The clinical importance of serrated lesions of the colorectum / La importancia clínica de las lesiones serradas del colon y recto

Colorectal cancer (CRC) is the third most common cancer in the world. Fortunately, it is also proven to be one of the most preventable cancers, in large part due to the utilization of CRC screening. Historically, it was believed that the adenomatous polyp was the only precursor to carcinoma of the colorectum. Within the last decade, it has been shown that approximately 20-30% of sporadic colon cancers arise through a distinct molecular pathway called CpG Island Methylation (CIMP) which is due to widespread DNA methylation. There is strong evidence that serrated polyps are the precursor lesions for colon cancers arising through the CIMP pathway.

Cáncer Colorectal (CRC) es el tercer cáncer más común en el mundo (1). Afortunadamente también se ha probado que es el cáncer que más se puede prevenir, en gran parte debido al "screening" del CRC. Históricamente, se creía que el pólipo adenomatoso era el único precursor del carcinoma de colon y recto. En la última década se ha demostrado que aproximadamente el 20 al 30% de los cánceres colónicos esporádicos se derivan de una vía molecular diferente llamada Metilación de las Islas CpG (CIMP) que es debida a una extensión de la metilación del DNA.Actualmente hay una fuerte evidencia que los pólipos serrados son las lesiones precursoras de cáncer de colon surgiendo desde la vía CIMP.

Interacciones entre la microbiota y el cáncercolorrectal / Interactions between microbiota and colorectal cancer

El intestino humano alberga un ecosistema complejo constituido por más de 500 especies bacterianas distintas, con determinadas características genéticas y metabólicas, generalmente denominado microbiota. La composición cuantitativa y cualitativa de la flora intestinal y su interacción con la mucosa intestinal se ha asociado en forma variable con condiciones fisiológicas y patológicas. En este contexto, las relaciones entre la microbiota y el cáncer de colon son controvertidas. Se analizarán y discutirán los principales temas en este campo de investigación, los posibles problemas y las perspectivas futuras. Se propone un modelo hipotético en el que el equilibrio de la microflora del hospedero representa un factor importante para el control de los trastornos proliferativos de la mucosa colónica, sobre la base de datos recientemente publicados. El estudio del papel de la microbiota en la aparición del cáncer de colon puede representar un enfoque novedoso y fascinante de esta neoplasia maligna frecuente y compleja.

The Role of NF-kappaB in Colon Cancer / 대한소화기학회지

Colon cancer is the 3rd common malignancy and 4th common cause of cancer death in Korea. Recent studies have shown that abnormal inflammatory response plays a critical role in colon carcinogenesis. A striking example of connection between inflammation and cancer is NF-kappaB, in which key regulator of inflammation and immune response is associated with target for colon cancer treatment. Constitutive NF-kappaB expression in colon cancer is 40-80% in vivo as well as in vitro, and the inactivation of IKKbeta subunit can reduce tumor multiplicity. The possible mechanisms by which NF-kappaB can contribute to colon carcinogenesis include the activator of antiapoptotic gene expression, enhanced cell survival and proliferation, regulation of angiogenesis and promotion of metastasis of cancer cells. Recent insights into the role of NF-kappaB involved in colon cancer development as well as their relevance as therapeutic targets are herein discussed.

Colonic cancer in Mosul, Iraq - a study of 454 cases over 25 years

The incidence of colonic cancer in Europe and United States of America is high, while it is moderate in the Middle East. To identify the different pathological types of malignant tumors of colon, clinical aspects, management, probable causes and prognosis in Mosul area. A retrospective study of 454 patients diagnosed with colonic cancer and treated in the Hospital for Oncology And Nuclear Medicine in Mosul between 1982 and 2007. Tumor type, incidence, age, sex distribution, anatomical sites, clinical presentations, staging, methods of treatment and prognosis of colonic cancer in Mosul area were studied. 454 colonic cancer cases in Mosul area were diagnosed during the period [1982 to 2007].They constituted [1.19%] of all malignancies. Colonic cancer were more common in males [male: female = 1.25: 1], the commonest age at presentation was the sixth decade. The most frequent sites were the sigmoid colon then the cecum.Most common presenting symptoms were abdominal pain, alteration of bowel habit, palpable abdominal mass and intestinal obstruction.The majority of patients subjected to curable resection 69.16% and the remaining to palliative surgery or conservative management, in addition to radiotherapy and/or chemotherapy, but prognosis was generally unsatisfactory. Carcinoma of the colon is rare in Mosul, usually presented in advanced stage, and hence carry poor prognosis.The common site has been the sigmoid colon

