<p>UVOD: Kolorektalni karcinom je na trećem mestu po učestalosti oboljevanja od svih karcinoma uz porast incidencije CRC u visoko razvijenim zemljama.70% obolelih od CRC je starije od 65 godina uz veću incidenciju proksimalnih karcinoma u odnosu na distalne u svim uzrasnim grupama i kod oba pola. Smatra se da bi 66-75% slučajeva CRC moglo biti izbegnuto zdravim načinom života. 75% CRC nastaje iz adenomatoznih preko polip kancer sekvence i da vi&scaron;e od 90% adenoma neće progredirati u karcinom. U studijama skrining kolonoskopija prijavljeno je 6-12% neviđenih velikih polipa i ko 5% CRC na inicijalnom kolonoskopskom pregledu. Postoperativne periodične kolonoskopije nakon operacije kolorektalonog karicinoma imaju za cilj otkrivanje metahronih carcinoma polipa kao pojavu bolesti na anastomozi ali nije dokazani benefit u preživljavanju bolesnika koji su imali učestalije postoperativne kolonoskopije (na godinu dana) u odnosu na one koji su praćenina 3 ili 5 godina. CILJEVI ISTRAŽIVANJA: Prospektivno ispitivanje pojave intervalnih lezija kolona (malignih i premalignih) u periodu od 2-7 godine od prve negativne kolonoskopije bez obzira na razlog pregleda. Ispitivanje razlike u životnim navikama između ispitanika u zavisnosti od nalaza na ponovljenoj kolonoskopiji. Retrospektivna analiza svih dijagnostičkih i kontrolnih kolonoskopija. MATERIJAL I METODE: Ponavljana je kolonoskopija kod ispitanika koj su na dijagnostičkim kolonoskopijama rađenim na Institutu za onkologiju Vojvodine u periodu 2005-2011. imali uredan kolonoskopski nalaz. Od 160 pozvanih ispitanika na ponovnu kolonoskopiju se odazvalo 64 ispitanika a 151 ispitanik je popunio upitnik o životnim navikama. Urađena je i retospektivna analiza 2750 dijagnostičkih kolonoskopija. Analizirani su rezultati 1064 prvih postoperativnih kolonoskopija kao i nalazi sa 1147 ponovljenih kolonoskopija kod ispitanika operisanih od kolorektalnog carcinoma koji su imali uredan nalaz na prvoj kolonoskopiji. REZULTATI: Od 160 pozvanih ispitanika,njih 64 (42,3%) se odazvalo na ponovni pregled (45 žena i 19 mu&scaron;karaca) prosečne starosti60,13 godina. Kod 15 ispitanika(24.3%) nađeno je ukupno 22 polipa (10 žena i 5 mu&scaron;karaca) bez statistički značajne razlike u pozitivnosti nalaza u odnosu na pol (x2test; x2=0,014; p=0,904) i pozitivnu porodičnu anamnezu (x2test; x2=0,125; p=0,724). 12 slucajeva (14,06%) su bili polipi visokog rizika: 5 (41.6%) lokalizovano u proksimalnom kolonu i 7 (58.3% ) u distalnom kolonu. Nije dijagnostikovan nijedan intervalni karcinom. Nije dokazana statistički značajna razlika u pozitivnosti nalaza na ponovljenoj kolonoskopiji u odnosu na razmak posmatran u grupama do 3 i do 5 godina od predhodne kolonoskpije (x2test; x2=0,020; p=0,887) niti ukoliko se posmatra po grupama do 5 i preko 5 godina od negative kolonoskopije (x2test; x2=3,082; p=0,079). Nema statistički značajne razlike u pozitivnosti nalaza na ponovljenoj kolonoskopiji u odnosu na to da li su pacijenti konzumiraju alkohol ili ne (x2test; x2=0,113; p=0,911) kao i u odnosu na to da li su pacijenti imali redovnu fizičku aktivnost (x2test; x2=0,476; p=0,490). Na dijagnostičkim kolonoskopijama je uočena statistički značajna razlika u uzrastu pacijenata u zavisnosti od razloga kolonoskopije (F=7,111; p=0,000) kod pacijenata kod kojih su dijagnostikovani polipi. Oni sa pozitivnom porodičnom anamnezom i polipima su statistički značajno mlađi u odnosu na ostale osim onih koji su se na pregled javili zbog bola u trbuhu poremećaja ritma stolice. Nije bilo statistički značajne razlike po polu, uzrastu, u razlogu kolonoskopije kod osoba sa dijagnostikovanim polipima. Statistički je značajniji broj žena sa lokalizacijom polipa u distalnom delu debelog creva u odnosu na proksimalni (x2test; x2=18,495; p=0,000). Kod