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Title: Localization, histological features and canceration potential of colorectal polyps in relation to patient’s sex and age

Abstract:

The aim of the study was to assess current frequency of all types of colon polyps potentially able to develop cancer (adenomatous, hyperplastic or serrated) as well as to determine polyp occurrence, its histological features and localization in relation to age and sex. We also tried to work out a total canceration potential index in relation to age, sex, number and histology of polyp carrying the risk of cancer development and foci of already developed cancer simultaneous with polyps. The study group consisted of 797 patients who between 2000 and 2006 was admitted to General and Oncologic Surgery Ward at the L. Rydygier's Provincial Specialist Hospital L. in Cracow to perform colonoscopy with polypectomy. Patients who underwent polypectomy constituted ca 10% of all patients with colonoscopies performed in this time in Surgery Ward at the L. Rydygier’s Hospital. In total, 1555 polyps (1176 adenomatous polyps (75.6%), 291 hyperplastic polyps (18.7%) and 88 serrated polyps (5.7%)) and 120 synchronous cancer foci were found in the studied population. All polyp’s type were significantly more frequent in men than in women. In men group the number of polyps increased in relation to age continuously, while in women polyps were most common in group 51-70 years. The performed analysis has shown diversity in frequency of each type of polyp in colon segments - adenomatous polyps were the most common in all segments, however, hyperplastic polyps were more frequent in rectum while serrated polyps were more common in proximal colon. Hyperplastic polyps had the lowest diameter while adenomas were the largest. Adenomatus polyps were more dysplastic than serrated polyps. The largest hyperplastic and serrated polyps were found in proximal colon, whereas the most dysplastic serrated polyps were observed in distal colon. The largest and the most dysplastic adenomatous polyps were found in distal colon, while villous or tubulovillous adenomatous polyps were more common in rectum. The patients with hyperplastic polyps were younger than patients with serrated and adenomatous polyps. Moreover, in cases of patients with hyperplastic polyps we found a difference in mean age between women and men - the men were younger. Adenomatous and serrated polyps in patients of all ages and hyperplastic polyps in the youngest group (up to 50 years of age) were more often found in men than in women, while the frequency of hyperplastic polyps in the patients over 50 years of age was similar for both sexes. Adenomatous polyps characterized by disadvantageous histological structure (large, high grade dysplasia, high villous content) in the patients up to 50 years of age was more common in males, while in patients over 70 years of age - in females. No significant structural differences in hyperplastic polyps between women and men were observed. The only difference in serrated polyps' structure concerned polyps' diameter in patients over 70 years of age (with larger lesions in men). In comparison to the older group, all polyps' types in patients up to 50 years of age were significantly more frequently found in rectum. The observation concerned both sexes equally. The topographic differences in polyp localization in relation to sex were found only in case of adenomatous and hyperplastic polyps in patients over 70 years of age. A relative shift of adenomatous polyps into distal part of the colon was observed in females, whereas hyperplastic polyps in the distal part of colon was more often found in males over 70 years old. Canceration potential index (CPI) values in all age groups were higher in males than in females. CPI values in male increased with age, while in female patients no statistically significant differences were observed. In patients over 50 years of age the largest part of total CPI was caused by rectal lesions, whereas in younger patients - distal colon lesions. ; In males below 50 years of age CPI value in proximal colon was significantly higher than in females of the same age. The presented results show a dominant role of classical carcinogenesis pathway in malignant transformation in the study group. Alternative pathway (transformation sequence: hyperplastic polyp - serrated polyp) dominate in proximal colon. Adenomatous polyps are the most commonly found in distal colon. Because the highest grade of dysplasia was found in distal colon and concerned both adenomatous and serrated polyps, distal part of large intestine seems to be very susceptible to intensive progression of precancerous lesions. Both carcinogenesis pathways, related to both classical adenomas and sequential polyps (hyperplastic polyp - serrated polyp) were more often found in males than in females. The alternative carcinogenesis pathway is more often observed in males with no relation to age. On the other hand, adenomatous polyps, because of their pathomorphological structure, are more dangerous to younger men, whereas in elderly patients (over 70 years of age) may dominate in women. In patients up to 50 years of age the risk of all polyps' type development is highest in rectum, while in older patients - in distal colon for adenomatous polyps and with proximal colon for serrated polyps. The above data shed new light on the need to perform additional studies on the selection of patients to endoscopic screening of precancerous lesions in colon. We suggest that males should be screened earlier than females, whereas the maximum age limit should be increased. Canceration potential index (CPI) reflects the trends indicating localization, number and pathomorphological features of polyps in various age groups and both sexes. Hence, it can become a useful tool in epidemiologic population studies of colon cancer.

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu trawiennego ; onkologia

Degree grantor:

Wydział Lekarski

Promoter:

Włodzimierz Drożdż

Date issued:

2010

Format:

application/msword

Identifier:

oai:dl.cm-uj.krakow.pl:832

Call number:

ZB-113849

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Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Oct 14, 2019

In our library since:

Nov 21, 2012

Number of object content hits:

5

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/832

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ZB-113849 Oct 14, 2019
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