Enfermedad inflamatoria intestinal y su asociación con cáncer colorectal: experiencia en un hospital universitario / Inflammatory bowel disease and its relationship with colorectal cancer: experience from the university hospital

The risk of colorectal cancer (CCR) in inflammatory bowel disease (IBD) patients is increased. The risk is associated mainly with longer duration and greater extent of disease and the presence of primary sclerosing cholangitis. Aim: to report our experience with a large group of IBD patients from the University Hospital of the University of Chile and to characterize the clinical features of patients with IBD who developed CCR during the course of disease. Patients and Methods: Retrospective review of 318 patients with IBD (age range of 30-57 years, 120 women) treated between January 1987 and December 2006. Results: Two hundred forty one patients had ulcerative colitis (UC) and 77 had Crohn's disease (CD). Five patients (1.6 percent), three UC and two CD, developed CCR during this period. The average time between the diagnosis of IBD and CCR was 12.5 years (range 10-12). All patients had pancolitis. Two patients, one UC and one CD, had primary sclerosing cholangitis. Conclusion: Chilean patients with IBD have a risk develop CCR during the course of the disease. The longer duration, greater anatomic extent of colitis and the presence of primary sclerosing cholangitis are risk factors of this complication. Chemoprevention and surveillance guidelines with new endoscopic techniques might be best approach to decrease the incidence of CCR in patients with IBD.

El riesgo de cáncer colorectal (CCR) en pacientes con enfermedad inflamatoria intestinal (EII) está aumentando. Este riesgo está asociado principalmente con la duración prolongada de la enfermedad, extensión del área comprometida y la presencia de colangitis esclerosante primaria. Objetivo: Analizar nuestra experiencia en pacientes con EII controlados en el Hospital Clínico de la Universidad de Chile y describir las características clínicas de los pacientes con EII que desarrollaron CCR durante su evolución. Pacientes y Métodos: Estudio retrospectivo con 318 pacientes con EII (rango de edad de 30-57 años, 120 mujeres) tratadas entre Enero de 1987 y Diciembre de 2006. Resultados: Doscientos cuarenta y un pacientes con colitis ulcerosa (CU) y 77 con Enfermedad de Crohn (EC). Cinco pacientes (1,6 por ciento), tres CU y dos EC, desarrollaron CCR durante ese período. El tiempo promedio entre el diagnóstico de EII y el de CCR fue de 12,5 años (rango: 10-12 años). Todos los pacientes tenían una pancolitis. Dos pacientes, uno con CU y otro con EC, presentaron una colangitis esclerosante primaria. Conclusión: Los pacientes chilenos con EII tienen un riesgo de desarrollar CCR durante su evolución: Larga duración de la enfermedad, extensión del área comprometida y la presencia de colangitis esclerosante primaria son factores de riego de esta complicación. La quimioprevención y programas de vigilancia con nuevas técnicas endoscópicas podrían ser las principales estrategias para disminuir la incidencia de CCR en pacientes con EII.

Pituitary toxicity but lack of rat colon carcinogenicity of a DC-magnetic field in a medium-term bioassay.

The present study was designated to evaluate the effect of direct current induced permanent magnetic field (DC-MF) on chemically induced rat colon carcinogenesis. Five experimental groups of male S.D. rats were injected with 1,2-dimethylhydrazine (DMH) subcutaneously, 20 mg/kg b.wt., once a week for four weeks, with exposure to 1 mT DC-MF (12 hours/day) as follows: Before (pre) the carcinogen administration (group 1), simultaneously (group 2), after (post) the carcinogen administration (group 3) and daily from the beginning to the end of the experiment after 12 weeks (group 4). Rats of group 5 served as carcinogen-only treated controls while those of group 6 were non-treated controls. There were no differences in the incidences and multiplicities of colonic aberrant crypt foci (ACF), putative preneoplastic lesions, among all groups except that large foci in group 1 were significantly fewer in numbers than those found in group 5. Proliferating cell nuclear antigen labeling indexes (PCNA-LI) in the colon epithelium were essentially the same in MF-treated and control rats. Histopathological examination showed evident hemorrhage in the pituitary glands of some rats of groups 1-3, and in most rats of group 4. Transmission electron microscopy also revealed ultrastructural changes, but DNA ploidy analysis revealed no carcinogenicity to MF-exposed pituitary glands. Serum levels of AST, ALT, total protein, creatinine, albumin, albumin/globulin ratio and growth hormone levels did not change among the groups. The present study revealed that the action of an artificial MF on rats is not carcinogenic/or cancer-promoting, at least in the present protocol for colon carcinogenesis.