mlađih uzrasnih grupa statistički značajnije su zastupljeni polipi u rektumu(x2test; x2=79,963; p=0,000). Ispitanici sa proksimalnom lokalizacijom polipa imaju 1,724 puta veću &scaron;ansu za adenome visokog rizika u odnosu na one sa distalnom lokalizacijom. Nema statistički značajne razlike u distribuciji karcinoma u odnosuna pol (x2test; x2=3,2110; p=0,201). Na 1064 prvih postoperativnih kolonoskopija je bilo ukupno 346 (32,5%) pozitivnih nalaza. Dijagnostikovano je 60 karcinoma od kojih je 43,3 % lokalizovano na anastomozi a kod 286 ispitanika nađeno je ukupno 546 polipa. Mu&scaron;karci statistički značajnije če&scaron;će imaju pozitiva nalaz (x2 test; x2=17,252; p=0,000). Bonferroni post hoc testom je utvrđeno da su polipi proksimalne lokalizacije statistički značajno veći od onih u rektumu (p=0,043). Na kontrolnim kolonoskopijama rađenim u cilju praćenja nakon resekcije kolorektalnog karcinoma multivarijatnom analizom ( pol, uzrast i vreme od operacije) utvrđeno je da mu&scaron;karci imaju 1,4 puta veću &scaron;ansu (OR=1,457) od žena za pojavu promena (polipa i karcinoma).Ispitanici kod kojih je od operacije pro&scaron;lo od 3 do 5 godina imaju 1,6 puta veću &scaron;ansu za pojavu promene u odnosu na one kod kojih je pro&scaron;la 1 godina (OR=1,605). ZAKLJUČAK: Kod 24.3% pregledanih ispitanika dijagnostikovani su polipi(jedan hipeplastičnii 21 adenoma ). 14,06% svih polipa je imalo karakteristike polipa visokog rizika bez statistički značajne razlike u pojavi polipa kod ispitanika kod kojih je pregled rađen 3,5 ili nakon 5 godina od prve negativne kolonoskopije. Nije dijagnostikovan niti jedan karcinom &scaron;to znači da nema potrebe za ponavljanjem kolonoskopija u kraćem vremenskom intervalu od unapred planirane kolonoskopije kod ispitanika koji su imali uredan inicijalni kolonoskopski nalaz &scaron;to se odnosi i na ponavljane kolonoskopije kod ispitanika operisanih od CRC-a. Na dijagnostičkim kolonoskopijama statistički značajniji broj žena sa lokalizacijom polipa u distalnom delu debelog creva u odnosu na proksimalni i nije zapažena razlika u distribuciji karcinoma u odnosu na pol i uzrast ispitanika.</p> / <p>INTRODUCTION:Colorectal cancer is the third most frequent illness of all carcinomas with an increase in the incidence of CRC in highly developed countries. 70% of patients with CRC are older than 65 years with higher incidence of proximal cancers compared to distal in all age groups and in both sexes. It is believed that 66-75% of CRC could be avoided through healthy lifestyle. 75% of CRC arise from adenomatous polyp cancer via sequences, and that more than 90% of adenoma will not progress to carcinoma. In studies of screening colonoscopy was reported 6-12% of unobserved large polyps and approximately 5% of the CRC on the initial colonoscopy.Postoperative periodic colonoscopy after colorectal cancer surgery aim to detect metachronous cancer and polyps and disease occurrence anastomoses but not proven survival benefit in subjects who had more frequent postoperative colonoscopy (per year) compared to those who were followed for 3 or 5 years. AIM:Prospective study of interval colon lesions occurrence (malignant and pre-malignant) in the period from 2-7 years after initial negative colonoscopy regardless of the reason for the check. Test of differences in lifestyle between subjects depending on the findings of the repeated colonoscopy.A retrospective analysis of all the diagnostic and control colonoscopy. METHODOLOGY: Repeated colonoscopy in subjects who are at-made diagnostic colonoscopy at the Oncology Institute of Vojvodina in the period 2005-2011 had normal colonoscopy findings. Of the 160 subjects invited to re colonoscopy for review responded 64 subjects and 151 subjects filled out a questionnaire