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Familial adenomatous polyposis (FAP) is a rare autosomal dominant inherited disease caused by APC tumor suppressor gene mutation. The result of the mutation is dysfunctional control of the intestine mucosa cell proliferation. The risk of cancer's development in these mutation carriers is almost 100%. Because of the late occurrence of the first symptoms, most of the patients seek medical attention when the disease is advanced, even progressed to large intestine's cancer. FAP's diagnostics is based on both clinical and genetic assessment. Positive family history is an indication for surgical treatment and oncological supervision of the patient. The treatment of choice is a total colectomy (TC) with making ileal pouch-anal anastomosis (IRA) or proctocolectomy with the formation of an ileostomy (IPAA). We present a case report of a 30 years old woman with metastatic large intestine cancer (pT4bN1cM1). The patient has a positive family history. She had been diagnosed with FAP at the age of 18 and refused prophylactic surgical treatment then. The TC with greater omentum resection was performed. In the abdominoperineal act, the rectum with tumor, uterus, part of posterior vagina's wall, left adnexa, and parametrium were resected either. The definitive ileostomy was created. No complications during the early postoperative period were observed. The patient was given recommendations and discharged from the hospital. The operation in patients with FAP is the only way to avoid cancer development and to maintain a relatively good quality of life. The availability of less radical, rectum sparing methods must be presented to each patient at an early stage of the disease. The intensification of the FAP patients' education to achieve a better awareness in order to decrease the cancer transformation rate is needed. The challenge remains to standardize the treatment regimen in the early stages of FAP treatment and to maintain a registry of FAP patients in order to coordinate the care. [ABSTRACT FROM AUTHOR]

Radiotherapy is an important adjuvant treatment for large intestine cancer even though it does not cause any response in many patients. The present study aimed to investigate the effects of the TTN antisense RNA 1 (TTN‐AS1) long noncoding RNA (lncRNA) on radiotherapy dynamics of large intestine cancer cells and to explore the underlying molecular mechanisms. TTN‐AS1 expression was evaluated by reverse‐transcription quantitative polymerase chain reaction, western blot, and cellular immunofluorescence, and flow cytometry analysis was used to measure apoptosis. Radiotherapy was simulated in vitro by exposing cancer cells to X‐ray. TTN‐AS1 was highly expressed in large intestine cancer cells after an X‐ray exposition for 24 hr. TTN‐AS1 knockdown improved the radiosensitivity of large intestine cancer cells and promoted apoptosis by increasing Bax/Bcl2 protein expression and the active‐caspase 3/caspase 3 ratios following X‐ray treatment. In addition, TTN‐AS1 negatively regulated miR‐134‐5p expression, and miR‐134‐5p‐mimic transfection decreased PAK3 protein expression in large intestine cancer cells. Importantly, TTN‐AS1 promoted PAK3 and P21 protein expression in HT29 cells after X‐ray treatment. Moreover, the knockdown of P21 protein expression improved radiosensitivity and promoted X‐ray‐induced apoptosis of HT29 cells. Finally, PAK3 knockdown expression decreased the p‐AKT/AKT and p‐GSK‐3β/GSK‐3β ratios and promoted the β‐catenin transfer from the nucleus to the cytoplasm. These data suggest that the TTN‐AS1 lncRNA promoted resistance to radiotherapy of large intestine cancer cells by increasing PAK3 expression via miR‐134‐5p inhibition, and this may be related to the P21 and AKT/GSK‐3β/β‐catenin pathway. [ABSTRACT FROM AUTHOR]

Apatinib, a novel small molecule tyrosine kinase inhibitor that inhibits vascular endothelial growth factor receptor-2, was approved for metastatic gastric adenocarcinoma in China in Oct 2014. This is the first report on its use for advanced colorectal cancer as a kind of third-line therapy to date. Here we report two Chinese patients who presented with metastatic colorectal cancer who received apatinib 850 mg daily as a third-line therapy. Both the patients achieved favorable benefits in outcomes after the administration of apatinib. Patient 1 benefited 4 months progression-free survival and 11 months overall survival, while patient 2's progression-free survival was over 10 months. Both the patients presented hand-foot syndrome, and one of them suffered a slight impairment of liver function, mild elevated blood pressure, and proteinuria. But these adverse events were manageable with symptomatic treatment and dose reduction or a short-time drug withdrawal. [ABSTRACT FROM AUTHOR]

Background: In colon cancer, the number of harvested lymph nodes is critical for pathological staging. It has been proposed that the more central the mesenteric vascular ligation, the greater the nodal yield. The aim of the current study was to determine the association of radiological and pathological ileocolic pedicle length on nodal harvest following right hemicolectomy for caecal cancer. Methods: A series of 50 patients undergoing right hemicolectomy for adenocarcinoma underwent specimen evaluation. Preoperative computed tomography images were reconstructed and analysed to determine the direct (vessel origin to caecum) ileocolic pedicle length. Results: The median pathological distance from the tumour to the high vascular tie was 80 mm, and median nodal yield was 16.5 nodes. Radiological pedicle length did not correlate with the pathological distance from the tumour to the high vascular tie or nodal yield; however, the pathological pedicle length did correlate with the total nodal yield ( r: 0.343, p = 0.015). The median pathologically determined length of colon resected ( r: 0.153, p = 0.289), ileum resected ( r: 0.087, p = 0.568) and total specimen length resected ( r: 0.182, p = 0.205) did not correlate with the total nodal yield. An ileal specimen length ≤25 mm [hazard ratio (HR) 14.8, 95 % confidence interval (CI) 1.1-194.5, p = 0.040] and a well-differentiated tumour (HR 10.5, 95 % CI 1.1-95.9, p = 0.037) increased the likelihood of retrieving <12 lymph nodes. Conclusions: Based on these data, pathologic pedicle length is a determining factor in lymph node retrieval. Preoperative radiological calculation of pedicle length does not help predict the number of lymph nodes retrieved. [ABSTRACT FROM AUTHOR]

Background:Frequently, subjects offered colonoscopy due to symptoms of colorectal neoplasia are diagnosed with diverticula. The symptoms may, however, also be related to extra-colonic neoplasia. The present retrospective study evaluated a possible association between increased levels of predefined biomarkers in subjects diagnosed with diverticula and risk of developing a primary malignant disease. Methods:During 2004/2005, about 4509 subjects were included in a multicenter study with collection of blood samples before bowel endoscopy. The aim was to evaluate a relation between the protein biomarkers CEA, TIMP-1, CA19-9 and YKL-40 and findings at endoscopy. Diverticula were diagnosed in 1021 subjects. By 31 December 2012, subjects who had developed primary malignancy were identified retrospectively and relation between biomarker levels at endoscopy and risk of developing primary malignancy was calculated. The relation with the four biomarkers was divided into three groups: 0 = none increased; 1 = one increased and 2 = two or more increased. Results:In the observation period, 148 subjects developed a primary malignant disease. Univariable analyzes of the biomarker levels showed that CEA, TIMP-1 and CA19-9 were significantly associated with development of primary malignancy. A multivariable analysis showed that increased levels were associated with development of malignancy (p < 0.0001). The 1- and 5-year cumulative risks of being diagnosed with a primary malignancy were: group 0: 1.1%/5.5%; group 1: 4.2%/10.1% and group 2: 11.4%/18.8%, respectively. Conclusion:Increased levels of CEA, TIMP-1 and CA19-9 at endoscopy with findings of diverticula were associated with a significantly increased risk of being diagnosed with a subsequent primary malignant disease. [ABSTRACT FROM PUBLISHER]

