• Asian Pacific Journal of Cancer Prevention
• /
• 제15권22호
• /
• pp.9773-9779
• /
• 2014

Background: Colorectal cancer (CRC) is one of the prime causes of mortality around the globe, with a significantly rising incidence in the Middle East region in recent decades. Since detection of CRC in the early stages is an important issue, and also since to date there are no comprehensive epidemiologic studies depicting the Middle East region with special attention to the average risk group, further investigation is of significant necessity in this regard. Aim: Our aim was to investigate the prevalence of preneoplastic and neoplastic lesions of the colon in an average risk population. Materials and Methods: A total of 1,208 eligible asymptomatic, average- risk adults older than 40 years of age, referred to Firuzgar Hospotal in the years 2008-2012, were enrolled. They underwent colonoscopy screening and all polypoid lesions were removed and examined by an expert gastrointestinal pathologist. The lesions were classified by size, location, numbers and pathologic findings. Size of lesions was measured objectively by endoscopists. Results: The mean age of participants was $56.5{\pm}9.59$ and 51.6% were male. The overall polyp detection rate was 199/1208 (16.5 %), 26 subjects having non-neoplastic polyps, including hyperplastic lesions, and 173/1208 (14.3%) having neoplastic polyps, of which 26 (2.15%) were advanced neoplasms. The prevalence of colorectal neoplasia was more common among the 50-59 age group. Advanced adenoma was more frequent among the 60-69 age group. The majority of adenomas were detected in the distal colon, but a quarter of advanced adenomas were found in the proximal colon; advance age and male gender was associated with the presence of adenoma. Conclusions: It seems that CRC screening among average-risk population might be recommended in countries such as Iran. However, sigmioidoscopy alone would miss many colorectal adenomas. Furthermore, the 50-59 age group could be considered as an appropriate target population for this purpose in Iran.

• 농촌의학ㆍ지역보건
• /
• 제39권3호
• /
• pp.137-145
• /
• 2014

대장내시경을 이용한 대장암 선별검사가 증가하면서 발견된 용종의 절제와 추적검사가 점차 많아지고 있다. 하지만 국내에 대장용종절제 후 추적검사에 대한 연구가 부족한 실정이다. 이에 본 연구에서는 대장용종절제술 후 용종의 재발률을 알아보고 재발 위험 인자를 알아보고자 하였다. 이를 위하여 2000년 1월부터 2008년 3월까지 기간 동안에 용종절제술을 시행 받고 이후 추적검사를 시행 받은 147명의 환자를 대상으로 의무기록을 통한 후향적 분석을 시행하였다. 대장내시경검사를 통해 발견된 용종은 Kudo의 분류법으로 기술하였다. 추적 조사기간은 용종절제술과 이후 시행한 추적 대장내시경 검사와의 간격으로 정의하였다. 대상자 중 남자가 76.2%이었고, 환자의 평균연령은 $56.5{\pm}8.1$세이었다. 대상자의 용종절제 후 평균 추적기간은 $24.9{\pm}13.7$(6 - 65)개월이었다. 1년 누적재발률은 11.6%, 2년 누적재발률은 36.7%이고, 3년 누적재발률은 55.8%이었다. 용종의 개수에 따라 재발율이 유의한 차이를 보였다. 용종의 재발여부에 독립적인 영향을 미치는 인자로는 조직학적 형태가 의미있는 인자로 조사되었다. 본 연구 결과 대장의 선종성 용종의 3년 누적재발률이 55%를 넘는 것으로 관찰되므로 대장용종절제 후 추적 대장 내시경의 중요성이 강조되며 향후 대장용종절제술 후 재발에 대한 국내의 대규모 연구가 이루어져야 할 것으로 보인다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권11호
• /
• pp.4885-4892
• /
• 2016

