Screening of colorectal cancer: present and future Maida, Marcello; Macaluso, Fabio Salvatore; Ianiro, Gianluca ...
Expert review of anticancer therapy,
12/2017, Letnik:
17, Številka:
12
Journal Article
Recenzirano
Colorectal cancer (CRC) is the third most common cancer in males and second in females, and the fourth most common cause of cancer death worldwide. Currently, about 60-70% of diagnosed cases in ...symptomatic patients are detected at an advanced stage of disease. Earlier stage detection through the use of screening strategies would allow for better outcomes in terms of reducing the disease burden. Areas covered: The aim of this paper is to review the current published evidence from literature which assesses the performance and effectiveness of different screening tests for the early detection of CRC. Expert commentary: Adequate screening strategies can reduce CRC incidence and mortality. In the last few decades, several tests have been proposed for CRC screening. To date, there is still insufficient evidence to identify which approach is definitively superior, and no screening strategy for CRC can therefore be defined as universally ideal. The best strategy would be the one that can be economically viable and to which the patient can adhere best to over time. The latest guidelines suggest colonoscopy every 10 years or annual fecal immuno-chemical test (FIT) for people with normal risk, while for individuals with high risk or hereditary syndromes specific recommendations are provided.
Background
Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of ...superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR).
Methods
This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy.
Results
Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher “en-bloc” and R0 resection rates for colonic lesions, but lower “en-bloc” and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar “en-bloc” resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated.
Conclusions
Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.
Microbiota refers to the population of microorganisms (bacteria, viruses and fungi) that inhabit the entire gastrointestinal tract, more particularly the colon whose role is to maintain the integrity ...of the intestinal mucosa and control the proliferation of pathogenic bacteria. Alteration in the composition of the gut microbiota is called dysbiosis. Dysbiosis redisposes to inflammatory bowel diseases such as ulcerative colitis, Crohn disease and indeterminate colitis.
The purpose of this literature review is to elucidate the influence of diet on the composition of the gastrointestinal microbiota in the healthy gut and the role of diet in the development of dysbiosis.
The "Western diet", in particular a low - fiber high fat/high carbohydrate diet is one factor that can lead to severe dysbiosis. In contrast, "mediterranean" and vegetarian diets that includes abundant fruits, vegetables, olive oil and oily fish are known for their anti-inflammatory effects and could prevent dysbiosis and subsequent inflammatory bowel disease.
Abstract Tumor necrosis factor alpha (TNF-alpha) antagonists have emerged as an effective therapy for patients with diseases as Crohn's disease, rheumatoid arthritis, and other chronic systemic ...inflammatory diseases. In the last years, there has been a growing interest in the role that inflammatory cytokines, which sustain the pathogenesis of these diseases, plays in regulating cardiac structure and function, particularly in the progression of chronic heart failure. In fact there is an increase of anti-TNF alpha levels in advanced heart failure but the treatment with anti-TNF alpha has been shown to worsen the prognosis of heart failure in randomized controlled trials. Patients with rheumatoid arthritis have an increased risk for cardiovascular disease and anti-TNF alpha therapy seems to be beneficial on the risk of cardiovascular disease. In Crohn's disease the increased risk of cardiovascular disease is controversial and therefore it is impossible to demonstrate an effect in reduction of the risk; however, heart failure in patients treated with anti-TNF alpha, despite in a small proportion, has been observed. On the basis of this observation, anti-TNF alpha therapy is contraindicated in patients with Crohn's disease and III–IV New York Heart Association heart failure class.
Patients with inflammatory bowel disease(IBD)have an increased risk of 10%-15%developing colorectal cancer(CRC)that is a common disease of high economic costs in developed countries.The CRC has been ...increasing in recent years and its mortality rates are very high.Multiple biological and biochemical factors are responsible for the onset and progression of this pathology.Moreover,it appears absolutely necessary to investigate the environmental factors favoring the onset of CRC and the promotion of colonic health.The gut microflora,or microbiota,has an extensive diversity both quantitatively and qualitatively.In utero,the intestine of the mammalian fetus is sterile.At birth,the intestinal microbiota is acquired by ingesting maternal anal or vaginal organisms,ultimately developing into a stable community,with marked variations in microbial composition between individuals.The development of IBD is often associated with qualitative and quantitative disorders of the intestinal microbial flora(dysbiosis).The healthy human gut harbours about10 different bacterial species distributed in colony forming units which colonize the gastrointestinal tract.The intestinal microbiota plays a fundamental role in health and in the progression of diseases such as IBD and CRC.In healthy subjects,the main control of intestinal bacterial colonization occurs through gastric acidity but other factors such as endoluminal temperature,competition between different bacterial strains,peristalsis and drugs can influence the intestinal microenvironment.The microbiota exerts diverse physiological functions to include:growth inhibition of pathogenic microorganisms,synthesis of compounds useful for the trophism of colonic mucosa,regulation of intestinal lymphoid tissue and synthesis of amino acids.Furthermore,mucus seems to play an important role in protecting the intestinal mucosa and maintaining its integrity.Changes in the microbiota composition are mainly influenced by diet and age,as well as genetic factors.Increasing evidence indicates that dysbiosis favors the production of genotoxins and metabolites associated with carcinogenesis and induces dysregulation of the immune response whichpromotes and sustains inflammation in IBD leading to carcinogenesis.A disequilibrium in gut microflora composition leads to the specific activation of gut associated lymphoid tissue.The associated chronic inflammatory process associated increases the risk of developing CRC.Ulcerative colitis and Crohn’s disease are the two major IBDs characterized by an early onset and extraintestinal manifestations,such as rheumatoid arthritis.The pathogenesis of both diseases is complex and not yet fully known.However,it is widely accepted that an inappropriate immune response to microbial flora can play a pivotal role in IBD pathogenesis.
Functional gastrointestinal disorders (FGIDs), also known as disorders of gut-brain interaction, are a group of disorders characterized by chronic gastrointestinal symptoms in the absence of ...demonstrable pathology on conventional testing ....
An adequate bowel preparation is essential for a successful colonoscopy, in particular, in the setting of colorectal cancer screening. However, up to one-quarter of colonoscopies are associated with ...inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, prolonged procedural time, and an increased likelihood of repeat the procedure. The ideal intestinal preparation should provide an optimal observation of the mucosa (at least > 90% of the visible surface), with adequate acceptability and safety for the patient. With this premise, a very low-volume 1 L PEG-ASC solution (Plenvu; Norgine, Harefield, United Kingdom) has been recently introduced to improve patients' experience in colonoscopy by reducing the total intake of liquids to be consumed. This could represent a valid option for bowel cleansing, considering CRC screening and surveillance programs, improving both the quality of the examination and the patients' compliance. Nevertheless, it must be emphasized that a "one size fits all" preparation strategy is not feasible and that a bowel preparation regime must always be selected and tailored by the clinician for each patient, evaluating the best options on a case by case basis. This narrative review aims to sum up the evidence regarding new bowel preparation regimens in order to help clinicians to tailor the best choice for patients undergoing colonoscopy.
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