Introduction: Large intestine is affected by various types of lesions, both non-neoplastic and neoplastic. Due to vague symptoms, the clinical diagnosis is usually delayed. A battery of laboratory tests including biopsy is essential to arrive at a specific diagnosis for appropriate management. Materials and Methods: This five years study was done during the period of 2005 to 2010 in a tertiary care centre which included 124 biopsies and resected specimens of large intestine and 64 from Anal canal. All tissues were fixed in formalin, stained with H&E and special stains like Periodic Acid Schiff (PAS), Reticulin, Zeihl Neelsen (ZN) along with Immunohistochemistry (IHC) were done as and when required. Results: Out of the 124 cases of large intestine 38 were nonneoplastic, 77 were neoplastic and 9 were inadequate biopsies. Sixty four cases from Anal canal included 55 non-neoplastic and 9 neoplastic lesions. The non-neoplastic conditions included congenital anomalies, infective and ischaemic lesions while neoplastic included benign and malignant lesions. Most of the cases presented with symptoms like abdominal pain, vomiting and constipation. Conclusion: We observed that neoplastic lesions were more common in large intestine while non-neoplastic lesions were frequently seen in Anal canal. Present study emphasizes the need for early histopathological diagnosis for appropriate treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND Heat shock protein 60 (Hsp60) is a chaperonin involved in tumorigenesis, but its participation in tumor development and progression is not well understood and its value as a tumor biomarker has not been fully elucidated. In the current study, the authors presented evidence supporting the theory that Hsp60 has potential as a biomarker as well as a therapeutic target in patients with large bowel cancer. METHODS The authors studied a population of 97 subjects, including patients and controls. Immunomorphology, Western blot analysis, and quantitative real-time polymerase chain reaction were performed on tissue specimens. Exosomes were isolated from blood and characterized by electron microscopy, biochemical tests, and Western blot analysis. RESULTS Hsp60 was found to be increased in cancerous tissue, in which it was localized in the tumor cell plasma membrane, and in the interstitium associated with cells of the immune system, in which it was associated with exosomes liberated by tumor cells and, as such, circulated in the blood. An interesting finding was that these parameters returned to normal shortly after tumor removal. CONCLUSIONS The data from the current study suggested that Hsp60 is a good candidate for theranostics applied to patients with large bowel carcinoma and encourage similar research among patients with other tumors in which Hsp60 has been implicated. Cancer 2015;121:3230-3239. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

Sodium and potassium regulate the total amount of water in the body and the transmission of sodium into and out of individual cells also plays a role in critical body functions. The movement of sodium is critical in generation of these electrical signals. Research was conducted on samples taken from women and men aged 20-90 years, derived from the stomach, small intestine and large intestine. Samples were dried at 80?C for 24 hours, and then increased temperature to 105?C and dried for seven days until dry mass was obtained. All dry material of each sample was weighted and placed in a separate mineralization tubes and mixed with 1 cm3 of 65% HNO3 and heated at 105?C for 120 minutes in a thermostat-controlled digestion block, VELP Scientifica DK 20. Metals such as sodium and potassium were detected using FAAS method. The average content of sodium in patients diagnosed with stomach cancer is lower, than in healthy person. Indicate higher mean content of sodium in the control tissues of stomach (2151,730 ?g?g-1d.m.), compared to a sodium content in tissues adjacent to the tumor (1813,958 ?g?g-1d.m.) and tumor tissues (2029,442 ?g?g-1d.m.). In the case of colon, control tissues have lower average content of sodium (2160,886 ?g?g-1d.m.), than the tissues surrounding the tumor (3325,963 ?g?g- 1d.m.) and tumor tissues (3037,121 ?g?g-1d.m.). The potassium level is higher in the control tissues of stomach (1428,993 ?g?g-1d.m.), than in the tissues adjacent to the tumor (1091,544 ?g?g-1d.m.) and tumor tissues (1220,471 ?g?g-1d.m.). In the large intestine higher average content of potassium is characterized by tumor tissues (2307,234 ?g?g-1d.m.) and tissues adjacent to the tumor (1712,779 ?g?g- 1d.m.), than control tissue (1389,703 ?g?g-1d.m.). Comparing this relationship with data on potassium channels, it can be assumed that in the some case of malignant transformation in the colon, potassium channels also play a big role. [ABSTRACT FROM AUTHOR]

Aim of the study: Cyclooxygenase-2 (COX-2) expression has been observed in a substantial percentage of classical adenomas of the large bowel. The aim of the study was to assess and compare the expression of COX-2 in serrated polyps of the colon. Material and methods: One hundred and nineteen serrated polyps were analyzed. There were 83 hyperplastic polyps (HP), 19 sessile serrated polyps (SSP) and 17 traditional serrated adenomas (TSA). COX-2 expression was assessed semi-quantitatively (0-2) and each lesion was fully characterized in terms of anatomical location, size, histology, age and sex of the patient. The general estimating equation (GEE) model with logit link was used in the statistical analysis. Results: Epithelial expression of COX-2 was found in 85/119 serrated polyps (71.43%): 57/83 (68.67%) HP, 16/19 (84.21%) SSP, and 12/17 (70.59%) TSA. In HP and SSP it was predominantly of weak (49/83 HP, 12/19 SSP), whereas in TSA it was mainly of medium/ strong intensity (8/17). The TSA category was associated with more frequent COX-2 expression (OR = 7.00, 95% CI: 1.49-32.88, p = 0.014) than HP, but such relation was not found for SSP vs. HP (p > 0.1). No associations between COX-2 expression and clinical parameters were found. Conclusions: Immunohistochemical COX-2 expression cannot serve as a diagnostic adjunct to differentiate HP and SSP. [ABSTRACT FROM AUTHOR]

Background: Large intestine malignances basically can be defined as cancer of the large bowel. It includes all malignant conditions originating from the ileocaecal valve down to the anus. In the year 2000, colorectal cancer was ranked the third most common form of cancer in adults world-wide in terms of incidence. This study aimed to document the profile of large intestine malignancies and early treatment outcomes among patients attended in major hospitals in Dar es Salaam, Tanzania. Methods: This was a one year hospital based retrospective cross sectional study conducted by using a structured data collecting tool. The data were analyzed using SPSS software. Results: A total of102 patients with Large intestine malignances were enrolled in our study. Both sexes were affected equally. The overall mean age was 51.23 (SD ± 15.5) years with a range of 22 to 80 years with those aged between 60 to 79 being the most affected group by 40.2%. Most tumours were located in the rectum and anal canal constituting 49.3% in males and 50.7% in females. DUKES C accounted for 79.4% of the cases with Adenocarcinoma being the commonest histopathological diagnosis accounting for 82.4% of the cases with Colo-Rectal tumours. Hemicolectomy was the most performed surgery by 57.1% with good outcomes at a follow up of thirty days. Only one death occurred in patient who underwent a low anterior resection. Conclusion: From our study Large bowel malignancy is no longer a rare condition with no gender bias. Majority of our patients with large intestine malignances still presents with advanced disease, we therefore call for high index of suspicion among clinicians for early diagnosis and prompt treatment to improve survival of patients. [ABSTRACT FROM AUTHOR]

