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Assessing the additional neoplasia yield of EndoRings in a colorectal cancer (CRC) screening setting

ABSTRACT: Background and study aims Bowel (or colorectal) cancer is one of the most common types of cancer. If a person is suspected to have colorectal cancer, they may undergo a colonoscopy, an examination of the bowel using a device called a colonoscope. A colonoscope is a flexible tube that is attached to a camera and a light. It is inserted into the bowel though the rectum. The tube is pushed through the entire length of the bowel and is then slowly taken out again (withdrawn). The bowel is examined for signs of cancer (the presence of adenomas and polyps) during withdrawal. The EndoRings is a flexible silicone rubber device that can be attached to the end of a colonoscope. It has circular wings that stretch the walls of the colon and flatten them. This, in turn, increases how much of the colon that can be seen during a colonoscopy. Previous studies have shown that EndoRings colonoscopy is more likely to detect adenomas and polyps and are less likely to miss them (miss rate) than standard colonoscopy. This study is comparing the diagnostic yield (that is, how many patients are diagnosed with bowel cancer) and the number of adenomas and polyps are missed (the miss rate) of EndoRings colonoscopy with standard colonoscopy. Who can participate? Adults that have tested positive in respect to a immunochemical fecal test as part of a screening program to detect bowel cancer. What does the study involve? Participants are randomly assigned to one of four groups. Those in group 1 are given a standard colonoscopy. Those in group 2 are given a EndoRings colonoscopy. Those in group 3 are given a standard colonoscopy followed by a EndoRings colonoscopy (one immediately after the other). Those in group 4 are given a EndoRings colonoscopy followed immediately by a standard colonoscopy. If any adenomas or polyps are identified during the procedures they are removed and analysed if appropriate. All patients are then called 30 days after the examination and asked about their experience.

DISEASE(S): Colorectal Adenomas And Serrated Polyps

PROVIDER: 2419978 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Colorectal cancer often arises from adenomatous polyps. Polyps can grow and progress to cancer, but may also remain static in size, regress, or resolve. Prediciting which progress to cancer and which remain benign is difficult. We developed a long-lived murine model of colorectal cancer with tumors that can be followed by colonoscopy. Our aim was to assess whether these tumors have similar growth patterns and histologic fates to human colorectal polyps to identify features to aid in risk stratification of colonic tumors. Long-lived Apcin/+ mice were treated with 4% dextran sodium sulfate to promote colonic tumorigenesis. Tumor growth patterns were characterized by serial colonoscopy, and pathology was determined. Serial biopsies of tumors were obtained for immunohistochemistry and gene expression profiling by microarray analysis with Affymetrix Whole Genome array. Tumors (n=424) grew, remained static, regressed, or resolved over time with different relative frequencies. Newly developed tumors demonstrated dynamic growth patterns with higher rates of growth and resolution, while more established tumors tended to remain static in size. Colonic tumors were hyperplastic lesions (3%), adenomas (73%), intramucosal carcinomas (20%), or adenocarcinomas (3%). Differentially expressed genes between adenomas and intramucosal carcinomas were identified. We did not identify differentially expressed genes between early and late biopsies from the same tumor. This novel murine model of intestinal tumorigenesis develops colonic tumors that can be monitored by serial colonoscopy, mirror growth patterns seen in human colorectal polyps, and progress to colorectal cancer. Further characterization of cellular and molecular features are needed to determine which features can be used to risk-stratify polyps for progress to colorectal cancer and potentially guide prevention strategies. F1 (SWR x C57BL/6) Apcin/+ mice who had been given two treatments of 4% dextran sodium sulfate in drinking water at weaning underwent colonoscopy around 80 days of age. Those with distal colonic tumors amenable to biopsy had two biopsies taken at that time. Tumors were monitored by colonoscopy every 14 days. Every 28 days, two additional biopsies were taken of each tumor. This protocol was repeated until mice were moribund. Six tumors were removed after sacrifice. The earliest and latest biopsies of each tumor were selected for RNA extraction and Affymetrix hybridization.

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Assessing the additional neoplasia yield of EndoRings in a colorectal cancer (CRC) screening setting

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