大肠癌的肿瘤坏死因子和白细胞介素-1基因多态性研究

大肠癌是常见的消化道恶性肿瘤之一，其发病机制仍不清楚。目前免疫遗传素质与大肠癌的关系越来越受到重视，肿瘤坏死因子（TNF）和白细胞介素-1（IL-1）是体内具有多种生物活性的重要细胞因子，有抗肿瘤、抗病毒感染及免疫调节作用。因此，本文对浙江地区汉族人群TNF-α和IL-1基因多态性分布进行研究，并分析其与大肠癌的相关性，阐明TNF—α和IL-1基因多态性在大肠癌发病中的作用。     

肠道菌群与大肠癌关系研究进展

大肠癌是人类常见的恶性肿瘤之一,在我国发病率逐年上升,其发病机制复杂,与遗传、环境等诸多因素有关。近年来,研究表明肠道菌群及其代谢产物与大肠癌密切相关。同时,肠道菌群也是导致炎症产生的主要因素,并且与大肠癌的发生密切相关。本文就肠道菌群及其代谢产物和炎症在大肠癌中的作用作一概述。     

蛋白质组学在大肠癌研究中的应用

大肠癌是我国常见恶性肿瘤之一, 且发病率和死亡率呈逐年上升趋势. 蛋白质组学的出现,使大肠癌的研究有了进一步的发展. 本文就国内外蛋白质组学在大肠癌诊断、发病机制、治疗等方面的研究进行综述.     

青年大肠癌21例临床分析

大肠癌是最常见消化道恶性肿瘤之一。大肠癌发病年龄多在40岁以上。但近年来,大肠癌的发病率和发病年龄有逐渐提高和提前的趋势。我国大肠癌的发病年龄比欧美等西方国家有明显提前。本组病例为1991年至2002年3月我院经大肠镜检查并经病理确诊的大肠癌283例,其中35岁以下(包括35岁)的青年大肠癌21例,我们就其中青年大肠癌的临床症状、镜下形态,病理资料等进行分析,以探讨青年大肠癌的某些临床特征。     

肥胖与大肠肿瘤的关系研究进展

大肠癌是临床常见的恶性肿瘤之一,发病呈上升趋势。肥胖被认为是乳腺癌、大肠癌等肿瘤的危险因素之一,大量流行病学资料显示肥胖与大肠癌发病危险增高明显相关,此文着重介绍肥胖相关因子如胰岛素、瘦素、脂联素、胰岛素样生长因子等与大肠肿瘤之间流行病学关系及其可能的发病机制,肥胖干预可能有助于大肠肿瘤的防治。     

大肠癌的筛查与监控

大肠癌包括结肠癌和直肠癌,是人类最常见的恶性肿瘤之一.在世界范围内,大肠癌年发病数近100万,发病率仅次于肺癌和乳腺癌居第三位.据美国癌症学会估计,2006年美国有148 610例大肠癌新发患者,并有55 170例大肠癌患者死亡[1].     

谷胱甘肽转硫酶基因型与浙江汉族人群散发性大肠癌的易感性

大肠癌的发生机制涉及环境、遗传两方面,而环境因素致癌主要取决于个体的易感性.毒物代谢酶的基因多态性是影响人类肿瘤遗传易感性的重要因素之一.     

胆囊切除术增加大肠癌风险及其机制的研究进展

大肠癌(colorectal cancer,CRC)包括结肠癌和直肠癌,是常见消化道恶性肿瘤之一.在世界范围内每年约有100万大肠癌新发病例,其中,有超过50万死于大肠癌,相当于全球8％的癌症死亡人数[1].中国年均新发大肠癌病例13万,并以年均4％的增幅不断攀升;在发达地区,以上海地区为例,2003～ 2007年大肠癌粗发病率和死亡率分别为43.35/105和22.42/105,位居全部恶性肿瘤的第2位[2].大肠癌目前尚未有确切的病因,但大肠癌的较为明确的诱发因素包括饮食环境因素、物理放射因素、遗传因素、其他因素等.其中,由于胆囊疾病所引起的大肠癌罹患率的增加,是近几十年关于大肠癌诱发因素研究的一个重要方向.     

大肠癌粪便脱落细胞及其基因的检测

随着人们生活水平的提高和医疗条件的改善,诸多急性传染病均得到了有效的控制.然而,一些与环境因素密切相关的慢性非传染性疾病,如心、脑血管疾病和恶性肿瘤的发病率有了明显上升.大肠癌便是一个突出的例子.欧美和日本等大肠癌高发国家的研究证明,长年的高蛋白、高脂肪和低纤维素饮食习惯是促发大肠癌的重要环境因素(外因),患者遗传上的缺陷,如多种病相关基因的突变又是大肠癌发病的内在因素,这些相关的内外因素结合在一起可能也是近年我国大肠癌发病率上升的重要原因之一.预防为主是我国一贯的卫生工作方针,也是大肠癌防治工作的重点,纠正不良的饮食习惯,深入研究大肠癌发病的分子机制,从病因上着手防病是大肠癌预防工作的一级预防,而提高早癌和癌前疾病的检出率则是大肠癌的二级预防.众所周知,大肠癌有两个特点:一是有明确的癌前病变(93％的大肠癌来源于腺瘤);二是从癌前病变发展为癌有一较长的过程(平均7a).我们可以利用这些特点,通过普查发现癌前病变和早期癌,经过内镜的微创治疗,预防大肠癌的发生,提高早癌治愈率.下面几篇论文将围绕大肠癌早诊、早治的问题进行初步讨论,希望能引起同行专家的兴趣,提出更深入的见解.     