Background: A clinical study was designed that aimed to analyze whether resection of the large bowel in cancer patients might benefit diabetes mellitus. Methods: This prospective case-control study included retrospective information. Patients ( n = 247) included diabetic and euglycemic groups with colorectal cancer operations ( n = 60), cancer gastrectomy ( n = 72), exclusive chemoradiotherapy for rectal cancer ( n = 46), and noncancer clinical controls ( n = 69). Follow-up periods were, respectively, 79.2 ± 27.4, 86.8 ± 25.1, 70.0 ± 26.3, and 85.1 ± 18.2 months (NS). Diabetes groups included patients with prediabetes. Results: Diabetes remission, defined as conversion from diabetes to prediabetes or from this condition to normal, was documented in, respectively, 32.4 % (11 of 34), 41.2 % (14 of 34), 7.1 % (1 of 14), and 7.7 % (3 of 39) in the four cohorts ( P = 0.004). Within the same period, progression of euglycemic participants to diabetes occurred in 30.8 % (8 of 26), 63.2 % (24 of 38), 25.0 (8 of 32), and 20.0 % (6 of 30) ( P = 0.028). Diabetes amelioration was associated with weight loss in gastrectomy patients but not in the other groups. Dietary intake, estimated in the two surgical populations, did not predict outcome. Conclusions: Diabetes amelioration after colorectal interventions was demonstrated, but progression of euglycemic patients toward prediabetes was not changed in comparison with nonsurgical controls. It is speculated that reshaping of the bowel microbiome or hormone changes after colorectal interventions underlay the improvement in diabetes. Body weight fluctuations could not be incriminated in this investigation. [ABSTRACT FROM AUTHOR]

Background: The French national screening programme for colorectal cancer (CRC) was rolled out nationwide from 2008. It targets men and women aged 50-74 who are invited every 2 years to perform a guaiac faecal occult blood test, followed, if positive, by a colonoscopy. This paper presents the evaluation of the programme for the 46 French districts that conducted a comprehensive screening campaign during 2008-2009, targeting 9.7 million people. Methods: National database gathering information on people who were screened was used to estimate indicators reflecting the programme performance. Results: Participation was 34.3%, with nearly three million people being tested. The percentage of positive tests was 2.8%. Completion of colonoscopies following a positive test was 88%. For men, 36.8% of the results of colonic explorations were normal, 40.1% were adenomas, and 9.0% were CRC, based on the most pejorative lesion. For women, corresponding figures were 55.9%, 25.7% and 5.8%. A CRC was detected for 7.5% of people who had a colonic exploration. The advanced adenoma detection rate among those screened was 4.9‰ and the CRC detection rate was 1.9‰. The description of CRC could only be made for 21 districts, for which 1441 invasive colonic adenocarcinomas were diagnosed; of these, 43% were stage I, 23% stage II, 25% stage III and 9% stage IV. Conclusion: This first evaluation since the programme was rolled out provides an inventory of CRC screening in France and points out some improvements expected, especially in terms of participation which is below the European recommendations. Future evaluations will analyse trends in these indicators. [ABSTRACT FROM AUTHOR]

Background: Participation in screening tests for colorectal cancer (CRC) is generally low in Ontario, Canada. In addition, inequities in participation exist including lower participation among low-income individuals, males and individuals living in rural areas. In April 2008, Colon Cancer Check (CCC) program, the province-wide CRC screening program, was launched in Ontario. This study describes the trends and inequities in CRC screening participation three years before and three years after the CCC, and assesses the effect of the program on CRC screening participation, overall and among certain population groups. Methods: We used administrative data to identify cohorts of individuals eligible for CRC screening in fiscal years 2005-2011. We calculated the age-standardized percent of Fecal Occult Blood Test (FOBT) participation, large bowel endoscopy participation, and being 'up-to-date' with CRC screening tests. Results: From 2005 to 2011, FOBT participation increased from 7.6% to 14.8%, large bowel endoscopy participation from 3.4% to 5.7%, and 'up-to-date' with CRC screening from 27.2% to 41.3%. Before the launch of the CCC program, the quarterly increase in FOBT participation was 0.07% (p = 0.19), increased immediately after the launch (1.8%, p < 0.01), followed by a decline ( -0.08%, p = 0.08), returning to its pre-program increase rate. We noted a significant decrease in FOBT participation every summer ( -0.44%, p < 0.01). The CCC program had minimal effect on large bowel endoscopy participation. Before the launch of the CCC program, the quarterly increase in 'up-to-date' with CRC screening was 0.9% (p < 0.01), increased immediately after the launch (2.5%, p = 0.05), followed by a modest decline thereafter ( -0.59%, p < 0.02). From 2005 to 2011, recent residents living in low-income neighborhoods were consistently and significantly less likely to have a FOBT and be 'up- to-date' with CRC screening than long-term residents living in high-income neighborhoods (2.9-4.5%; 14.7-17.3% respectively). Pre-CCC inequities in CRC participation persisted after the launch of the program. Conclusion: CRC testing was increasing in Ontario from 2005. An immediate increase in CRC testing, FOBT in particular, occurred after the launch of the CCC program, followed by a return to its pre-CCC increase rate thereafter. Future efforts are needed to improve screening participation and address inequities. [ABSTRACT FROM AUTHOR]

Background: Growing awareness of the potential to predict a person's future risk of cancer has resulted in the development of numerous algorithms. Such algorithms aim to improve the ability of policy makers, doctors and patients to make rational decisions about behaviour modification or surveillance, with the expectation that this activity will lead to overall benefit. There remains debate however, about whether accurate risk prediction is achievable for most cancers. Methods: We conducted a brief narrative review of the literature regarding the history and challenges of risk prediction, highlighting our own recent experiences in developing tools for oesophageal adenocarcinoma. Results and conclusions: While tools for predicting future risk of cardiovascular outcomes have been translated successfully to clinical practice, the experience with cancer risk prediction has been mixed. Models have now been developed and validated for predicting risk of melanoma and cancers of the breast, colo-rectum, lung, liver, oesophagus and prostate, and while several of these have adequate performance at the population-level, none to date have adequate discrimination for predicting risk in individual patients. Challenges of individual risk prediction for cancer are many, and include long latency, multiple risk factors of mostly small effect, and incomplete knowledge of the causal pathways. [ABSTRACT FROM AUTHOR]

Objective: To adjust an excess hazard regression model with a random effect associated with a geographical level, the Département in France, and compare its parameter estimates with those obtained using a "fixed-effect" excess hazard regression model. Methods: An excess hazard regression model with a piecewise constant baseline hazard was used and a normal distribution was assumed for the random effect. Likelihood maximization was performed using a numerical integration technique, the Quadrature of Gauss-Hermite. Results were obtained with colon-rectum and thyroid cancer data from the French network of cancer registries. Result: The results were in agreement with what was theoretically expected. We showed a greater heterogeneity of the excess hazard in thyroid cancers than in colonrectum cancers. The hazard ratios for the covariates as estimated with the mixed-effect model were close to those obtained with the fixed-effect model. However, unlike the fixed-effect model, the mixed-effect model allowed the analysis of data with a large number of clusters. The shrinkage estimator associated with Département is an optimal measure of Département-specific excess risk of death and the variance of the random effect gave information on the within-cluster correlation. Conclusion: An excess hazard regression model with random effect can be used for estimating variation in the risk of death due to cancer between many clusters of small sizes. [ABSTRACT FROM AUTHOR]