about life habits. Retrospective analysis of 2750 and diagnostic colonoscopy has been done. Results of the 1064 first postoperative colonoscopy and results of the 1147 repeated colonoscopy in patients operated on for colorectal cancer that had normal findings on the first colonoscopy has been analyzed. RESULTS:Of the 160 invited subjects, 64 of them (42.3%) responded to the repeated review (45 women and 19 men), mean age 60.13 years. In 15 subjects (24.3%) found a total of 22 polyps (10 women and 5 men) with no statistically significant differences in positivity findings in relation to sex (x2test; x2 = 0.014; p = 0.904) and a positive family anamnesis (x2test; x2 = 0.125; p = 0.724).12 cases (14.06%) were high risk of polyps: 5 (41.6%) localized in the proximal colon, and 7 (58.3%) in the distal colon. Not a single interval cancer diagnosed. There was no statistically significant difference in positivity findings with repeated colonoscopy in relation to the distance observed in groups of 3 to 5 years from the previous colonoscopy (x2test; x2 = 0.020; p = 0.887) or when observed in groups up to 5 and over 5 years of negative colonoscopy (x2test; x2 = 3.082; p = 0.079). No statistically significant differences in positivity findings with repeated colonoscopy in relation to whether the patients consume alcohol or not (x2test; x2 = 0.113; p = 0.911) as well as in relation to whether patients are regularly exercising (x2test; x 2 = 0.476; p = 0.490). Statistically significant difference is confirmed in the age of patients at the diagnostic colonoscopy, depending on the reason for colonoscopy (F = 7.111; p = 0.000) in patients who were diagnosed polyps. Those with a family anamnesis and polyps were statistically significant younger in comparison to others except those who have come forward for review because of abdominal pain and bowel movement rhythm disturbances.There were no statistically significant differences by sex, age, the reason for colonoscopy in patients diagnosed with polyps.Statistically is more significant number of women with the localization of polyps in the distal part of the colon comparing to the proximal (x2test; x2 = 18,495; p = 0.000).In younger age groups are represented statistically significant polyps in the rectum (x2test; x2 = 79.963, p = 0.000). Subjects with proximal localization of polyps are 1,724 times more likely for high-risk adenomas compared to those with distal localization.No statistically significant differences in the distribution of cancer in relation to sex (x2test; x2 = 3.2110; p = 0.201).On the first postoperative colonoscopy in 1064 subjects there were a total 346 (32.5%) positive findings. 60 carcinoma diagnosed of which 43.3% is localized on the anastomosis and in 286 of the subjects had a total of 546 of the polyps.Men statistically significantly more likely to have positive findings (x2 test; x2 = 17,252; p = 0.000). Bonferroni post hoc test showed that polyps proximal localization significantly bigger than those in the rectum (p = 0.043). On the control colonoscopy-made for the purpose of monitoring after resection of colorectal cancer by multivariate analysis (sex, age and time of surgery) it has been found that men are 1.4 times more likely (OR = 1.457) than women for the occurrence of changes (polyps and cancers).Subjects having passed since the operation of 3 to 5 years are 1.6 times more likely to develop a change with respect to those in which the more than one year elapsed (OR = 1.605). CONCLUSION:In 24.3% subjects were diagnosed polyps (one hyperplastic and 21 adenomas).14.06% of all polyps had the characteristics of high-risk polyps with no statistically significant difference in the occurrence of polyps in subjects where the examination was done after 3,5 or 5 years since the first negative colonoscopy. No cancers diagnosed, meaning there is no need to repeat colonoscopy in a shorter period of time than pre-planned colonoscopy in subjects who had normal initial colonoscopy findings which refers to the repeated colonoscopies in subjects operated on for CRC.For diagnostic colonoscopy statistically significant number of women with the localization of polyps in the distal part of the colon compared to proximal and was not observed differences in the distribution of carcinoma in relation to sex and age of the subject.