Spontaneous resolution of rectal polyps in patients with familial polyposis following abdominal colectomy and ileorectal anastomosis

Feinberg, Stanley M.; Jagelman, David G.; Sarre, R. G.; McGannon, Ellen; Fazio, Victor W.; Lavery, Ian C.; Weakley, Frank L.; Easley, Kirk A.

doi:10.1007/bf02552541

Cited by 64 publications

(27 citation statements)

References 7 publications

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“…The demonstration and study of the disappearance of the initial lesion in neoplasia has been done consistently in the hepatic system and should be regarded as a prototype of behaviour of initial lesions. The initial lesions, in Farber's view, are not pathology but a physiological response, he has termed clonal adaptation (Farber, 1990 (Feinberg et al, 1988). As a rule the sequential series of qualitatively different polyps is accompanied by progressive increase in size of the lesions.…”

Section: Definitionsmentioning

confidence: 99%

Tumour progression and the nature of cancer

1991

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Summary The nature of neoplasia and its sometime end result, cancer, has been studied by exposition and explanation of the sequential lesions of tumour progression. Neoplastic lesions were divided into four classes on the basis of growth characterisitcs and whether lesional growth is confined to one The induction of a neoplastic system does not result in cancer as the initial lesion, with rare exceptions. At the outset, the lesions produced by carcinogens are not cancer but focal proliferations that are orderly in form and temporally restricted in their growth; benign tumours in classical nosology. If other lesions, with abnormal form and cytology as compared with the initial lesion, are to appear they follow the initial lesion. If a lesion with the biological properties of primary cancer is to appear, it usually does so only after at least one half of the life span of the affected subject has passed. The sequential lesional events between induction and cancer, including metastases, may be encompassed by the term tumour progression; the subject of this paper. The development of cancer seems to be similar, though not precisely identical, in all neoplastic systems. The concepts presented are based upon the personal study, over a period of some 25 years, of all of the sequential lesions of human melanocytic neoplasia and a comparison of the observed phenomena with some other forms of neoplasia. What I have attempted to do is to describe the classes of lesions seen in neoplatic development based upon the behaviour (life history) of the various lesions. Next, I have presented, without explanation, the lesional classes as illustrated by human melanocytic neoplasia. These classes are then compared with other neoplastic systems. Finally, I have attempted explanation and formulation of a conceptual framework for the nature of cancer based upon these observations of cancer development. The conclusions derived about the nature of cancer are pluralistic and are not considered as due to some discrete change in a cell, whose progeny, as a result of that discrete change, carries all of the information required to explain the almost limitless events of a neoplastic system.The Pigmented Lesion Study Group of the University of Pennsylvania has studied tumour progression in melanocytic neoplasia since 1 September 1972. We have studied 2,383 patients with melanoma through 31 DefinitionsThe lack of understanding of the basic biology of neoplasia has resulted in different definitions of even its most fundamental terms. The following definitions permit the reader to understand how we use terms essential to discussions of neoplastic biology (Clark, 1991).Cancer Class IIIB: Primary cancer with manifest competence for metastasis This class of lesions completely satisfies the definition of a primary invasive, tumourigenic cancer as the lesions have the ability to grow in three or more tissue compartments: the site of origin of the primary cancer, the mesenchyme of the primary site, and one or more distant sites. Squamous cell carcino...

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Section: Definitionsmentioning

confidence: 99%

Tumour progression and the nature of cancer

1991

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“…The follow-up of operated patients shows that in a great proportion there is a spontaneous decrease of rectal polyps density after IRA, although this is a temporary phenomenon (3-4 years) (21) . While lesions smaller than 5 mm do not need to be excised, greater adenomas should be excised or cauterized.…”

Section: Discussionmentioning

confidence: 94%

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Campos

Perez

Imperiale

et al. 2009

Arq. Gastroenterol.

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-Context -Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. Objectives -To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8%). Conclusions -1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated by restorative proctocolectomy are not free from the risk of pouch degeneration; 4. the disease complexity and the various risk factors (clinical, endoscopic, genetic) indicate that the best choice for operative treatment should be based on individual features discussed by a specialist; 5. all patients require continuous and long-term surveillance during postoperative follow-up.

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“…The reversal of physiologically induced transformation by alterations in growth conditions in cell culture raises the possibility that some early stages of human tumors could be similarly reversed by changing the environment of the tumors. Indeed, this has been achieved with rectal polyps in patients with familial polyposis by abdominal colectomy and ileorectal anastamosis (20). Alterations in diet and lifestyle may have similar effects.…”

Section: Discussionmentioning

confidence: 99%

Growth in high serum concentrations leads to rapid deadaptation of cells previously adapted to growth in an extremely low concentration of serum.

Yao

Huang

Rubin

1991

Proc. Natl. Acad. Sci. U.S.A.

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A subline of NIH 3T3 cells adapted to multiply in 0.25% calf serum (CS) by frequent passage (every 2-3 days) at low population density in 0.25% CS was deadapted by frequent successive passages of the cells in 10% CS for 3 weeks. The cells adapted to 0.25% CS multiplied with an average doubling time of 16.9 hr in 10% CS, and cells that had always been kept in 10% CS multiplied with an average doubling time of 14.6 hr, so there was weak selection for the latter in the higher serum concentration. When adapted cells were subjected to two passagers in 10% CS prior to assay of growth in 0.25% CS, a 4-day lag period was evident before commencement of exponential growth, and there was a decrease in saturation density. Further delay of growth in 0.25% CS developed as the number of passages of cells in 10% CS increased. The marked delay of growth in 0.25% CS of the bulk population after a few days in 10% CS argued against selection in 10% CS of rare nonadapted mutants from the adapted population and for an epigenetic origin of the change. Reconstruction experiments utilizing adapted cells mixed with non-adapted cells in 0.25% CS buttressed this explanation. Eight clones of the adapted population exhibited some loss of growth capacity in 0.25% CS after a single passage in 10% CS, though the extent of loss varied from clone to clone. The results support the idea that all cells in the adapted population respond to the lifting of growth constraints with loss of their growth potential under highly constrained conditions. They are consistent with the concept of progressive state selection in which selection operates on fluctuating metabolic states of individual cells rather than on genetic variants.

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Spontaneous resolution of rectal polyps in patients with familial polyposis following abdominal colectomy and ileorectal anastomosis

Cited by 64 publications

References 7 publications

Tumour progression and the nature of cancer

Tumour progression and the nature of cancer

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Growth in high serum concentrations leads to rapid deadaptation of cells previously adapted to growth in an extremely low concentration of serum.

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