Colorectal cancer prevention and detection:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2002
|
| Schriftenreihe: | Gastroenterology clinics of North America
31,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 926 - 1181 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Colorectal cancer prevention and detection |c David A. Ahlquist guest ed. |
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Datensatz im Suchindex
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| adam_text | COLORECTAL CANCER PREVENTION AND DETECTION
CONTENTS
Preface xi
David A. Ahlquist
Modifiable Risk Factors for Colon Cancer 925
Edward Giovannucci
Although the specific mechanisms have not been fully elucidated,
certain aspects of a Western diet and lifestyle play a critical role in
the development of colon cancer. A likely important factor is en¬
ergy balance; a high body mass index, the tendency of central de¬
position of adiposity, and physical inactivity increase the risk of
colon cancer, possibly through their effects on hyperinsulinemia.
Beyond their role in energy balance, it is unclear if macronutrients
influence the risk of colon cancer, although some evidence suggests
that red meat, especially processed meats, and highly refined car¬
bohydrates may be deleterious. A strong benefit of fiber and fruits
and vegetables has not been confirmed in most recent studies,
though some evidence indicates that folate may be beneficial. High
intakes of alcohol and smoking also appear to increase risk, while
use of aspirin and other nonsteroidal anti inflammatory drugs and
postmenopausal estrogens may be beneficial.
Hypermethylation Pathways to Colorectal Cancer:
Implications for Prevention and Detection 945
James G. Herman
Epigenetic changes play an important role in the development and
progression of colorectal cancer. The best characterized of these
changes is the promoter region methylation of CpG islands of
genes that play key roles in this disease. These changes compliment
and lead to genetic changes that are well established as central to
colorectal cancer progression. They may also prove useful in mole¬
cular detection approaches.
VOLUME 31 • NUMBER 4 • DECEMBER 2002 V
Colorectal Polyps and Other Precursor Lesions:
Need for an Expanded View 959
Lawrence J. Burgart
Adenomas are well established as precursors to colorectal carcino¬
ma. Adenoma variants and nonneoplastic lesions, such as serrated
adenomas and hyperplastic polyps, are receiving renewed atten¬
tion as colorectal carcinoma is recognized as a collection of clini¬
cally and genetically heterogeneous tumors. This article discusses
the expanding view of the adenoma carcinoma sequence.
Chemoprevention of Colorectal Cancer:
Problems, Progress, and Prospects 971
Jaye L. Viner, Asad Umar, and Ernest T. Hawk
Although clinical efforts once focused exclusively on the diagnosis
and treatment of colorectal cancer (CRC), early neoplastic changes
are increasingly regarded and managed as disease entities in them¬
selves. Indeed, carcinogenesis presents us with the Rosetta Stone of
cancer prevention. By deciphering the pathways and mechanisms
that underlie carcinogenesis, we learn the language of risk and dis¬
cover new methods of interrupting the malignant process. Molecu¬
lar prevention (ie, chemoprevention) draws upon insights into the
pathogenesis of cancer to identify agents that can prevent or reduce
the impact of neoplasia. Experience with the process of chemo
preventive agent development is helping us test promising com¬
pounds more effectively and efficiently, however, much work
remains to be done. Current systems for translating emerging
knowledge into clinically applicable tools are ill adapted to the
pace and magnitude of advances in the basic sciences, imaging,
and bioinformatics. We are rethinking how to overcome formidable
challenges to chemoprevention, such as limited access to new
agents and slow execution of clinical trials. Such complex problems
are not amenable to random approaches or ad hoc research struc¬
tures. A clinical resource infrastructure designed to test the abso¬
lute and relative usefulness of emerging technologies will speed
the rate at which challenges to CRC chemoprevention are over¬
come.
Immunoprevention of Colorectal Cancer:
A Future Possibility? 1001
Pier Luigi Lollini, Carla De Giovanni,
Giordano Nicoletti, Emma Di Carlo, Piero Musiani,
Patrizia Nanni, and Guido Forni
Immunoprevention of cancer is based on the idea that the immune
system can be used to reduce cancer incidence in individuals at
risk. Excellent results were obtained in the prevention of mammary
carcinoma in HER 2/neu transgenic mice using a variety of indivi¬
dual immunological strategies including passive administration of
anti pl85neu antibodies, treatment with cytokines such as interleu
vi CONTENTS
kin 12 (IL 12), and specific vaccines based on whole cells, proteins,
peptides and DNA. The complete prevention of mammary carcino¬
ma, which was obtained with a combination of IL 12 and allo
geneic tumor cells expressing HER 2/neu, is an important proof
of the validity of this principle. Immunoprevention is also effective
for other mouse tumors, such as carcinogen induced sarcoma and
transgenic prostate carcinoma. In principle, the concept of immu¬
noprevention is applicable to every tumor type, including colo
rectal cancer. This article discusses the main immunological
conclusions that can be drawn from successful models of cancer
immunoprevention by outlining specific immunopreventive strate¬
gies for colorectal cancer.
Flexible Sigmoidoscopy for Colorectal Cancer Screening:
Valid Approach or Short sighted? 1015
Theodore R. Levin
Flexible sigmoidoscopy is a safe, effective test that may be deliv¬
ered feasibly on a large scale for mass colorectal cancer screening.