Introduction: Colonic metastasis following curative surgery for renal cell carcinoma has rarely been described in the literature. Case Presentation: We present a case of a 64-year-old man who previously had a left nephrectomy for renal cell carcinoma. Five months post-operatively the patient presented with microscopic intestinal bleeding and anemia. Colonoscopic surveillance revealed a metastatic lesion in the ascending colon, and a right hemicolectomy was subsequently performed. Discussion: Colonic metastasis following resection for renal cell carcinoma is a rare entity, as evidenced by its lack of description in the literature. Imaging scans, such as computed tomography, have little diagnostic value and an increased medical suspicion is warranted for prompt diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution's experience with this and propose a treatment algorithm based on the best available evidence. Methods: From 2000 to 2011, a retrospective review of institutional databases was performed to identify patients with synchronous prostate and rectal cancers where the rectal cancer lay in the lower two thirds of the rectum. Operative and non-operative outcomes were analysed and a management algorithm is proposed. Results: Twelve patients with prostate and rectal cancer were identified. Three were metachronous diagnoses (>3-month time interval) and nine were synchronous diagnoses. In the synchronous group, four had metastatic disease at presentation and were treated symptomatically, while five were treated with curative intent. Treatment included pelvic radiotherapy (74 Gy) followed by pelvic exenteration (three) and watchful waiting for rectal cancer (one). The remaining patient had a prostatectomy, long-course chemoradiotherapy and anterior resection. There were no operative mortalities and acceptable morbidity. Three remain alive with two patients disease-free. Conclusions: Synchronous detection of prostate cancer and cancer of the lower two thirds of the rectum is uncommon, but likely to increase with rigorous preoperative staging of rectal cancer and increased awareness of the potential for synchronous disease. Treatment must be individualized based on the stage of the individual cancers taking into account the options for both cancers including EBRT (both), surgery (both), hormonal therapy (prostate), surgery (both) and watchful waiting (both). [ABSTRACT FROM AUTHOR]

The number of large intestine cancer patients has been increasing steadily. An endoscope can be used to diagnose as well as to treat the diseased part of the intestine. A large intestine endoscope is used mainly to examine cancer of the large intestine. However, many doctors have problems handling an endoscope. To resolve this issue, there is demand for a robotic application to assist in inserting the endoscope and straightening the slack from the intestine. We propose a robot that imitates the peristaltic crawling of an earthworm and uses an artificial rubber muscle as an actuator. By attaching the robot to an existing endoscope, it will be possible to move the endoscope forward and pull up the intestine simultaneously, while retaining the functions of the existing endoscope. In this paper, we test the forward and pulling movements of a sliding-air-tube robot in a large intestine of model to evaluate its performance. From these experiments, the robot equipped with the endoscope of 11 mm in the diameter can be moved at the speed that satisfies it. Further, air-emit function is added to this robot and its performance in the large intestine of a dead swine is evaluated. Result of accomplishing experiment by using imitation of endoscope of 8 mm, this robot showed that it had the ability to move the endoscope. [ABSTRACT FROM PUBLISHER]

Neuroendocrine carcinoma (NEC) of the anal canal is exceedingly rare and its histogenesis is poorly understood. We present a case of small-cell NEC of the anal canal in a 70-year-old woman. The NEC appeared as a submucosal tumor at the dentate line and was associated with squamous intraepithelial neoplasia (SIN). The NEC was positive for neuroendocrine markers including synaptophysin, chromogranin A and CD56, whereas the SIN component did not express any of these markers. Both components exhibited p16 overexpression. A PCR analysis revealed that both the SIN and NEC components were positive for human papillomavirus (HPV) 18 DNA. Our observations imply that SIN may be a precursor of anal canal NEC and that HPV18 may play an important role in the histogenesis of anal canal NEC, similar to its role in cervical NEC. [ABSTRACT FROM AUTHOR]

Abstract: The bioavailability of the minor Fusarium mycotoxins enniatins (ENs) utilizing an in vitro method which allows the simulation of the small and large intestine tracts has been studied. This method, based on the application of the Caco-2 cells grown alone or in symbiosis with several strains characteristics of the gastrointestinal tract, has permitted to simulate the duodenal and colonic intestinal compartments, respectively. The duodenal bioavailability expressed as absorption value after 4h of exposure, ranged from 57.7 to 76.8% for EN A, from 68.8 to 70.2% for EN A1, from 65.0 to 67.0% for EN B, and from 62.2 to 65.1% for EN B1. Colonic bioavailability after 48h of incubation ranged from 17.3 to 33.3% for EN A, from 40.8 to 50.0% for EN A1, from 47.7 to 55.0% for EN B, and from 52.4 to 57.4% for En B1. The highest duodenal and colonic bioavailability was observed after Caco-2 cells exposed to EN A, ENs B and B1, respectively. [Copyright &y& Elsevier]

Purpose: To evaluate the long-term efficacy of concurrent radiotherapy with mitomycin-C (MMC)–based or cisplatin (CP)-based combinations in a cohort of patients with locally advanced anal canal carcinoma. Methods and Materials: Between 1988 and 2000, 179 patients with locally advanced anal canal carcinoma were treated at the Instituto Nacional de Câncer with two cycles of chemotherapy during Weeks 1 and 5 of radiotherapy. 5-Fluorouracil (750 mg/m2 120-hour infusion or 1,000 mg/m2 96-hour infusion) plus CP (100 mg/m2) on the first day of each cycle or MMC (10–15 mg/m2) on the first day of Cycle 1 was administered concurrent with radiotherapy (total dose, 55–59.4 Gy). Of the 179 patients, 60% were included from a randomized trial initiated at the Instituto Nacional de Câncer in 1991 that compared concurrent chemoradiotherapy with MMC vs. CP. Results: The median follow-up for the whole chemoradiotherapy group was 83 months. The median patient age was 58 years, 57% had Stage T3-T4 tumors, and 35% had N-positive disease. The 5-year cumulative colostomy rate was not significantly different between the CP group (22%) and MMC group (29%; p = .28). The actuarial 10-year overall survival and disease-free survival rate for the CP group was 54% and 49% and for the MMC group was 52% and 53%, respectively (p = .32 and p = .92, respectively). On multivariate analysis, male gender (p = .042) and advanced Stage T3-T4 disease (p <.0001) were statistically significant for worse disease-free survival. Stage T3-T4 (p = .039) and N+ (p = .039) disease remained independently significant for overall survival. Conclusion: Long-term follow-up has confirmed the good results of chemoradiotherapy with CP plus 5-fluorouracil, which seem to provide results equivalent to those with MMC plus 5-fluorouracil. [ABSTRACT FROM AUTHOR]