</p>

<p>Uvod. Rak debelog creva predstavlja 9,7% svih malignih bolesti u svetu, i drugi ili treći je po učestalosti u onkolo&scaron;koj strukturi obolevanja, u zavisnosti od pola. Skrining, ili sekundarna prevencija populacije u prosečnom riziku ima centralnu ulogu u kontroli kolorektalnog karcinoma. Cilj. Utvrditi nivo znanja, stavove i pona&scaron;anje u odnosu na rak debelog creva i njihov uticaj na odaziv na skrining raka debelog creva, u zavisnosti od primenjenog modela skrininga. Materijal i metode. U istraživanje je pozvano 1.213 osoba oba pola, starosti 50-74 godine, za uče&scaron;će u studiji znanja, stavova i pona&scaron;anja (KAP studija) u odnosu na rak debelog creva, popunjavanjem upitnika (Sessa A). Formirane su tri grupe prema modelu skrininga: populacioni - model 0; oportuni skrining uz kontakt ispitanika sa medicinskim osobljem, bez dodatnih informacija o bolesti, skriningu i testu &ndash; model 1; oportuni skrining kada se uz kontakt sa medicinskim osobljem dobija informacija o bolesti i skriningu, uz prikaz izvođenja testa - model 2. U ovoj studiji je kao skrining metoda kori&scaron;ćen imunolo&scaron;ki test stolice -Wondfo FOB.Obrada podataka je rađena statističkim programom SPSS (version 13). Značajnost razlika je testirana parametrijskim (t-test, ANOVA) i neparametrijskim (Mann-Whitney U test) testovima, dok se komparacija kategoričkih varijabli vr&scaron;ila &chi;&sup2; testom i Fisher Exact testom. Test-retest analiza je rađena Cohen&#39;s Kappa testom. Rezultati. Od 1.213 pozvanih, 666 (55%) osoba je prihvatilo uče&scaron;će u KAP studiji. Vi&scaron;e od polovine (54,5%) ispitanika ima ukupan skor znanja manji od 50%. Nivo znanja, sociodemografske karakteristike, procena sopstvenog rizika obolevanja, stav u odnosu na korist testa, stepen sopstvenog rizika obolevanja i mogućnosti prevencije raka debelog creva, nisu faktori koji utiči na participaciju u skriningu kolorektalnog karcinoma. Najvažniji faktor za uče&scaron;će u skriningu u ovom istraživanju je kontakt i razgovor sa lekarom o bolesti, prevenciji i skrining testu.Odaziv u skrining, u odnosu na celokupno pozvanu populaciju je 51,2%. Od ispitanika koji su popunili anketni upitnik, participacija u skriningu je 93,4%. Statistički značajno manji odaziv u skriningu je u modelu 0 (12%) i modelu 1 (6%) u odnosu na model 2 (1%). Zaključak. Poznavanje bolesti, faktora rizika i mogućnosti prevencije generalno je oskudno, ali ne utiče na participaciju u skriningu. Faktor koji utiče na visok odaziv u skrining kolorektalnog karcinoma je kontakt i razgovor sa medicinskim osobljem, pre svega sa lekarom.</p> / <p>Introduction. Colorectal cancer represents 9.7% of all malignancies in the world and it is second or third in frequency in oncological structure depending on the sex. Screening, or secondary prevention of the average risk in the population has a central role in the control of colorectal cancer. Aim. Determine the level of knowledge, attitudes and behaviour in relation to colon cancer and their impact on turnout for colorectal cancer screening, depending on the applied screening model. Material and method. There were 1213 people of both sexes aged 50-74 years participating in this study of