some experts to suggest that African Americans begin screening prior to age 50. African Americans should ask their physician about an appropriate screening schedule.
Polyps are grapelike growths on the lining of the colon or rectum that may become cancer. These polyps can be removed to prevent cancer from occurring. Colonoscopy, when performed by a well-trained endoscopist, gastroenterologist or surgeon, is the most effective screening test. Colonoscopy plays an important role in colon cancer prevention because precancerous polyps can be removed when they are discovered during the procedure.
Here are a few important facts African Americans need to know about colon cancer:
— The rate of being diagnosed with colon cancer is higher among African Americans than among any other population group in the U.S.
— Death rates from colon cancer are higher among African Americans than any other population group in the U.S.
— Colon cancer is the third most common cancer among African Americans, with more than 16,000 cases estimated to be diagnosed each year and approximately 7,000 deaths annually.
— There is evidence that African Americans are less likely than Caucasians to have screening tests for colon cancer.
— African Americans are less likely than Caucasians to have colorectal polyps detected at a time when they can easily be removed.
— African Americans are more likely to be diagnosed with colon cancer in advanced stages when there are fewer treatment options available. They are less likely to live five or more years after being diagnosed with colon cancer than other populations.
— Diet, tobacco use and a lack of access to equal medical treatment options may increase African Americans’ risk of developing colon cancer.
— There may also be genetic factors that contribute to the higher incidence of colon cancer among some African Americans. Learn your family’s medical history and tell your health care professional if a relative — parent, brother, sister or child — has had colon cancer or colorectal polyps.
— African American women have the same probability of getting colon cancer as men, and are more likely to die of colon cancer than are women of any other population group.
— African American patients experience a larger number of polyps on the right side of the colon, versus the left. A screening endoscopy must cover the entire colon, as is performed with a colonoscopy.
For more information about colorectal cancer screening or to find a qualified physician, visit ASGE’s colorectal cancer awareness Web site at http://www.screen4coloncancer.org.
About the American Society for Gastrointestinal Endoscopy
Founded in 1941, the mission of the American Society for Gastrointestinal Endoscopy is to be the leader in advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 10,000 physician members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit http://www.asge.org and http://www.screen4coloncancer.org for more information.
About Endoscopy
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system. In many cases, screening or treatment of conditions can be delivered via the endoscope without the need for further sedation, treatment or hospital stay.
American Society for Gastrointestinal Endoscopy
http://www.asge.org
Earlier Colon Cancer Screening Recommended For Smokers
February 16, 2008
New evidence suggests screening for colorectal cancer, which is now recommended to begin at age 50 for most people, should start five to 10 years earlier for individuals with a significant lifetime exposure to tobacco smoke, a University of Rochester Medical Center study said.
An examination of 3,450 cases found that current smokers were diagnosed with colon cancer approximately seven years earlier than people who never smoked. The study is also one of the first to link exposure to second-hand smoke, especially early in life, with a younger age for colon cancer onset.
The article appears online in the Journal of Cancer Research and Clinical Oncology.
“The message for physicians and patients is clear: When making decisions about colon cancer screening you should take into account smoking history as well as family history of disease and age,” said lead author Luke J. Peppone, Ph.D., research assistant professor of Radiation Oncology at the James P. Wilmot Cancer Center at the University of Rochester.
Peppone’s group examined data from patients diagnosed with colorectal cancer between 1957 and 1997 at Roswell Park Cancer Institute in Buffalo. (Peppone joined the University of Rochester in 2007, coming from RPCI. Co-authors are from RPCI.)
Over the 40-year period smoking habits changed, with a decrease in the percentage of current or active smokers and an increase in the percentage of former smokers. Still, the age at colon cancer diagnosis was 6.8 years younger among current smokers and 4.3 years younger for former smokers who quit less than five years ago, the results showed. People who quit more than five years ago had no significant increased risk.
However, people who reported they began smoking as young teens (before age 17) or who smoked heavily (1 pack a day or more) were the most likely to be diagnosed with cancer much younger than their never-smoking counterparts. Past exposure to second-hand-smoke was an additional, significant risk factor, compared to never smoking. In fact, when active smokers and passive smoking were combined into one subgroup, the age at cancer diagnosis was nearly 10 years earlier, Peppone said.
Although smoking is a well-known risk factor for many cancers, only recent studies have suggested that cigarettes may cause colon cancer.
The biological reasons for the cigarette smoke-colon cancer risk are unclear. However, researchers believe that cigarette smoke reduces the body’s resistance to malignancies, just as smoking can depress immune function in general, impairing the ability to fight off infections and viruses. Carcinogens from smoke reach the bowel through direct circulation or by swallowing smoke and passing it through the intestines.
Colorectal cancer is the third most commonly diagnosed cancer among men and women. Genetics account for about 10 percent of new cases, the study said, while more than 75 percent of the cases arise from sporadic mutations and/or environmental and lifestyle factors such as smoking, a poor diet, alcohol use, lack of exercise and obesity.
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The National Cancer Institute funded the research.
Source: Leslie Orr
University of Rochester Medical Center
