Genetic, clinical and pathological factors in management and surveillance of patients with colorectal tumours

Turner, Jeffrey 2014. Genetic, clinical and pathological factors in management and surveillance of patients with colorectal tumours. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Numerous factors influence an individual’s risk of colorectal cancer, including pathological features such as polyp size and multiplicity, and family history of colorectal malignancy. In clinical practice polyp size can be measured at different time points, however adenoma surveillance guidelines do not define which measurement to utilise, due to variance in data source. The initial study compared the measurements of 107 polyps. Variation in surveillance intervals occurred less frequently with postfixation than in situ measurements (5.6 versus 9.5%), supporting the use of post-fixation polyp size. A further study considered the level of agreement amongst histopathologists in Wales in the reporting of colorectal polyps. Only fair agreement (k = 0.24) was observed in the reporting of the completeness of excision. A lesion with epithelial misplacement and high grade dysplasia was misclassified as adenocarcinoma by five pathologists, indicating the need for further training and potential introduction of a formal accreditation process. Individuals with a moderate family history risk of colorectal cancer are at increased risk of colorectal lesions. Pathways through the Welsh genetics service were studied. 63.4% referrals were received from primary care. The majority of patient’s were female (70.8%). 93.8% patients were advised to undergo 5-yearly surveillance. Existing referral pathways were found to be complex increasing the risk of over/under surveillance. Little is known about colonoscopic surveillance outcomes following genetic assessment. A study of 172 patients revealed an adenoma detection rate (ADR) of 11.1% and advanced ADR of 4.1% at the index procedure. Cancer was diagnosed in 0.6% cases. The majority of lesions identified were diminutive low grade adenomas. Several endoscopic modalities have been utilised to enhance polyp detection in patients with a propensity to colonic polyps. Narrow band imaging was studied in 37 high-moderate risk patients, but did not significantly increase polyp yield above high definition white light colonoscopy.

Item Type:	Thesis (MD)
Status:	Unpublished
Schools:	Medicine
Subjects:	R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Date of First Compliant Deposit:	30 March 2016
Last Modified:	06 Oct 2023 15:57
URI:	https://orca.cardiff.ac.uk/id/eprint/58422

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