A Case of More Abundant and Dysplastic Adenomas in the Interposed Colon than in the Native Colon

We report a 60-year-old woman with intramucosal adenocarcinoma arising in the interposed colon, 40 years after the esophageal reconstruction for lye induced esophageal stricture. Although synchronous adenomas were also found in the native colon where the graft was taken, the number of adenomas was greater in the interposed colon and more dysplastic, even progressed to adenocarcinoma, than that of the native colon. The microsatellite instability-testing performed in the intramucosal carcinoma from interposed colon showed absence of microsatellite instability. Changing of location and functional deman]d of colonic segment, and the exposure to different intraluminal contents might have facilitated the adenoma- carcinoma transformation in the interposed colon.

Calcium intake and disease prevention / Ingesta de cálcio e prevenção de doença

While the fundamental metabolic function of calcium is to serve as a second messenger, coupling intracellular responses to extracellular signals, nutritional deficiency of calcium is manifested at a higher level of organization: 1) depletion of the calcium nutrient reserve; 2) inadequate complexation of digestive byproducts; and 3) collateral effects of hormones produced primarily to compensate for low calcium intake. The first mechanism contributes to the osteoporosis problem, the second to kidney stones and colon cancer, and the third to hypertension, preeclampsia, obesity, and insulin resistance, among others. Adequate calcium intakes (1000­1500 mg/d) in adults have been shown in controlled trials to lower the risk of osteoporotic fractures, kidney stones, obesity, and hypertension. The best source of calcium is dairy foods, largely because the disorders concerned depend upon multiple nutrients, not just calcium, and dairy provides a broad array of essential nutrients in addition to calcium, and at low cost.

Enquanto a principal função metabólica do cálcio é atuar como um secundo mensageiro, acoplando as respostas intracelulares aos sinais extracelulares, a deficiência nutricional do cálcio é manifestada num nível mais alto de organização: 1) depleção da reserva de cálcio; 2) inadequada formação em complexo digestivo; 3) efeitos colaterais dos hormônios produzidos para compensar a baixa reserva de cálcio. O primeiro mecanismo contribui para o surgimento da osteoporose, o secundo para cálculos renais e câncer, e o terceiro hipertensão arterial, preeclampsia, obesidade e resistência insulínica, entre outros. Uma adequada ingesta de cálcio (1000­1500 mg/d) tem mostrado em estudos clínicos controlados em adultos, reduzir os riscos de fraturas osteoporóticas, cálculos renais, obesidade e hipertensão. A melhor fonte de cálcio são os laticínios, porque além do cálcio, fornecem múltiplos nutrientes e são de baixo custo.

Spider angiomas in the gastrointestinal tract.

Spider angiomas are cutaneous manifestations of endocrine imbalances in cirrhosis. We describe unusual cases of massive bleed from spider angiomas in the oral cavity and colon in association with cirrhosis of liver.

Poliposis múltiple rectocolónica / Colonic multiple polyposis

Se presentan 10 (diez) casos de poliposis múltiple familiar, de los cuales 8 (ocho) pertenecen a un mismo árbol genealógico. Se empleó la siguiente metodología de estudio: examen semiológico con pesquisa de antecedentes hereditarios, colon por enema doble contraste, tránsito de intestino delgado, fibrocoloscopía, gastrofibroscopía, radiografías de partes óseas y biopsias endoscópicas múltiples de los pólipos más grandes con su correspondiente estudio histológico. Se detallan los tipos de técnicas quirúrgicas realizadas y la evolución de los mismos. Destacamos y demostramos la importancia del seguimiento familiar para la profilaxis del cáncer colonorectal y de otras neoplasias extracolónicas como manifestación de la enfermedad

