Adenomatous Lesions of the Large Bowel

Our plain-English summary of Adenomatous Lesions of the Large Bowel, by R.R. Rickert, O. Auerbach, L. Garfinkel, et al (1979).

The study

• Authors: R.R. Rickert, O. Auerbach, L. Garfinkel, E.C. Hammond, J.M. Frasca
• Published: Cancer 45:1847-1857 May (1979)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This autopsy survey examined the colon and rectum of 518 people, 307 males and 211 females aged 20 through 102 years. People with previously diagnosed large bowel cancer were excluded. The authors searched for adenomas (growths of the bowel lining) and checked lesions under the microscope. They confirmed 658 adenomatous lesions and 365 hyperplastic (metaplastic) polyps. Of the 658 lesions, 623 were adenomatous polyps (tubular adenomas), 16 were mixed tubulo-villous adenomas and 19 were cancers. In all, 46.9% of cases had at least one adenoma: 51.5% of men and 40.1% of women after adjusting for age. Adenomas became more common with age, but their average size did not apparently increase. Adenomatous polyps averaged 5.8 mm, and 86.7% were under 10 mm. Tubulo-villous adenomas averaged 19.0 mm. Fourteen of the 19 cancers still contained benign adenoma. The authors wrote that the results suggest most adenomas are simple adenomatous polyps that do not undergo progressive growth and malignant change. They wrote that it appears cancers may arise from benign adenomas that are large and have a more complex villous architecture.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Autopsy survey (examination of large bowel specimens removed at autopsy, with microscopic examination of lesions)
• Who was studied: 518 colon-rectum specimens from autopsies: 307 males and 211 females, aged 20 through 102 years. Cases with previously diagnosed large bowel carcinoma were excluded. The authors worked at Saint Barnabas Medical Center, Livingston, New Jersey and the Veterans Administration Hospital, East Orange, New Jersey. The article does not state where or when the autopsies were done.
• Main results:
  • Across the 518 specimens, 658 adenomatous lesions and 365 hyperplastic (metaplastic) polyps were confirmed histologically.
  • Of the 658 adenomatous lesions, 623 were adenomatous polyps and 16 were mixed tubulo-villous adenomas. No pure villous adenomas were found. There were 19 cancers.
  • Of the 19 cancers, 8 were carcinoma in situ in an adenoma, 6 were invasive carcinoma with residual adenoma and 5 were invasive carcinoma with no detectable residual adenoma. All were clinically unsuspected.
  • 46.9% of all cases had at least one adenoma: 52.8% of males and 38.4% of females. Adjusted for age, the figures were 51.5% for men and 40.1% for women. Cases with at least one adenoma had a mean of 2.6 adenomas.
  • Adenomatous polyps had a mean size of 5.8 mm, tubulo-villous adenomas averaged 19.0 mm and the cancers averaged 28.8 mm. Under 10 mm in diameter were 86.7% of adenomatous polyps, 6.3% of tubulo-villous adenomas and 5.3% of the cancers.
  • Adenomas became more common with age, but mean size did not apparently increase: 6.2 mm in cases under 60 years, 6.0 mm at 60 to 74 years and 6.3 mm beyond 75 years.
  • 66.5% of adenomatous polyps were in the proximal half of the bowel (cecum, ascending and transverse colon), and 84.2% of the cancers were also in the proximal half.
  • Cancers made up 2.9% of all adenomatous lesions. Counting only carcinomas with residual adenoma (14 cases), 2.1% of adenomas contained carcinoma: 1.2% in situ and 0.9% invasive.
• The authors' conclusion: The authors wrote that the results suggest that, although adenomas of the large bowel are very common, the vast majority are simple adenomatous polyps that do not undergo progressive growth and malignant change. They wrote that it appears cancers may arise from benign adenomas that are large and have a more complex villous architecture.
• Limitations the authors state:
  • Not all hyperplastic polyps in the rectum were sectioned, so the count of hyperplastic polyps is incomplete.
  • Excluding previously diagnosed cancers meant the study selected for small ('early') cancers, which affected the size and site distribution of the cancers found.
  • Too few adenomas contained carcinoma for a meaningful analysis of their gross configuration by size and location.
  • The study does not contribute significantly to understanding what makes adenomas develop into large, villous, higher-risk lesions.

Topics

Medical terms in this study, explained in our Lexicon: Autopsy.

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