Background: Chinese and Korean Americans have lower colorectal cancer (CRC) screening rates than other racial/ ethnic groups, which may be explained by a low level of CRC knowledge and a high level of misconceptions. This study explores the role of knowledge in CRC screening among these groups. Methods: Chinese (N=59) and Korean (N=61) Americans older than 50 were recruited from the Washington D.C. Metropolitan area. They completed a detailed survey and participated in focus groups to discuss their knowledge on CRC and CRC screening. Seventeen physicians, community leaders, and patient navigators participated in key informant interviews. Using a mixed methods approach, data were analyzed quantitatively and qualitatively. Results: Participants lacked knowledge about CRC and CRC screening. More than half did not know that screening begins at age 50 and there are several types of tests available. More than 30% thought CRC screening was not necessary if there were no symptoms or there was nothing they could do to prevent CRC. Focus group findings suggested understanding about CRC was limited by an inadequate source of linguistically and culturally relevant health information. For example, many participants considered CRC a western condition mainly caused by unhealthy diet. This led to under-estimations about their susceptibility to CRC. Knowledge was positively associated with self-reported screening. Participants who had higher knowledge scores were more likely to report ever having had a colonoscopy and confidence in ability to have CRC screening. Conclusions: Mixed-methods analysis provides multi-faceted perspectives on CRC knowledge and its influence on screening. Study findings can help inform interventions to increase CRC screening among Chinese and Korean Americans.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권1호
• /
• pp.237-241
• /
• 2012

Objective: Screening for colorectal cancer using guaiac-based fecal occult blood tests (gFOBT) is well established in Western populations, but is hampered by poor patient compliance due to the imposed dietary restrictions. Fecal immunochemical tests (FIT) do not require dietary restriction, but are more expensive than gFOBT and therefore restrict its use in developing countries in Asia. However, Asian diets being low in meat content may not require diet restriction for gFOBT to achieve equivalent results. The objective of this study was to evaluate and compare the validity and suitability of gFOBT and FIT or a combination of the two in screening for colorectal neoplasias without prior dietary restriction in an Asian population. Methods: Patients referred to the Endoscopic Unit for colonoscopy were recruited for the study. Stool samples were collected prior to bowel preparation, and tested for occult blood with both gFOBT and FIT. Dietary restriction was not imposed. To assess the validity of either tests or in combination to detect a neoplasm or cancer in the colon, their false positive rates, their sensitivity (true positive rate) and the specificity (true negative rate) were analyzed and compared. Results: One hundred and three patients were analysed. The sensitivity for picking up any neoplasia was 53% for FIT, 40% for gFOBT and 23.3% for the combination. The sensitivities for picking up only carcinoma were 77.8%, 66.7% and 55.5%, respectively. The specificity for excluding any neoplasia was 91.7% for FIT, 74% for gFOBT and 94.5% for a combination, whereas for excluding only carcinomas they were 84%, 73.4% and 93.6%. Of the 69 with normal colonoscopic findings, FOBT was positive in 4.3%, 23.2 %and 2.9% for FIT, gFOBT, or combination of tests respectively. Conclusion: FIT is the recommended method if we are to dispense with dietary restriction in our patients because of its relatively low-false positivity and better sensitivity and specificity rates.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권4호
• /
• pp.1667-1670
• /
• 2014

Background: Calprotectin in feces seems to be a more sensitive marker for gastrointestinal (GI) cancers than fecal occult blood, but its specificity may be too low for screening average risk populations. This study aims at evaluating the diagnostic value of fecal calprotectin as a screening biomarker for GI malignancies. Materials and Methods: In a case-control study, 100 patients with GI malignancies (50 patients with colorectal cancer and 50 patients with gastric cancer) and 50 controls were recruited in Tabriz Imam Reza and Sina hospitals during a 24-month period. One to two weeks after the last endoscopy/colonoscopy, fecal specimens were collected by the patients and examined by ELISA method for quantitative measurement of calprotectin content. The results were compared between the three groups. Results: The mean fecal calprotectin level was $109.1{\pm}105.3$ (2.3-454.3, median:74), $241.1{\pm}205.2$ (3.4-610.0, median:19.3) and $45.9{\pm}55.1{\mu}g/g$ (1.3-257.1, median:19.3) in gastric cancer, colorectal cancer and control group, respectively, the differences being significant (p<0.001) and remaining after adjustment for age. The optimal cut-off point for fecal calprotectin was ${\geq}75.8{\mu}g/g$ for distinguishing colorectal cancer from normal cases (sensitivity and specificity of 80% and 84%, respectively). This value was ${\geq}41.9{\mu}g/g$ for distinguishing gastric cancer from normal cases (sensitivity and specificity of 62%). Conclusions: Our results revealed that fecal calprotectin might be a useful and non-invasive biomarker for distinguishing colorectal cancer from non-malignant GI conditions. However, due to low sensitivity and specificity, this biomarker may not help physicians distinguishing gastric cancer cases from healthy subjects.

