Prospective determination of distal colon findings in average-risk patients with proximal colon cancer☆,☆☆
Section snippets
PATIENTS AND METHODS
The study was approved by the institutional review board at Indiana University/Purdue University at Indianapolis. All participating centers removed patient identifiers from patient records and coded the records before forwarding them to the study center. Investigators were asked to recruit consecutive patients identified with a new diagnosis of cancer proximal to splenic flexure. After identifying and taking biopsy samples from or endoscopically removing a proximal cancer, they removed all
RESULTS
The study investigators prospectively identified 136 consecutive patients with colon cancer proximal to the splenic flexure, and the location was confirmed by surgical resection in 130 patients (Table 1).
Distal colon findings Average risk n = 116 Positive family history n = 20 Normal 68 (58.6)* 11 (55) Cancer 3 (2.6) 0 (0) Cancer and adenoma 5 (4.3) 1 (5) Largest adenoma ≥ 10 mm† 19 (16.4) 6 (30) Largest adenoma
DISCUSSION
To our knowledge, this is the first prospective evaluation of colonoscopic findings distal to the splenic flexure in patients with colon cancer proximal to the splenic flexure. The principal finding is that the percentage of patients with proximal cancer who have no neoplasia identified distal to the splenic flexure in the prospective study (65.5%) is numerically lower but is comparable to the range of findings reported in retrospective studies of this issue, 70% to 83%.4, 5, 6, 7, 8, 9, 10
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Cited by (71)
Colonoscopy and Flexible Sigmoidoscopy in Colorectal Cancer Screening and Surveillance
2011, Early Diagnosis and Treatment of Cancer Series: Colorectal CancerColonoscopy and Flexible Sigmoidoscopy in Colorectal Cancer Screening and Surveillance
2010, Early Diagnosis and Treatment of Cancer Series: Colorectal CancerCanadian Colorectal Cancer Screening Initiatives and Barriers
2008, Journal of the American College of RadiologyASGE guideline: Colorectal cancer screening and surveillance
2006, Gastrointestinal EndoscopyCitation Excerpt :Lieberman et al19 and Imperiale et al20 demonstrated that approximately 50% of patients with proximal advanced neoplasia have no distal polyps. In a prospective multicenter study of 116 average-risk patients with established colon cancer located proximal to the splenic flexure, 58.6% had no distal polyps.22 This evidence favors the use of colonoscopy as the primary method of screening for CRC, given that a significant portion of proximal advanced neoplasia will not be detected with use of flexible sigmoidoscopy.
Screening and surveillance of colorectal cancer
2005, Gastrointestinal Endoscopy Clinics of North America
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Reprint requests: Douglas K. Rex, MD, Indiana University Hospital, 550 North University, Room 2300, Indianapolis, IN 46202.
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