knowledge, attitudes and practice (KAP studies) in relation to colorectal cancer, by filling in the questionnaire (Sessa A). Three groups were formed with respect to model screening: population - model 0; opportunistic screening involving the contact of patients and medical staff, without receiving additional information about the disease, screening and test - model 1; opportunistic screening involving the contact of patients and medical staff while receiving information about the disease and screening, and explaining the test performance - model 2. In this study, a screening method used was fecal occult blood test - Wondfo FOB. Data processing is performed by the statistical program SPSS (version 13). The significance of differences was tested by parametric (t-test, ANOVA) and nonparametric (Mann-Whitney U test) tests, while the comparison of categorical variables was performed with &chi;&sup2; test and Fisher Exact test. Test-retest analysis was performed with Cohen&rsquo;s Kappa test. Results. Out of all the 1213 participants, 666 (55%) of them accepted to participate in the KAP study. More than half of them (54.5%) have a total score of knowledge less than 50%. The level of knowledge, socio-demographic characteristics, assessment of the risk of the disease, the attitude towards the benefit of the test, degree of the risk of disease and opportunities for prevention of colorectal cancer, are not factors in deciding to participate in the screening of colorectal cancer. The most important factor for the participation in the screening in this study is the contact and conversation with the doctor about the disease, prevention and screening test. The turnout for the screening, in relation to the number of people who participated is 51.2%. Out of those who completed the questionnaire, participation in the screening is 93.4 %. Statistically significantly lower response in the screening is in model 0 (12%) and in model 1 (6%) in relation to model 2 (1%). Conclusion. Knowledge of the disease, risk factors and prevention opportunities are generally scarce, but do not affect the participation in screening. The factor influencing the high turnout for colorectal cancer screening is contact and conversation with the medical staff, primarily the doctor.</p>

<p>Karcinom debelog creva predstavlja treći uzrok smrnosti od maligniteta kod mu&scaron;karaca i drugi kod žena. Postoji osnovana sumnja da kancerske matične ćelije (KMĆ) imaju veliki značaj u karcinogenezi, invazivnosti, &scaron;irenju i rezistenciji na hemioterapiju primarnog tumora. Njihova identifikacija u primatnom kolorektalnom karcinomu (KRK) putem markera kancerskih matičnih ćelija bi selektovala visokorizičnu grupu bolesnika, omogućila ciljano delovanje na ove ćelije i veću &scaron;ansu za izlečenje. Cilj ovog istraživanja je bio utvrđivanje uticaja prisustva kancerskih matičnih ćelija u primarnom tumoru obolelih od karcinoma kolona na pojavu relapsa bolesti, dužino preživljavanja bez bolesti i sveukupno preživljavanje.&nbsp; Istraživanje je sprovedeno kao prospektivno&minus;retrospektivna randomizovana analitička studija na Klinici za operativnu onkologiju i Službi za patolo&scaron;ko &ndash; anatomsku i laboratorijsku dijagnostiku Instituta za onkologiju Vojvodine u Sremskoj Kamenici u periodu od 2016-2019. godine. U studiju su uključeno 112 bolesnica operisanih na Institutu za onkologiju Vojvodine u periodu od 2007-2012. godine sa patohistolo&scaron;ki potvrđenom dijagnozom primarnog, nemetastatskog (stadijumi I, II i III) KRK. Bolesnici su randomizovani u odnosu na pojavu recidiva bolesti i prisustvo metastaza u regionalnim limfnim čvorovima u odnosu 1:1. Uzorci tumorskog tkiva dobijeni hirur&scaron;kom resekcijom su nakon standardne patohistolo&scaron;ke obrade tretirani