Fecal bile acid excretion profile in gallstone patients

Epidemiological studies have shown a positive association between choloesterol gallstones and colonic cancer. These two diseases may be somehow related with bile acids metabolic alterations. The aim of this study was to evaluate the profiles of fecal bile acid in gallstone patients, in order to estimate the quality and amount of fecal bile acids. A fecal bile acid profile of ten gallstone patients and ten controls was compared using high performance liquid chromatography. Total fecal bile acid excretion was significantly increased in gallstone patients compared with controls (692.7 mg/day (302.5-846.2) vs 165.7 mg/day (138.7-221.3), p<0.01) as was the excretion of secondary free bile acids 562.9 mg/day (253.3-704.9) vs 99.9 mg/day (88.9-154.2), p<0.01). Lithocholic and glycodeoxycholic and percentages have also been found to show differences with controls of 55.4 (47.4-73.9) vs 24.6 (22.1-38.4) (p<0.01) and 29.4 (3.3-41.7) vs 2.8 (1.0-3.8) (p<0.03), respectively but deoxycholic acid has not shown differences between the two groups. Moreover, the percentage of ursodeoxycholic acid diminished significantly in gallstone patients (1.5 (1.0-2.8) vs 8.6 (6.0-10.39) (p<0.001), and the decrease of chenodeoxycholic acid was also significant (20.0 (11.4-23.6) vs 8.9 (3.1-10.9) (p<0.03) along with a rise in the rations lithocholic/deoxycholic acids (1.8 (1.4-6.4) vs 0.9 (0.6-1.6) (p<0.05) and glycine/taurine of deoxycholic acid (7.3 (4.1-46.6) vs 0.2 (0.1-0.5) (p<0.01). In conclusion, we have observed a significant increase of total and secondary fecal bile acid excretion as well as a rise of LCA and GDCA percentages and a rise in the ratios of LCA/DCA and glycinet/taurine of DCA.

Role of redchilli (Capsaicin) in the formation of colonic carcinoma.

The effect of feeding redchilli (Capsaicin) powder on the histopathological changes occurring in the colonic mucosa was studied in rats. These animals were compared with those treated with a colonic carcinogen 1,2-dimethylhydrazine (DMH). Animals fed with redchilli, dimethylhydrazine, dimethylhydrazine plus redchilli powder showed polyp and dysplasia, malignant tumour and malignant tumour with transitional area of dysplasia.

Adenomas colónicos: factores de riesgo para su malignización / Colonic adenomas: risk factors for its malignization

Antecedentes: La mayoría de los cánceres colorrectales se desarrollan en pólipos adenomatosos; su detección y extirpación previene el cáncer colorrectal. Varias características de los adenomas, como: número, tamaño, morfología, variedad histológica y grado de displasia, se han considerado como factores de riesgo para su malignización. Objetivo: Conocer la frecuencia de los adenomas colorrectales los principales factores de riesgo para su malignización. Métodos: Se analizaron retrospectivamente los hallazgos endoscópicos de 846 colonoscopias realizadas en nuestro servicio entre 1989 y 1994, regisrándose los pacientes con pólipos colorrectales, así como las características de los adenomas, para determinar los factores de riesgo para su malignización. Resultados: Se encontraron 183 821.6 por ciento) pacientes con 322 pólipos colorrectales; sólo se estudiaron 214 extirpados por polipectomía transcolonoscópica; 120 (57 por ciento) fueron pólipos neoplásicos, y 94 (43 por ciento) no neoplasicos; entre los neoplásicos, 100 (83.4 por ciento) fueron adenomas tubulares, 11 (9.1 por ciento) adenomas tubulovellosos y 9 (7.5 por ciento) adenomas vellosos. Se encontraron. 16 (7.4 por ciento) adenomas con carcinoma, 14 (87.5 por ciento) de ellos en pacientes mayores de 50 años y en pólipos mayores de 1 cm (p 0.040); 11 (68.7 por ciento) fueron sésiles, con una p 0.001. Conclusiones: Los adenomas tubulares son los pólipos neoplásicos más frecuentes. La edad del paciente, el tamaño y morfología del pólipo, son los factores de riesgo significativamente estadístico para la malignización de los adenomas.

Pesquisaje de lesiones precancerosas y cancerosas del colon en los trabajadores del asbesto / Screening of precancerous and cancerous lesions of the colon in asbestos-cement exposed workers

Se realizo un pesquisaje mediante la aplicacion de la prueba de sangre oculta en heces fecales y colonoscopia a los trabajadores de la Fabrica de Asbesto-Cemento "Armando Mestre" de Ciudad de la Habana. De los 400 trabajadores con que cuenta la fabrica fueron encuestados 272, de los cuales solo161 (59,1 por ciento), acudieron a entregar las heces fecales para la determinacion de sangre oculta. La prueba fue positiva en el 19,8 por ciento, es decir, 32trabajadores de estos 161. De los casos positivos solo 16 aceptaron hacerse la colonoscopia, y en 6 de ellos (37,5 por ciento) se encontraron polipos. De estosultimos 2 presentaron lesiones multiples y 4, lesiones unicas. El estudio histologico mostro que todos los polipos eran adenomas y 2 de ellos presentaban displasias. Ninguno de los trabajadores con polipos tenia evidencias de sangramiento rectal, ni aun los que presentaban lesiones mayores de 1 cm. No se observo cancer de colon en este pesquizaje. Por los resultados de nuestro trabajo no parece existir relacion entre la presencia o no de polipos y los anos de exposicion al asbesto