Roentgenologic Observations of Growth Rates of Colonic Polyps and Carcinoma

Figiel, Leo S.; Figiel, Steven J.; Wietersen, F. K.

doi:10.1177/028418516500300504

Cited by 38 publications

(12 citation statements)

References 11 publications

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“…We usually attempt total colonoscopy and with increasing experience and improvements in instruments this is usually possible. This policy of total colonoscopy has evolved for several reasons; smaller lesions (less than 10 cm in size) are more accurately detected by colonoscopy than by radiology (Williams et al, 1974); there is evidence that many adenomatous polyps increase in size (Mayo and de Castro, 1956;Scarborough, 1960;Welin et al, 1963;Figiel et al, 1965;Smith et al, 1970), and that the malignant potential appears to be greater as this occurs (Grinell and Lane, 1958;Morson, 1976). Unfortunately, the factors that determine which particular adenoma will increase in size, how quickly it will do so, and if an individual lesion is a greater risk than another are not known.…”

Section: Discussionmentioning

confidence: 99%

Colonic adenomas--a colonoscopy survey.

Gillespie¹,

Chambers²,

Chan³

et al. 1979

Gut

153

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SUMMARY A colonoscopy survey of 620 patients with 1049 colon adenomas showed a predominantly left-sided distribution (77 %). Of these lesions 97 % were amenable to endoscopic removal or ablation. Sixty per cent of patients presented with rectal bleeding as their major symptom. There was agreement between radiology and colonoscopy in only 62 % of patients, as many of the studies were single contrast barium enemas, performed before referral. Forty-eight per cent of adenomas in our series were less than I 0 cm in diameter. Of the larger adenomas ( > 2-0 cm in diameter) 66 % were situated in the sigmoid colon, and of those containing invasive carcinoma (4-8 % of the total) an even higher percentage (94 %) were in the sigmoid and low descending colon. With increasing polyp size, there was a greater predominance of villous elements and this was associated with a higher risk of malignant change than the more frequent and generally smaller tubular adenoma. Local colonoscopic excision alone is sufficient treatment for adenomas with malignant change unless they are poorly differentiated histologically and providing adequate resection is demonstrated. Twenty-eight patients treated in this way are alive without recurrence at periods from six to 62 months. Although 65 % of patients had only one adenoma, and 90% three or less, there is a risk of developing other benign and malignant colon neoplasms and careful follow-up is required.It is now widely accepted that adenomas of the colorectum are premalignant (Grinnell and Lane, 1958;Kalus, 1972;Morson, 1974;Muto et al., 1975;Enterline, 1976), although only a small minority will develop into invasive carcinoma, and the risk for an individual adenoma is difficult to assess. Acceptance of the concept of the 'adenoma-cancer' sequence (Morson, 1974) means that removal of all colonic adenomas is desirable. Since the advent of fibreoptic colonoscopy polypectomy is now possible without the need to resort to abdominal surgery in the majority of patients except those with familial polyposis coli. Removal and histological examination allow for a clear separation between adenomas and other types of polyp, and enable the histopathologist to exclude the presence of malignancy and to assess the cancer risk factors for a particular adenoma and perhaps for the particular patient. The risk factors used are size (especially in excess of 1I0 cm in diameter), histological type (particularly where there is a villous pattern), and the presence of cellular atypia (Muto et al., 1975).Previous reports of adenoma distribution, size, and histopathology have largely been based on resected colon specimens obtained at necropsy or at Received for publication 2 October 1978 surgery (Grinnell and Lane, 1958;Blatt, 1961;Chapman, 1963;Arminski and McLean, 1964;Hughes, 1968). The purpose of this study is to present the clinical and pathological features of 1049 adenomas observed at colonoscopy in a symptomatic population of 620 patients over a five year period, and to outline the role of colonoscopy in their manage...

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Section: Discussionmentioning

confidence: 99%

Colonic adenomas--a colonoscopy survey.

Gillespie¹,

Chambers²,

Chan³

et al. 1979

Gut

153

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“…Using the available data on the growth rate of adenomas and carcinomas and including information on average age of diagnosis of adenomas by size and level of dysplasia and cancer [170,200], a mathematical model has suggested that for those that grow, it takes 2-3 years for a small adenoma (< 0.5 cm) to grow to 1 cm and another 2-5 years for the 1cm adenoma to progress to carcinoma [205,206]. Invasion and metastasis probably takes another 2 years, and on average, death occurs 2 years after this.…”

Section: Evidence From Clinical Observationsmentioning

confidence: 99%

Neoplastic and Nonneoplastic Polyps of the Colon and Rectum

Macrae

Young

2008

Textbook of Gastroenterology

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Epidemiology PrevalenceInformation on the prevalence of polyps comes from autopsy studies and from colonoscopic surveys, which are of a much smaller scale. Autopsy studies generally show a higher prevalence of polyps and adenomas than endoscopic studies. Prevalence rates vary considerably between gender (males more common), ethnic groups, and countries, and reflect the rates of colorectal cancer in those population groups (see Chapter 63). In the United States, autopsy studies suggest an overall polyp prevalence of up to 50% [6,7], but colonoscopic surveys suggest no more than 40% [8][9][10][11][12][13][14][15]. In autopsy studies, fixation of the colon and careful use of a magnifying glass allow detection of small polyps that are more readily missed during colonoscopy [16][17][18][19][20].More than 90% of polyps detected at colonoscopy are epithelial in origin, that is, adenomas or hyperplastic polyps, and 75% of these are adenomas [8][9][10][11][12][13]. In the case of diminutive epithelial polyps (less than 5 mm), about half are hyperplastic [14,15].Age is the major determinant of adenoma prevalence [6,7]. Size at detection also increases with age [20]. Colorectal adenomas are uncommon in patients younger than 30 years of age. Anatomical distributionStudies show that colorectal adenomas are more common in the distal colon and rectum, similar to the distribution of colorectal cancer (see Chapter 63). Distribution, however, relates to size. Small adenomas are more uniformly distributed throughout the entire colon, whereas large adenomas (greater than 1 cm) show a distal predominance [7,8,21,22].

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“…Before the advent of endoscopic polypectomy, the accepted management of polyps out of the reach of the sigmoidoscope was to advise operative removal if the polyp was over 1 cm in diameter-when there is a higher risk of malignancy-or to review the smaller polyps by yearly barium enema examinations with the prospect of eventual surgery if the lesions increased in size. 7 Beahrs and Sanfelippo8 reported that polyps under 05 cm in diameter were never shown to be malignant, that 1 , of those measuring 1 cm in diameter had undergone malignant change, and that 71 ,, of polyps that had reached 1 5 cm in size were malignant. The technique of colonoscopic polypectomy requires considerable skill and is time consuming, but Williams and his colleagues5 from St Mark's Hospital reported the removal of 300 polyps of up to 4-5 cm in diameter from 169 patients with no serious complications.…”

Section: Colonoscopymentioning

confidence: 99%

Section: Colonoscopymentioning

confidence: 99%