Flexible sigmoidoscopy is 67% to 80% as sensitive as colonoscopy
in a screening population, but is probably 10 to 20 times safer than
colonoscopy in terms of complications. Several national guidelines
recommend combining flexible sigmoidoscopy with fecal occult
blood tests. There is limited evidence to support this practice,
and the added benefit to an existing flexible sigmoidoscopy screen¬
ing program although real, may be marginal. In the future, it is
likely that flexible sigmoidoscopy screening among patients aged
50 to 65 will be supplemented with total colonic screening, using
molecular based fecal tests or virtual colonoscopy, after age 65.
Screening Colonoscopy in Balance:
Issues of Implementation 1031
David F. Ransohoff
Although colonoscopy is currently considered an option for colon
cancer screening, its choice as a preferred screening test is not sup¬
ported by data, recommendations, or cost effectiveness analysis.
The use of colonoscopy in postpolypectomy surveillance constitu¬
tes a huge potential effort that should be appropriately anticipated
and managed. Noninvasive methods for colon cancer screening
may reduce the need for colonoscopy in the future.
The Future of Colorectal Imaging:
Computed Tomographic Colonography 1045
Amy K. Hara
Computed tomographic colonography (CTC) represents a mini¬
mally invasive alternative to current methods of colorectal cancer
screening. CTC appears to be equal or superior to the barium
enema for detection of colorectal lesions. In addition, CTC causes
little patient discomfort, is less operator dependent than the barium
CONTENTS vii
enema, and can evaluate other abdominal organs in addition to the
colon. This article discusses technical features of a CTC examina¬
tion, current clinical studies, interpretative pitfalls, and the future
development of this technology.
Barriers to Preventive Intervention 1061
Gloria M. Petersen
A spectrum of colorectal cancer screening studies identified bar¬
riers to screening adherence, although definitive and compre¬
hensive conclusions cannot be drawn. Barriers can be intrinsic
(demographic, medical, psychological, and knowledge/attitudes/
beliefs) or extrinsic (access to health care, health care provider
knowledge and motivation, and lifestyle issues). Certain consis¬
tent patterns are emerging. Lower adherence is generally seen in
persons who have less knowledge and lower perceived risk of
colorectal cancer, as well as when health care providers do not re¬
commend screening. Remedies that reduce intrinsic and extrinsic
barriers to screening adherence are needed.
Cost effectiveness in the Prevention
of Colorectal Cancer 1069
Amnon Sonnenberg
In cost effectiveness analyses of cancer prevention, the ratio of cost
and medical effectiveness serves as the primary measure for com¬
paring various strategies. Models of medical decision making are
used to simulate the natural history of colorectal cancer and test
how it becomes affected by various means of screening and pre¬
vention. Compared with no prevention, a single colonoscopy at
age 65 is the most cost effective means of cancer prevention in
the general population, followed by screening colonoscopy every
10 years or screening colonoscopy every 10 years plus chemopre
vention with daily aspirin. Other means of prevention, involving
annual fecal occult blood testing or flexible sigmoidoscopy every
5 10 years, are dominated by cheaper and more effective strategies.
Endoscopic Ultrasound for Rectal Cancer 1093
Maurits J. Wiersema and Gavin C. Harewood
The application of endoscopic ultrasound (EUS) has improved the
way we evaluate and manage patients with rectal cancer. EUS has
substantially greater sensitivity than computed tomography in de¬
tecting advanced T stage tumors. Such improved sensitivity results
in changes in preoperative therapy that would not otherwise have
occurred without EUS. Whether the accurate staging ability of EUS
translates into improved outcomes in terms of reduced recurrence
rates and ultimately prolonged survival remains uncertain. This
will require further long term outcome studies focusing on the end
point of tumor recurrence and patient survival.
viii CONTENTS
Heritable Colorectal Cancer Syndromes:
Recognition and Preventive Management 1107
Lisa A. Boardman
Nearly one fifth of all colorectal cancers (CRC) arise in the context
of a family history of CRC. Hereditary nonpolyposis colorectal can¬
cer, familial adenomatous polyposis, juvenile polyposis syndrome,
and Peutz Jeghers syndrome are the four main familial CRC syn¬
dromes that have been characterized both clinically and genetically.
Current methods for recognizing that an individual might belong
to a CRC kindred are discussed, and screening and treatment
recommendations are outlined for these four syndromes.
Cancer Prevention in Patients with Inflammatory
Bowel Disease 1133
Steven H. Itzkowitz
Colorectal cancer is an important, and often dreaded, consequence
of long standing ulcerative colitis and Crohn s colitis. Surveillance
colonoscopy, despite its limitations, is beneficial for detecting ear¬
lier stage cancers, and probably mortality reduction. Agents such
as anti inflammatory medications, folic acid, and ursodeoxycholic
acid show promise for chemoprevention in this disease. Future re¬
search will help to define better the natural history of dysplasia in
inflammatory bowel disease, as well as determine how molecular
approaches may be integrated into surveillance programs to reduce
colorectal cancer risk.
Cumulative Index 1145
CONTENTS «
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| title | Colorectal cancer prevention and detection |
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| title_full | Colorectal cancer prevention and detection David A. Ahlquist guest ed. |
| title_fullStr | Colorectal cancer prevention and detection David A. Ahlquist guest ed. |
| title_full_unstemmed | Colorectal cancer prevention and detection David A. Ahlquist guest ed. |
| title_short | Colorectal cancer prevention and detection |
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