Cancer of large bowel, colon and rectum is among the most frequent cancers in Western Europe. The diagnosis of colorectal cancer is possible mostly as a direct result of using videoendoscopy and having the possibility of taking colonic biopsies. To assess and correlate the endoscopic and histopathological parameters of malign colorectal tumors. 230 patient diagnosed at endoscopy with colonic tumors tumors between 2007 and 2009 in the Endoscopy Department of the 3rd Medical Clinic from Oradea were analyzed. We studied the epidemiological parameters, the morphologic features and the site of lesions identified during the endoscopy, as well as the histopathology characteristics using Dukes staging system (1940). From 2017 patients who underwent endoscopy, 203 (10%) were diagnosed with different histopathological types of colorectal cancer. The left colon was the most frequent localization (77%). Endoscopicaly, the polypoid-stenotic appearance was the most frequent (40.8%) type of cancer. In the majority of the cases we identified invasive carcinomas (88.2%) like intestinal adenocarcinoma (158 cases -77.8%) or „signet ring cells‟ carcinoma (12 cases -5.9%). The grading of the adenocarcinomas was assessed using the Grinnel scale: G-I: 97 cases, G-II: 48 cases, G-III: 13 cases. The frequency of colorectal cancer in western Romania is relatively high. The majority of the patients in our study had rectosigmoidian cancers. Most of them were polypoid-stenotic cancers and histologically, the adenocarcinoma was the most frequent form of colorectal cancer. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Lower incidence rates of distal large bowel cancer in women when compared with men support the protective role of female hormones. We aimed to determine the associations between hormone replacement therapy, oral contraceptive use, and distal large bowel cancer.METHODS:We conducted a population-based case–control study of incident distal large bowel cancer in North Carolina between 2001 and 2006. Data on hormone replacement therapy, oral contraceptive use, demographics, and risk factors were obtained through in-person interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between oral contraceptive use, hormone replacement therapy, and distal large bowel cancer were estimated through unconditional logistic regression models overall, by duration of use, and within strata of race.RESULTS:There were a total of 443 women with distal large bowel cancer and 405 controls. Ever use of hormone replacement therapy was strongly associated with a reduced risk of distal large bowel cancer (OR 0.52, 95% CI 0.38–0.72). Further reduction of distal large bowel cancer risk occurred with increased duration of use (<4 years (OR 0.77, 95% CI 0.44–1.35), 4–8 years (OR 0.64, 95% CI 0.37–1.10), 9–14 years (OR 0.47, 95% CI 0.27–0.81), and 15 years (OR 0.34, 95% CI 0.20–0.58)). Ever use of oral contraceptives was not associated with reduced incidence of distal large bowel cancer (OR 0.95, 95% CI 0.67–1.34) nor was duration of use. There were no differences by race.CONCLUSIONS:Hormone replacement therapy is associated with a lower risk of distal large bowel cancer. This risk is further reduced with increased duration of use. Hormone replacement therapy may be partially responsible for the reduced incidence of distal large bowel cancer in women compared with men. [ABSTRACT FROM AUTHOR]

Objective We report a single-incision laparoscopic left colectomy for a patient with a distal transverse colon cancer. Method A 78-year-old man with carcinoma of the transverse colon close to the splenic flexure underwent a single-incision laparoscopic left colectomy with full mobilization of splenic flexure using the TriPort™ Access System and ordinary laparoscopic instruments. Results The operation was successfully performed. The patient recovered uneventfully and was discharged after 3 days. Histopathological examination showed a T3N1 tumour with clear resection margins. Conclusion This case demonstrates that single-incision laparoscopic colectomy can be applied safely to large bowel cancer close to the splenic flexure. The technique warrants further investigation. [ABSTRACT FROM AUTHOR]

Transverse colon volvulus is an uncommon cause of large bowel obstruction. Clinical presentation is not specific and therefore, diagnosis is usually made by radiological investigation. Plain abdominal radiograph resembles sigmoid volvulus, but gastrograsphin enema in non emergency cases will reveal a more proximal obstruction. Therapy consists of urgent surgery, usually with resection of the twisted transverse colon. We present a case with an overview of the literature. [ABSTRACT FROM AUTHOR]

Long-chain ω-3 polyunsaturated fatty acids (PUFAs) may have antineoplastic properties in the colon. The authors examined the association between intakes of different PUFAs and distal large bowel cancer in a population-based case-control study of 1,503 whites (716 cases; 787 controls) and 369 African Americans (213 cases; 156 controls) in North Carolina (2001-2006). Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals for distal large bowel cancer risk in relation to quartiles of PUFA intake. Increased consumption of long-chain ω-3 PUFAs was associated with reduced risk of distal large bowel cancer in whites (multivariable odds ratios = 0.88 (95% confidence interval (CI): 0.63, 1.22), 0.69 (95% CI: 0.49, 0.98), and 0.49 (95% CI: 0.34, 0.71) for second, third, and highest vs. lowest quartile) (Ptrend < 0.01). Intake of individual eicosapentaenoic acids and docosahexaenoic acids was inversely related to distal large bowel cancer risk, whereas the ratio of ω-6 to long-chain ω-3 PUFAs was associated with increased risk of distal large bowel cancer in whites, but not among African Americans (Pinteraction < 0.05). Study results support the hypothesis that long-chain ω-3 PUFAs have beneficial effects in colorectal carcinogenesis. Whether or not the possible benefit of long-chain ω-3 PUFAs varies by race warrants further evaluation. [ABSTRACT FROM AUTHOR]

Mutations of the adenomatous polyposis coli (APC) gene predispose individuals to familial adenomatous polyposis (FAP), characterized by multiple tumours in the large intestine. Most mouse models heterozygous for truncating mutant Apc alleles mimic FAP, however, the intestinal tumours occur mainly in the small intestine. To model large intestinal tumours, we generated a new conditional Apc-mutant allele, Apc15lox, with exon 15 flanked by loxP sites. Similar survival of Apc1638N/15lox and Apc1638N/+ mice indicated that the normal function of Apc was not impaired by the loxP sites. Deletion of exon 15, encoding nearly all functional Apc domains and containing the polyadenylation signal, resulted in a mutant allele expressing low levels of a 74 kDa truncated Apc protein. Germ line Cre-mediated deletion of exon 15 resulted in ApcΔ15/+ mice, showing a severe ApcMin/+-like phenotype characterized by multiple tumours in the small intestine and early lethality. In contrast, conditional Cre-mediated deletion of exon 15 specifically directed to the epithelia of distal small and large intestine of FabplCre;Apc15lox/+ mice led to longer survival and to tumours that developed predominantly in the large intestine, mimicking human FAP-associated colorectal cancer and sporadic colorectal cancer. We conclude that the FabplCre;Apc15lox/+ mouse should be an attractive model for studies on prevention and treatment of colorectal cancer. [ABSTRACT FROM PUBLISHER]

Objectives: Symptoms of colonic lipomas generally have a silent clinical course. We presented the clinical features, treatment methods, and follow-up results of six cases with large bowel lipoma. Patients and Methods: A retrospective review of patients with a diagnosis of large bowel lipoma between January 2000 and December 2006 was conducted. Data related to presentation, diagnosis, surgical treatment and pathology were analyzed. Results: Six patients (4 men, 2 women; mean age 63 years; range 43 to 82 years) were operated on due to lipoma of large intestine. Abdominal pain was the most common presenting complaint. One of the patients was treated urgently due to colo-colonic intussusception and the others were operated in elective conditions. The endoscopic biopsies were inconclusive. The preoperative diagnosis was colonic lipoma in two patients and four patients were treated due to suspected tumor of the colon. The locations of the lesions were ascending and transverse colon in two patients, cecum and sigmoid colon in the others. Right hemicolectomy was performed in three patients, left hemicolectomy, sigmoid and segmenter colon resections were performed in the others. Histopathologic examinations of the resected materials showed submucosal lipoma of the large intestine. Postoperative period was uneventful in all of the patients. Conclusion: In large symptomatic colonic lipomas that can cause obstruction or hemorrhage, surgical treatment is needed to prevent complications and to exclude the possibility of malignancy. [ABSTRACT FROM AUTHOR]

