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The pathophysiology, clinical presentation, and (临床表现,病理生理学)
Med Clin N Am 89 (2005) 1–42
The pathophysiology, clinical
presentation, and diagnosis of colon
cancer and adenomatous polyps
Mitchell S. Cappell, MD, PhD, FACG
Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center,
5501 Old York Road, Philadelphia, PA 19141-3098, USA
Colon cancer afflicts more than 135,000 patients per year in America. It
kills more than 55,000 patients per year [1] and many more patients suffer
morbidity from curative colon cancer surgery or chemotherapy. Recently
promulgated screening and surveillance colonoscopy regimens, as recom-
mended by medical professional societies (including the American Gastro-
enterological Association [2], the American Society for Gastrointestinal
Endoscopy [3], the American College of Gastroenterology [4], and the
American Cancer Society [5,6]), and as approved by Medicare [7] and most
private medical insurance companies [8] for reimbursement, can largely
avoid this morbidity by colonoscopic removal of premalignant polyps [9],
and can largely prevent this mortality by early detection of colon cancer at
a curable stage [9–11].
Yet only about one quarter of eligible patients currently undergo any form
of colon cancer screening [12]. This failure tragically results in tens of
thousands of preventable deaths and even greater morbidity per annum in
America. Aside from patient reluctance to undergo colonoscopy because of
the invasiveness, risks, and discomfort of the test [13], a major factor in this
breakdown is the failure by primary care physicians and internists to educate
their patients and refer them for screening colonoscopy [14]. Contrariwise,
primary care physicians and internists occasionally refer patients who are
inappropriate candidates for screening colonoscopy because of age less tha
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