• Journal of Digestive Cancer Reports
• /
• 제7권2호
• /
• pp.45-50
• /
• 2019

Incidence of rectal neuroendocrine neoplasms (NEN) has increased tremendously over the decades due to disease awareness and widespread use of screening colonoscopy. Although NEN has been recognized as malignant disease, most rectal NENs are initially found as small mass confined to the submucosa, which can be removed completely through various endoscopic treatments with good prognosis. In this review, we summarize the treatment options focusing on localized T1 rectal NEN by comparing representative international guidelines and discuss current controversies on the management. We also discuss various resection techniques focusing on endoscopic resection.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권22호
• /
• pp.9933-9937
• /
• 2014

Background: Colorectal cancer is the third most common type of cancer in males and the second in females in Iran. Males are more likely to develop CRC than women and age is considered as a main risk factor for colorectal cancer. Prevalence of colorectal cancer has been increasing in Asian countries. Aim: The object of this study was to determine the clinical and pathology characteristics of colorectal polyps in Iranian patients and to investigate the variation between our populations with other populations. Materials and Methods: A total of 167 patients with colorectal polyps were included in our study. All underwent colonoscopy during 2009-2013 and specimens were taken through polypectomy and transferred to pathology. All data in patient files including pathology reports were collected and analyzed by SPSS 16 software. A two-tailed test was used and a P-value of < 0.05 was considered significant. Results: Mean age of participants was $57{\pm}15$. Some 84 were females (50.3%) and 83 males (49.7%). Total of 225 polyps were detected which 119 (52.9%) were in males and 106 (47.1%) were in females. Solitary polyps were observed in 124 patients (74%), 26 (15.6%) had two polyps and 17 (10.1%) with more than two polyps (three to five). Rectosigmoid was the site of most of the polyps (63.1%), followed by 19.6% in the descending colon, 7.6% in the transverse, 5.8% in the ascending, and 3.1% in the cecum, data being missing in two cases. Conclusions: Recto sigmoid was site of most of the polyps. The most prevalent type of lesion was adenomatous polyps detected in 78 (34.7%). Mixed hyperplastic adenomatous type observed in 70 (31.1%). This high prevalence of adenomatous polyps in Iranian patients implies the urgent need for screening plans to prevent further healthcare problems with colorectal cancer in the Iranian population.