大肠癌的常规诊断

随着人们生活水平的提高和医疗条件的改善,诸多急性传染病均得到了有效的控制.然而,一些与环境因素密切相关的慢性非传染性疾病,如心、脑血管疾病和恶性肿瘤的发病率有了明显上升.大肠癌便是一个突出的例子.欧美和日本等大肠癌高发国家的研究证明,长年的高蛋白、高脂肪和低纤维素饮食习惯是促发大肠癌的重要环境因素(外因),患者遗传上的缺陷,如多种病相关基因的突变又是大肠癌发病的内在因素,这些相关的内外因素结合在一起可能也是近年我国大肠癌发病率上升的重要原因之一.预防为主是我国一贯的卫生工作方针,也是大肠癌防治工作的重点,纠正不良的饮食习惯,深入研究大肠癌发病的分子机制,从病因上着手防病是大肠癌预防工作的一级预防,而提高早癌和癌前疾病的检出率则是大肠癌的二级预防.众所周知,大肠癌有两个特点:一是有明确的癌前病变(93％的大肠癌来源于腺瘤);二是从癌前病变发展为癌有一较长的过程(平均7a).我们可以利用这些特点,通过普查发现癌前病变和早期癌,经过内镜的微创治疗,预防大肠癌的发生,提高早癌治愈率.下面几篇论文将围绕大肠癌早诊、早治的问题进行初步讨论,希望能引起同行专家的兴趣,提出更深入的见解.     

Korean guidelines for colorectal cancer screening and polyp detection

Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.     

Obesity and colorectal cancer

Obesity worldwide is constantly increasing. Obesity acts as an independent significant risk factor for malignant tumors of various organs including colorectal cancer. Visceral adipose tissue is physiologically more important than subcutaneous adipose tissue. The relative risk of colorectal cancer of obese patients is about 1.5 times higher than the normal-weight individuals, and obesity is also associated with premalignant colorectal adenoma. The colorectal cancer incidence of obese patients has gender-specific and site-specific characteristics that it is higher in men than women and in the colon than rectum. Obesity acts as a risk factor of colorectal carcinogenesis by several mechanisms. Isulin, insulin-like growth factor, leptin, adiponectin, microbiome, and cytokines of chronic inflammation etc. have been understood as its potential mechanisms. In addition, obesity in patients with colorectal cancer negatively affects the disease progression and response of chemotherapy. Although the evidence is not clear yet, there are some reports that weight loss as well as life-modification such as dietary change and physical activity can reduce the risk of colorectal cancer. It is very important knowledge in the point that obesity is a potentially modifiable risk factor that can alter the incidence and outcome of the colorectal cancer.     

窄带成像内镜技术在结直肠病变诊断中的应用

结直肠肿瘤的发病率和死亡率近年呈明显上升的趋势,因此早期诊断和治疗结直肠肿瘤显得十分重要。窄带成像内镜技术作为一种新的内镜下诊断技术,已初步显示出其对结直肠病变的诊断价值。本文就窄带成像内镜技术的原理及其诊断结直肠病变的作用作一综述。     

人工智能辅助结肠镜检查在下消化道病变的应用进展

随着我国科技的进步及人民生活质量的逐渐提高,结直肠癌已跃升为前五高发的癌症,严重影响人民的健康及预期寿命。结直肠癌的形成需要一个很漫长的过程,因此,早发现、早诊断及早治疗极其重要,其中规范化的结肠镜检查是发现早期结直肠癌最有效的方法。近年来,人工智能辅助消化内镜检查正成为研究的热点,其应用在结直肠癌早诊早治方面有明显的成效。本文就人工智能辅助结肠镜检查的优缺点及存在的问题进行综述,并对未来人工智能辅助内镜诊断结直肠癌中的应用方向进行展望。     

Depressed-type submucosal colon cancer: report of a case

PURPOSE: The article presents one of very few Korean reports on the detection of depressed early colorectal cancers, which have been cited by some Japanese doctors as another pathway for the development of colon cancers. Depressed-type early colorectal cancers have mainly been reported in Japan, and recently a few have also been reported in Western countries. Depressed early colorectal cancers are still rarely detected in Korea, where most colorectal surgeons, endoscopists, and radiologists refer to Western guidelines. METHODS: Recently, the authors experienced a typical 12-mm depressed-type early colon cancer in the ascending colon of a 55-year-old Korean male patient. It was detected by a colonoscopic examination. RESULTS: The lesion was flexible on insufflation and deflation with air and was considered an early colon cancer. Because of the large size, a surgical resection was performed. The final pathologic result was a minimally invasive submucosal cancer without lymph node metastasis. CONCLUSION: This Korean case is one of very few reported abroad, so we think that it might make an important contribution to research on depressed-type early colorectal cancer.     