Background: Emergent surgical management of malignant large bowel obstruction (LBO) carries a high rate of morbidity and mortality. Self-expanding metal stents have emerged as an alternative for palliation of malignant LBO. However, there are few long-term studies documenting the effect of surgical palliation or colonic stents on symptoms or quality of life (QoL). Study Design: Between 2003 and 2006, patients with unresectable-for-cure malignancies presenting with LBO were enrolled in this prospective study. Patients elected to undergo stent placement or surgical palliation. Patients completed a symptom questionnaire and a QoL instrument (Functional Assessment of Cancer Therapy-Colorectal [FACT-C]) at weeks 1, 2, 4, 8, 12, and 24 after palliation. Symptoms were assessed using the Colon Obstruction Score, a novel instrument comprising nausea, vomiting, pain, distension, and bowel movement frequency scores. Results: Thirty patients had successful stent placement; 14 underwent surgical diversion. Colon Obstruction Scores immediately improved after both stent placement and surgery (p < 0.05 for all time points). Composite FACT-C scores progressively improved after stent placement (p = NS), with the colon symptoms subscale improving after 1 month (p < 0.05). FACT-C scores declined initially after surgery and then returned to baseline, with modest improvements seen in the Colon Symptoms subscale (p = NS). Conclusions: Both stent placement and surgical diversion provide durable improvement in symptoms from LBO, as readily assessed by the Colon Obstruction Score. QoL is difficult to assess in terminal cancer patients, but colon stent placement is associated with improved overall QoL and QoL related to gastrointestinal symptoms. [Copyright &y& Elsevier]

Aims:  To compare the molecular profile of a series of sessile serrated adenomas (SSAs) and hyperplastic polyps (HPs), in order to distinguish these lesions, SSAs having a potential role in the genesis of serrated adenocarcinomas through a serrated pathway in which methylation plays a key role. Methods and results:  Twelve HPs and sixteen SSAs of the right and left colon were investigated for microsatellite instability, DNA mismatch repair genes, p53, p16, and β-catenin expression, MLH1 and p16 ( CDKN2A) gene methylation, and KRAS and BRAF mutations. Both SSAs and HPs were microsatellite stable. MLH1 and MSH2 protein silencing , aberrant cytoplasmic expression and methylation of p16 were found to be exclusive to right-sided SSAs. The MLH1 promoter gene was frequently methylated in right-sided SSAs in contrast with HPs. Abnormal p53 and β-catenin expression was present in both SSAs and HPs. BRAF and KRAS mutation were mutually exclusive, but KRAS mutation was present only in left-sided SSAs and HPs. Conclusions:  HPs and SSAs may be related lesions. However, at least right-sided SSAs differ from left-sided SSAs and HPs in the occurrence of MLH1 and p16 methylation, supporting the hypothesis that SSAs could be precursors of serrated adenocarcinomas. [ABSTRACT FROM AUTHOR]

Background: We compared the prevalence of colorectal adenoma (polyps) in men and women and examined the role of body mass index (BMI) on polyp risk according to patient age and gender. Methods: The risk of developing colorectal polyps was studied in 15 380 subjects (7155 men and 8225 women) who underwent colonoscopy for the first time from April 1998 to March 2006 at our ‘Human Dry Dock’, which is the check-up service provided in Japan. Eligible subjects were 20–86 years old (mean age ± SD, 47.3 ± 8.5) and were free of invasive cancer, hyperplastic polyps and familial polyposis. Polyps were found in 1590 subjects (1062 men and 528 women). The odds ratio (OR) of detection of polyps in relation to obesity was determined in all cases by multivariate logistic regression analysis after making an adjustment for gender and age. Results: The OR of polyp detection in obese subjects (BMI ≥ 25) versus non-obese subjects (BMI < 25, OR = 1) was 1.34 ( P < 0.001) in men and 1.13 ( P = 0.26) in women. As the BMI increased in increments of one, the OR in men increased significantly to 1.01 ( P < 0.001), whereas the OR in women was unchanged at 1.00 ( P = 0.23), which was without significance. Conclusions: We conclude that obesity in men is a risk factor for the development of polyps. These results must be confirmed by additional epidemiological studies. [ABSTRACT FROM AUTHOR]

The study compares the short-term results of the laparoscopic and open approach for the surgical treatment of rectal cancer. Consecutive cases with rectal cancer operated upon with laparoscopy from 2004 to 2007 were compared to open rectal cancer cases. Total mesorectal excision (TME) was attempted in all cases. Forty-two cases were included in the OPEN and 45 in the LAP group and were matched for age, gender, disease stage and operation type. Duration of surgery was longer and blood transfusion requirements were less in the LAP group. Higher blood loss was observed in patients with neoadjuvant treatment in both groups. Patients with neoadjuvant treatment in the OPEN group had higher operation time, but that was not the case in the LAP group. There were three conversions (7%). Overall morbidity was higher in the OPEN group. LAP group patients were found to recover faster. R0 resection was achieved in 88% in the OPEN and 94% in the LAP group. Less morbidity and faster recovery is offered after laparoscopic TME. Quality of surgery assessed by histopathology is similar between the approaches. Neoadjuvant chemoradiation seems to have significant impact on blood loss but results in longer operation times of the OPEN group. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Several countries have recently implemented national bowel cancer screening programs. To ensure equal access to screening, information is needed to suit adults ranging in literacy level. Decision aids are effective in providing balanced information and have been applied in screening. However, few have been designed for populations with lower education and literacy. This article describes the development and preliminary evaluation of a bowel cancer screening decision aid for this group. Method: We conducted face-to-face interviews with adults of varying literacy ability, to develop the decision aid (Stage 1). We applied principles of plain language, created visual illustrations to support key textual messages, and used colour coding to direct the reader through the booklet. We then explored its acceptability and comprehension among consumers with higher and lower education (Stage 2). Participants were recruited from a community sample with lower education and a university alumni network. Results: A total of 75 participants were interviewed, 43 with lower educational attainment and 32 with university education. The decision aid was positively reviewed by both education groups. Results highlighted the need to clarify the purpose of the decision aid and the availability of choice in the context of screening, especially to those with lower education. Conclusion: The 2 stage iterative development process identified important factors to consider in the development of decision tools for this target group, and is recommended. Practice implications: Our findings have implications for how to support people with lower education and literacy make informed screening decisions. [Copyright &y& Elsevier]

Abstract: The inhibitory effects of exogenous melatonin (MEL) on colon oncogenesis were investigated using an azoxymethane (AOM)/dextran sodium sulfate (DSS) rat model. Male F344 rats initiated with a single intraperitoneal injection of AOM (20mg/kg bw) were promoted by 1% (w/v) DSS in drinking water for 7 days. They were then given 0.4, 2 or 10ppm MEL in drinking water for 17 weeks. At week 20, the development of colonic adenocarcinoma was significantly inhibited by the administration with MEL dose-dependently. MEL exposure modulated the mitotic and apoptotic indices in the colonic adenocarcinomas that developed and lowered the immunohistochemical expression of nuclear factor kappa B, tumor necrosis factor α, interleukin-1β and STAT3 in the epithelial malignancies. These results may indicate the beneficial effects of MEL on colitis-related colon carcinogenesis and a potential application for inhibiting colorectal cancer development in the inflamed colon. [Copyright &y& Elsevier]

