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Normal Colon.- A. Anatomic Considerations.- B. Histology.-
Pathology.- A. General Prevalence and Anatomic Distribution.- B.
Gross Appearance.- Multiplicity.- Size.- C. Microscopic Features.-
Tubular versus Villous Adenomas.- Degree of Dysplasia.- Problems in
Grading Dysplasia.- Carcinoma in a Polyp.- Morphometric Studies.-
D. Differential Diagnosis.- Hyperplastic (Metaplastic) Polyps.-
Mixed Hyperplastic-Adenomatous Polyps.- Juvenile Polyps.-
Hamartomatous Polyps.- Polypoid Carcinoma.- Nonepithelial Polyps.-
E. The Diminutive Polyp.- F. Other Characteristics of Polyps.-
Kinetics.- Electron Microscopy.- Histochemistry.- Markers.- Tissue
Culture.- DNA Content.- Doubling Time.- Regression of Polyps.- G.
Histogenesis of Polyps.- Adenomatous Polyposes.- A. Familial
Polyposis Coli and Gardner's Syndrome.- B. Other Adenomatous
Polyposis Syndromes.- C. The Genetics of Adenoma Transmission.-
Malignant Potential of Adenomatous Polyps.- A. Association of
Polyps and Carcinomas.- Risk Factors for Carcinomas among
Polyp-Bearers.- Natural History of Polyps; Metachronous
Carcinomas.- Peak Incidences of Adenomatous Polyps and Colorectal
Carcinomas.- Metachronous Carcinomas in Subjects with Synchronous
Polyps and Carcinomas.- Prevalence of Polyps in Subjects with
Colorectal Carcinomas.- Opposing Views.- B. Histological Evidence
of Malignant Transformation.- C. Adenomatous Remnants in
Carcinomas.- D. Epidemiological Evidence and Etiological Factors.-
Sex and Age.- Relationship of Polyps and Colorectal Carcinomas.-
Dietary and Other Factors.- Etiology.- E. Findings in Experimental
Animals.- Observations.- Genesis of Tumors.- Interpretation of
Findings and Relevance to Humans.- F. Alternate Hypotheses of
Carcinogenesis.- The Flat Mucosa.- Other Routes.- Nonadenomatous
Polyps.- Inflammatory Bowel Disease.- Miscellaneous.- The Field
Effect.- Hereditary Nonpolyposis Colorectal Cancer.- G.
Conclusions.- Evidence of Malignant Potential of Adenomatous
Polyps.- Significance of Malignant Potential of Adenomatous
Polyps.- The Problem of the Metachronous Carcinoma.- Detection and
Management.- A. Screening, Diagnostic, and Surveillance
Techniques.- Principles of Screening.- The At-Risk Population to Be
Screened.- Digital Examination of the Rectum.- Stool Blood Tests.-
Barium Enema (BE).- Endoscopy.- Proctosigmoidoscopy.- Colonoscopy.-
Sensitivity.- Comparisons with Barium Enema.- Effectiveness of
Screening.- B. The Malignant Polyp.- The Problem.- Frequency.- Risk
Factors for Malignancy in a Polyp.- Size.- Multiplicity.- Villous
Component.- Degree of Dysplasia.- Effects of Study Design and Polyp
Processing Technique.- Statistical Analysis.- Adverse Outcomes.-
Level of Submucosal Invasion by Carcinoma.- Postpolypectomy
Therapy.- C. Endoscopic Polypectomy.- How Polyps Are Detected.-
Rationale for Detection and Eradication of Polyps.- Manpower and
Cost Considerations.- Therapy of Diminutive Polyps.- Polypectomy
Technique.- D. Postpolypectomy Surveillance Recommendations.-
Recurrent Polyps.- Risk Factors for New Polyps.- Surveillance
Schedules.- Effectiveness and Cost of Surveillance.- E. The
National Polyp Study.- F. Polyp Registries.- Conclusions.- Glossary
and Abbreviations.
Adenomatous Polyps of the Colon: Pathobiological and Clinical
Features consolidates the vast body of basic science and clinical
data associated with adenomatous polyps of the colon, much of it
inspired by the realization that most colorectal carcinomas seem to
arise in such polyps. This book strives to evaluate these data,
with particular emphasis on their implications for management of
polyp-bearing subjects. Topics comprehensively explored include
anatomy and histology of the normal colon; pathologic
characteristics of adenomatous polyps, differential diagnosis, and
grading schemes for degree of dysplasia and villosity; adenomatous
polyposes; histologic and epidemiologic evidence for the malignant
potential of adenomatous polyps; and detection and management, with
special attention to endoscopy, endoscopic polypectomy, the
malignant polyp, and post-polypectomy surveillance schedules.
The past 20 years have seen a surge of research into colorectal
cancer, which is a reflection of the need to improve our methods of
treating patients suffering from this increasingly common form of
cancer. Greater knowledge of the basic mechanisms involved in
colorectal carcinogenesis is an essential prerequisite to
improvements in cancer prevention. In this volume the editors have
brought together an impressive list of experts to cover the
epidemiology, pathophysiology, morphology and basis for new
diagnostic and therapeutic approaches to early detection and
prevention. This broad scientific approach provides the reader with
up-to-date review of our current state of knowl edge of colorectal
carcinogenesis and indicates how this information can be used to
generate more research and create new opportunities for diagnosis
and treatment. This is a book of knowledge and ideas, some of them
still at the stage of theoretical interest, but others with
practical potential for the care of patients. I recommend it to
those who have a research interest in colorectal carcinogenesis, as
well as to readers who wish to know just how far medical scientists
have progressed in their efforts to achieve the ideal of cancer
prevention."
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