Depressed-Type Submucosal Colon Cancer

PURPOSE: The article presents one of very few Korean reports on the detection of depressed early colorectal cancers, which have been cited by some Japanese doctors as another pathway for the development of colon cancers. Depressed-type early colorectal cancers have mainly been reported in Japan, and recently a few have also been reported in Western countries. Depressed early colorectal cancers are still rarely detected in Korea, where most colorectal surgeons, endoscopists, and radiologists refer to Western guidelines. METHODS: Recently, the authors experienced a typical 12-mm depressed-type early colon cancer in the ascending colon of a 55-year-old Korean male patient. It was detected by a colonoscopic examination. RESULTS: The lesion was flexible on insufflation and deflation with air and was considered an early colon cancer. Because of the large size, a surgical resection was performed. The final pathologic result was a minimally invasive submucosal cancer without lymph node metastasis. CONCLUSION: This Korean case is one of very few reported abroad, so we think that it might make an important contribution to research on depressed-type early colorectal cancer.     

Life after colectomy

Animal and epidemiologic studies have raised hopes that effective chemoprevention of colorectal cancer in very high-risk patients may be possible in the future, but at present, the only established effective way to prevent colorectal cancer in very high-risk patients is colectomy. Advances in surgical techniques, improvements in stomal appliances, and medical advances in dealing with complications of colorectal surgery (such as impotence) have contributed to substantial improvements in the quality of life of patients who have had prophylactic colectomies.     

Pathologic characteristics of colorectal cancer in the elderly: a retrospective study of 947 surgical cases

To determine the pathologic characteristics of colorectal cancer in the very old, a retrospective study of 947 consecutive Japanese patients aged > or =65 with 1,039 lesions were examined. Pathologic findings in the very old group (>85 years, n = 140) were compared with those in the younger groups; young-old group (65-74 years, n = 352) and middle-old group (75-84 years, n = 455). Although male:female ratio significantly decreased with advancing age, reaching 1:1.8 in the very old group, the relative odds of colorectal cancer in men were higher than that in women in all age groups. In the very old group, cancer of the proximal colon (proximal to the splenic flexure) accounted for 52% in women and 37% in men, being significantly higher than those in the younger groups. Proximal colonic cancers increased with advancing age in both genders. Higher proportions of poorly differentiated adenocarcinoma, mucinous carcinoma, cancer >5 cm in size, and protruding type cancer were present in the very old group, although these kinds of tumors typically occur in the proximal colon. The incidence of multiple cancers in the large intestine was not different among any age group (average, 8.6%). These results indicated that, even in the very old, colorectal cancers showed marked proximal excess, being explained by effect of both age and gender, and that the proximal shift may influence the proportion of histologic type and size of the tumor. These findings have important implications for screening and diagnosis of colorectal cancer in the elderly.     

Colorectal cancer and risk of atrial fibrillation and flutter: a population-based case–control study

Colorectal cancer has recently been associated with an increased atrial fibrillation risk, but evidence is very sparse. So, we conducted a population-based case-control study in northern Denmark (population 1.7 million) during 1998-2006 to estimate the atrial fibrillation/flutter risk in colorectal cancer patients. We identified 28,333 atrial fibrillation/flutter cases and 283,260 sex-, age-, and county-matched population controls. We searched the databases for a prior colorectal cancer diagnosis, a prior cancer diagnosis other than colorectal cancer, and performance of surgery within 30 days prior to atrial fibrillation/flutter. We used conditional logistic regression to estimate the OR of atrial fibrillation/flutter in patients with colorectal cancer, cancers other than colorectal and in patient with surgery. Among cases, 0.59% (n = 168) had a colorectal cancer diagnosis within 90 days before their atrial fibrillation/flutter diagnosis, compared with 0.05% (n = 155) of controls (adjusted OR = 11.8; 95% CI 9.3-14.9). Beyond the first 90 days after a colorectal cancer diagnosis, atrial fibrillation/flutter risk was no longer increased. There was likewise an increased atrial fibrillation/flutter risk in patients diagnosed with another cancer form in the prior 90 days (OR = 7.0, 95% CI 6.3-7.8). Furthermore, the atrial fibrillation/flutter risk was elevated fivefold in patients who had undergone surgery, whether or not cancer-related. We therefore conclude that colorectal cancer patients are at increased atrial fibrillation/flutter risk exclusively in the first 90 days after cancer diagnosis, but to no greater an extent than are patients with other cancers. The performance of surgery probably plays an important role in this association.