Introduction. Rectal cancer is a common disease in Western populations. Improved treatment modalities have resulted in increased survival and tumour control. With increasing survival there is a growing need for knowledge about the long-term side effects and functional results after the treatment. Aim. To describe the long-term functional outcome in patients treated for rectal cancer through a systematic review of the current literature and to provide an outline of the promising developments within this area. Results. Standard resectional surgery with loss of the rectal reservoir function results in poor functional results in up to 50-60% of the patients. New methods of surgery including the construction of a neoreservoir and improvement of the technique for local excision have been developed to minimize the functional disturbances without compromising the oncological result. The addition of chemo and/or radiotherapy approximately doubles the risk of poor functional results. During the last decades the techniques for chemo/radiotherapy has been markedly improved with a positive impact on functional outcome. New methods for treatment of functional disturbances e.g. bowel irrigation and sacral nerve stimulation are currently under development. Perspectives. To improve the functional outcome in this growing patient population several approaches can be taken. The primary cancer treatment must be improved by minimizing the surgical trauma and optimizing the imaging and radiation techniques. Population screening should be considered in order to find the cancers at an earlier stage, hereby increasing the proportion of patients eligible for local excision without the need for chemo/irradiation. All patients recovering from rectal resection should be examined and registered systematically regarding their functional results and treatment should be offered to the severely affected patients. More studies are still needed to evaluate the efficacy of irrigation and nerve stimulation in this patient group. [ABSTRACT FROM AUTHOR]

Colorectal carcinoma is still one of the most crucial problems in oncology today. Firstly, this neoplasm occurs frequently and in terms of new cases world wide -- at around one million per year it is second on the list, right after pulmonary carcinoma. Secondly, it is a neoplasm which still has a poor prognosis in which the survival rate over a five-year period, in the majority of cases, is below 50%. Moreover, there are around half a million deaths a year worldwide. In this work, the authors discussed the role of neoangiogenesis in the large intestine cancer pathogenesis. [ABSTRACT FROM AUTHOR]

It is often reported that metastases in the form of linitis plastica developed in the gastrointestinal system are rare cases and frequently the primary tumor is located in the stomach. We presented a case of gastric adenocarcinoma developing a metastasis in the rectum in the form of linitis plastica, which appeared as a primary local advanced rectum cancer. We discussed the clinical, radiological, and pathological characteristics of the intestinal metastases of gastriá adenocarcinomas. [ABSTRACT FROM AUTHOR]

The ephrin-A1 and EphA receptors are frequently highly expressed in different human cancers, suggesting that they may promote tumor development and progression. We generated transgenic mice carrying Fabpl4xat-132 ephrin-A1, which express ephrin-A1 in the intestinal epithelial cells. Those mice were then mated with Apcmin/+ mice to produce the compound mice, which overexpress ephrin-A1 in the intestinal tumors of Apcmin/+ mice. We compared the number, size and histopathological features of the intestinal tumors in the Fabpl4xat-132 ephrin-A1/Apcmin/+ compound mice with those of the Apcmin/+ mice. The compound mice showed an increased number of intestinal tumors, significantly in the large intestine, and developed more invasive tumors. Among the 20 mice of each type examined, 5 Apcmin/+ mice developed 5 invasive tumors, 1 invasive tumor in each mouse, in the proximal or middle portions of the small intestine. On the other hand, 14 out of 20 compound mice developed 29 invasive tumors and 16 of them were in the distal small intestine and the large intestine, where transgenic ephrin-A1 was highly expressed. These results suggested that the increased expression of ephrin-A1 accelerated the malignant progression of the intestinal adenoma to invasive tumors.Oncogene (2008) 27, 3265–3273; doi:10.1038/sj.onc.1210992; published online 4 February 2008 [ABSTRACT FROM AUTHOR]

Background: Appropriate partial mesorectal excision (PME) is extremely important for prevention of local recurrence even in upper rectal cancer. However, it is not always easy to conduct PME in the narrow pelvic cavity. We devised a new surgical technique that involves a rectal transection followed by PME. Methods: After rectal mobilization in the layer targeted for total mesorectal excision, only the rectal wall was bluntly dissected at an appropriate distance from the tumor. Initial transection of the rectum allows drawing the rectum toward the anal side so that the mesorectum can be confirmed with a good visual field. Excision of the mesorectum was easy, and it could be resected in a short time. Results: This technique was conducted on seven patients with upper rectal cancer and on four patients with rectosigmoid cancer. Separation of the rectal wall was comparatively easy, and we had no incidence of wall injury. The average distance from the rectal stump to the distal mesorectum in the freshly resected specimen was 15 mm, indicating satisfactory PME. Conclusions:This easily performed method is a promising procedure for achieving sufficient PME in upper rectal cancer. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Red and processed meat (PM) consumption increases the risk of large bowel cancer and it has been demonstrated that haem in red meat (RM) stimulates the endogenous production of N-nitroso compounds (NOCs) within the human intestine. To investigate whether N-nitrosation occurs in the upper gastrointestinal tract, 27 ileostomists were fed diets containing no meat, or 240 g RM or 240 g PM in a randomly assigned crossover intervention design carried out in a volunteer suite. Endogenous NOC were assessed as apparent total N-nitroso compounds (ATNC) in the ileostomy output. ATNC concentration in the diets was 22 μg ATNC/kg (RM) and 37 μg ATNC/kg (PM), and 9 μg ATNC/kg in the no meat diet. Levels significantly increased to 1175 μg ATNC/kg SEM = 226 μg ATNC/kg) following the RM (P = 0.001) and 1832 μg ATNC/kg (SEM = 294 μg ATNC/kg) following PM (P < 0.001) compared to the no meat diet (283 μg ATNC/kg, SEM = 74 μg ATNC/kg). ATNC concentrations in the ileal output were equivalent to those measured in faeces in similarly designed feeding studies. Supplementation with either 1 g ascorbic acid or 400 IU α-tocopherol had no effect on the concentration of ATNC detected in the ileal output. In in vitro experiments, N-nitrosomorpholine (NMor) was formed in the presence of nitrosated haemoglobin, at pH 6.8 but not in the absence of nitrosated haemoglobin. These findings demonstrate that haem may facilitate the formation of NOC in the absence of colonic flora in the upper human gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Our study suggested that the super-small sized (less than 15 mm in maximum diameter) large bowel advanced cancers, which were sometimes found, were derived from the superficial depressed-type or flat elevation-type of the colorectal early cancers, not polyp-type of those. [ABSTRACT FROM AUTHOR]

Background: With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Because of its high operating cost, however, robotic surgery should be reserved to procedures in which the technology can be of maximum benefit, usually when precise dissections in confined spaces are required. Because conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the DaVinci robotic system in laparoscopic low anterior resections for cancer of the rectum.Methods: Between November 2004 and May 2005 robotic-assisted low anterior resection with total mesorectal excision was performed on six consecutive patients with rectal cancer. These cases were compared with six consecutive low anterior resections performed with conventional laparoscopic techniques by the same surgeon.Results: There were no conversions in either group. Operative and pathological data, complications, and hospital stay were similar in the two groups. Robotic operations appeared to cause less strain for the surgeon.Conclusions: Robotic-assisted laparoscopic low anterior resection for rectal cancer is feasible in experienced hands. This technique may facilitate minimally invasive radical rectal surgery. [ABSTRACT FROM AUTHOR]