• 대한핵의학회지
• /
• 제39권1호
• /
• pp.15-20
• /
• 2005

목적 : 건강검진 등을 목적으로 시행된 무증상의 성인에서 대장 섭취는 매우 자주 관찰되나 대장선종 및 암종에서 FDG 섭취가 보고되어 생리적인 FDG 섭취와 구별이 쉽지 않았다. 이에 저자들은 무증상 성인을 대상으로 FDG-PET을 시행하여 그 섭취 패턴과 섭취 강도를 조사하고 대장내시경 소견과 비교하였다. 대상 및 방법 : FDG-PET과 대장내시경을 모두 시행한 무증상인 64명($27{\sim}87$세, 남:여=31:33) 을 대상으로 하였다. FDG 섭취 양상은 focal, segmental, diffuse세 그룹으로 나누고 모든 환자에 대해 최대 SUV값을 구하고 병소의 크기 및 조직학 소견과 비교하였다. 결과 : Diffuse 53.1%, Segmental 26.5%, Focal 20.3%의 섭취양상을 보였으며, Diffuse 양상을 보이면 대부분에서 정상이었고 선종이 소수 발견되었으나 크기가 작았다. Focal 양상의 환자에서는 선종 또는 기타 병리 소견 등의 양성 대장내시경 결과를 더 많이 보였고 다른 두 섭취 양상에서보다. 발견된 선종의 크기가 컸다. 대장 섭취정도를 SUV로 측정하였을 때 내시경 음성인 환자들은 선종 및 기타 병리소견이 있는 내시경 양성환자보다 SUV가 낮았으나 선종의 크기에 따른 SUV의 차이는 없었다. 결론: 무증상 환자에서 FDG-PET를 시행하였을 때 본 연구에서 제시된 대장 섭취 패턴과 섭취강도에 따른 내시경 결과와의 관계가 대장 선종 및 기타 병소를 진단하거나 내시경 등의 다음 검사로의 진행 결정에 일부 역할을 할 것으로 기대된다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권18호
• /
• pp.7583-7588
• /
• 2014

Background: Colorectal cancer (CRC) is a major cause of cancer-related death and cancer-related incidence worldwide. The potential of microRNA-21 (miR-21) as a biomarker for CRC detection has been studied in several studies. However, the results were inconsistent. Therefore, we conducted the present meta-analysis to systematically assess the diagnostic value of miR-21 for CRC. Materials and Methods: Using a random-effect model, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to evaluate the diagnostic performance of miR-21 for CRC. A summary receiver operating characteristic (SROC) curve and an area under the curve (AUC) were also generated to assess the diagnosis accuracy of miR-21 for CRC. Q test and I2 statistics were used to assess between-study heterogeneity. Publication bias was evaluated by the Deeks' funnel plot asymmetry test. Results: A total of 986 CRC patients and 702 matched healthy controls from 8 studies were involved in the meta-analysis. The pooled results for SEN, SPE, PLR, NLR, DOR, and AUC were 57% (95%CI: 39%-74%), 87% (95%CI: 78%-93%), 4.4 (95%CI: 2.4-8.0), 0.49 (95%CI: 0.32-0.74), 9 (95%CI: 4-22), and 0.83 (95%CI: 0.79-0.86), respectively. Subgroup analyses further suggested that blood-based studies showed a better diagnostic accuracy compared with feces-based studies, indicating that blood may be a better matrix for miR-21 assay and CRC detection. Conclusions: Our findings suggest that miR-21 has a potential diagnostic value for CRC with a moderate level of overall diagnostic accuracy. Hence, it could be used as auxiliary means for the initial screening of CRC and avoid unnecessary colonoscopy, which is an invasive and expensive procedure.

• Journal of Digestive Cancer Reports
• /
• 제9권2호
• /
• pp.57-59
• /
• 2021

Carcinoid tumor is called as neuroendocrine tumor and is classified into neuroendocrine tumor Grade 1, neuroendocrine tumor Grade 2, and neuroendocrine carcinoma based on the differentiation of tumors. Recently, the incidence of rectal carcinoid tumor has been increasing probably due to the increased interest on screening colonoscopy and the advancement of endoscopic imaging technology. As the rectal carcinoid shows a wide range of clinical characteristics such as metastasis and long-term prognosis depending on the size and histologic features, it is a challenge to give a consistent diagnostic code in patients with the rectal carcinoid. If the rectal carcinoid tumor is less than 1 cm in size, it can be given as the code of definite malignancy or the code of uncertain malignant potential according to International Classification of Diseases for Oncology (ICD-O) by World Health Organization (WHO). Because patients get different amount of benefit from the insurance company based on different diagnostic codes, this inconsistent coding system has caused a significant confusion in the clinical practice. In 2019, WHO updated ICD-O and Statistics Korea subsequently changed Korean Standard Classification of Diseases (KCD) including the code of rectal carcinoid tumors. This review will summarize what has been changed in recent ICD-O and KCD system regarding the rectal carcinoid tumor and surmise its clinical implication.