primenom monoklonskih antitela na CD44, CD166 i &alpha;-Lgr5. Određivani su prisustvo, intezitet i lokalizacija kancerskih matičnih ćelija (KMĆ) u primarnom tumoru i njihov uticaj na pojavu relapsa bolesti, dužinu preživljavanja bez bolesti i sveukupno preživljavanje u grupi svih bolesnika a potom bolesnika podeljenih prema stadijumu bolesti. Bolesnici u prvom i drugom stadijumu bolesti koji su imali relaps su imali statistički značajno veće prisustvo CD44+ KMĆ u primarnom tumoru. Kod ovih bolesnika je prisutan kraći period preživljavanja bez bolesti kao i kraće sveukupno preživljavanje. Takođe, uočen je statistički značajan uticaj koekspresije CD44/CD166 u KMĆ na pojavu relapsa bolesti, dužinu preživljavanja bez bolesti i sveukupno preživljavanje kod bolesnika u prvom i drugom stadijumu bolesti. Nije uočena statistička značajnost prisustva KMĆ u primarnom tumoru na pojavu relapsa bolesti, dužinu preživljavanja bez bolesti i sveukupno preživljavanje kod bolesnika u trećem stadijumu bolesti. Prisustvo CD166 i &alpha;-Lgr5 obojenih KMĆ nije pokazalo statističku značajnost u pogledu pojave relapsa bolesti, dužine preživljavanja bez bolesti i sveukupnog preživljavanja, kako u grupi svih bolesnika tako i prilikom podele bolesnika na stadijume bolesti.</p> / <p>Colon cancer is the third most common case of death of malignancy in the world. There is justified theory that cancer stemm cells have significant impact on colon cancer tumorogenesis, invasiviness, spread and resistancy on chemotherapy. Identification of colon cancer stem cells in primary tumor by various biological markers would lead to identification of high risk group of patients, target therapy of colon cancer an higher chance to cure. Aim of this study was to determine wether presence of colon cancer stem cells in primary tumour have impact on recurrence, disease free survival (DFS) and overall survival (OS) in patients with colorectal cancer. An randomized, analytical prospective-retrospective study was performed on Clinic for Operative Oncology and Department for Anatomical Pathology of Oncology Institute of Vojvodina in Sremska Kamenica in period of 2016&minus;2019. Study included 112 patient with patohistological proven, non metastatic colon adenocarcinoma who were operated on Oncology Institute of Vojvodina in period of 2007-2012. Patients were randomized by recurrence and presence of metastatic lymph nodes by 1:1 ratio. After standard patohistological preparation, tumour specimens were stained for monoclonal CD44, CD166 and &alpha;-Lgr5 antibody. Presence, intensity of expression and localization of colon cancer stem cells were observed and their impact on relapse, disease free survival and overall survival in group of all patients as well as in groups divided by stages of the disease. We demonstrate that patients in Stage I and II of the disease who experience disease recurrence have statistically significant higher expression of CD44+ in primary tumor specimen. They also have shorter DFS and OS. Coexpression of CD44/CD166 antibody also have strong negative impact on recurrence, disease free survival and overall survival in Stage I and II patients. There is no correlation between presence of colon cancer stem cells and recurrence nor presence of colon cancer stem cells had impact on disease free survival and overall survival. Presence of CD166 and &alpha;-Lgr5 expression did not show significant impact on recurrence nor disease free survival and overall survival as in group of all patients as well in group of patients divided by stages of the disease. High expression of CD44+ and coexpression of CD44/CD166+ colon cancer stem cell markers in primary tumor specimen correlates with higher chance for disease recurrence and also leads to shorter DFS and OS.</p>