Our previous studies have implicated the Wnt antagonist, sFRP1, as a tumour suppressor gene in advanced colorectal cancer. In this study, we set out to investigate the relationship between sFRP1 expression and large bowel adenomas, a precursor of colorectal cancer. The induction of β-catenin/TCF mediated transcription is both a frequent early event in colorectal neoplasia, and a key downstream effect of wnt growth factor signalling. Lithium treatment of a small bowel mucosal cell line (FHs 74 int) induced sFRP1 within 8 h, indicating that this gene is positively regulated by β-catenin, contrasting with the suppression of sFRP1 expression, we saw previously in advanced colorectal cancers. We therefore investigated a series of 12 adenomas and matched large bowel mucosa samples. Real-time RT–PCR analysis showed a reduction in sFRP1 expression in all 12 dysplastic lesions (median 485-fold, IQR 120- to 1500-fold), indicating factors other than β-catenin influence sFRP1 levels. In a second series of 11 adenomas, we identified methylation of the sFRP1 promotor region in all 11 samples, and this was increased compared with the surrounding normal mucosa in seven cases. Immunohistochemical analysis using a polyclonal antibody supported these findings, with sFRP1 expression reduced in many of the adenoma samples examined. sFRP1 staining in normal mucosa adjacent to the dysplastic tissue was also reduced compared with the normal controls, suggesting that sFRP1 expression may be suppressed in a field of mucosa rather than in individual cells. This study identifies sFRP1 inactivation at the premalignant stage of colorectal cancer development, indicating that these pathways may be useful targets for chemoprevention strategies in this common solid tumour.British Journal of Cancer (2006) 94, 922–927. doi:10.1038/sj.bjc.6602967 www.bjcancer.com Published online 7 March 2006 [ABSTRACT FROM AUTHOR]

Abstract: To investigate whether serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were related to first stage cancer before diagnosis of cancer, we compared serum levels of these adhesion molecules between pre-clinical cases and controls using a nested case-control study method. Cancer cases were recruited from a cohort database of 1465 participants who completed a baseline questionnaire and provided blood samples, and were followed up from 1989 to 2003. They consisted of 15 individuals who died of cancer and 31 individuals newly diagnosed with cancer during the follow-up period. Controls were subjects who did not suffer from cancer, cerebral apoplexy, diabetes mellitus, liver disease, or myocardial infarction during the follow-up period. Using commercially available enzyme-linked immunosorbent assay (ELISA) kits, we showed that serum levels of sVCAM-1, but not sICAM-1 were elevated in cases with pre-clinical or early cancer. We suggest that elevated serum levels of sVCAM-1 might serve as a possible marker for detecting pre-clinical or early cancer. [Copyright &y& Elsevier]

Objectives: The authors tried to elucidate the effects of food intake on the incidences of colorectal cancer and adenoma. Materials and Methods: Large intestines obtained from a series of consecutive autopsies performed at the Tokyo Metropolitan Geriatric Hospital were scrutinized to detect colorectal neoplasms. Chronological trends and age-dependent incidences of adenoma and overt lethal cancer were checked, while cancer in adenoma were included in the category of adenoma. Data on food consumption were obtained from the ‘The National Nutrition Survey in Japan’ (Ministry of Health, Labor and Welfare of Japan). Results: There were 405 cancers and 12,883 adenomas in the 7,091 large intestines examined. The incidences of cancer and adenoma increased with age; overt lethal cancer was found in 5.79% and adenoma in 56.79% of the general population ≥60 years in Tokyo. Calorie intake steeply increased since 1964, the year of the Olympic Games in Tokyo, until the early 1970s. Subsequently, it has continuously declined down to the level of the late 1940s, although the ingredients have changed tremendously. Chronological trends of the incidences of colorectal cancer and adenoma showed similar patterns as calorie intake, but, the influence of calorie intake on the incidences of cancer or adenoma was manifested 18 and 24 years later, respectively. Conclusions: (1) During the last 30 years, the incidences of colorectal cancer and adenoma were 5.79 and 56.79%, respectively, in individuals aged ≥60 years in Japan. (2) The chronological trends of both lesions showed a pattern similar to that of calorie intake, but, as the trend of cancer incidence preceded the course of adenoma by 6 years, adenoma is not the sole precursor lesion of overt lethal cancer. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

INTRODUCTION: Endoscopic ultrasound (EUS) has emerged as a promising diagnostic modality for locoregional staging of rectal cancer. However, as with any new technology, publication bias, the selective reporting of studies featuring positive results, may result in overestimation of the capability of EUS. The aim of this study was to systematically assess for publication bias in the reporting of the accuracy of EUS in staging rectal cancer.METHODS: A MEDLINE search for all published estimates of EUS accuracy in staging rectal cancer between 1985 and 2003 was performed. All retrieved studies were fully published in the English literature. Published studies were analyzed and the following information was abstracted: accuracy of EUS, year of publication, number of subjects studied, impact factor of journal, and type of journal (gastroenterology, surgery, radiology, other).RESULTS: Two hundred and two abstracts were reviewed; 41 publications met the stated criteria for inclusion. EUS T-staging accuracy was reported in 40 studies while EUS N-staging accuracy was reported in 27 studies. The experience of 4, 118 subjects was reported with an overall mean T-staging accuracy of 85.2% (median, 87.5%) and N-staging accuracy of 75.0% (median, 76.0%). There was a paucity of smaller studies expressing low EUS accuracy rates. Both T-staging and N-staging accuracy rates also declined over time with the lowest rates reported in more recent literature.CONCLUSION: The performance of EUS in staging rectal cancer may be overestimated in the literature due to publication bias. This inflated estimate of the capability of EUS may lead to unrealistic expectations of this technology.(Am J Gastroenterol 2005;100:1-9) [ABSTRACT FROM AUTHOR]

Cancers of the colon and rectum are the second leading cause of cancer death among adult Americans. When detected at early stages, colon cancer is highly curable. Colonoscopy, an effective but invasive screening test, has been limited in its public acceptance. The goal of this study was to identify novel serum markers of colon cancers and precancerous colon adenomas as potential candidates for noninvasive detection of early colon neoplasms. Employing expression microarrays, we identified colon cancer secreted protein-2 (CCSP-2) as a novel transcript whose expression is generally absent in normal colon and other normal body tissues, but that is induced an average of 78-fold in Stage II, III, and IV colon cancers, as well as in colon adenomas and colon cancer cell lines. These findings were validated by real-time PCR analysis in an independent panel of colon cancer cases. Moreover, CCSP-2 was shown to encode a secreted protein that circulates stably and is detectable in the blood of mice bearing human cancer xenografts transfected with epitope-tagged CCSP-2. As a novel secreted protein that is markedly induced in colon adenomas and cancers, CCSP-2 is a novel candidate for development as a diagnostic serum marker of early stage colon cancer.Oncogene (2005) 24, 724-731. doi:10.1038/sj.onc.1208134 Published online 6 December 2004 [ABSTRACT FROM AUTHOR]

The analysis included 53 patients (32 men and 21 women) aged 43 to 66 years, who were subjected to radical treatment (surgical or combined) because of stomach (22 patients) or large bowel (31 patients) cancer. All the patients were included in the same model of control examinations, which considered evaluation of the erythrocytes TAS and of the Ca19-9, CEA and AFP concentrations in serum. It was confirmed that in all the patients in whom the recurrence and/or the dissemination occurred of the cancer, the average erythrocytes TAS value increased 5.5 times by comparison with the period before progression and 7 times in comparison with the patients without recurrence and/or dissemination of the cancer. Moreover it was shown that statistically significantly higher TAS values were associated with the progression of the large bowel cancer in comparison with the stomach cancer and that the blood cells TAS positively correlated with the changes of the Ca19-9, CEA and AFP concentrations in patients with progression of the cancer after radical treatment. [ABSTRACT FROM AUTHOR]

Explores the prognostic value of surgeons' and pathologists' assessments of tumor clearance in patients with primary rectal cancer who underwent resection. Incidence of tumor recurrenc; Relative risk of recurrence high when the surgeon and pathologist disagreed than when they both agreed on the complete clearance.