28.07.2015

Bowel cancer testing england

The colon and the rectum are the final portions of the tube that extends from the mouth to the anus. View an Illustration of Colon Cancer and learn more about Medical Anatomy and Illustrations. Science, Technology and Medicine open access publisher.Publish, read and share novel research. Cytomegalovirus Prophylaxis following Solid Organ Transplants Guideline Team, Cincinnati Children?s Hospital Medical Center: Evidence-based care guideline for CMV Prophylaxis following Solid Organ Transplant.
Colorectal Surgeons Sydney provide specialist colorectal surgery & bowel cancer screening including colonoscopy.
From 2015 the iFOBT is now mailed out free of charge every 2 years to all Australians turning 50, 55, 60, 65 and 70 as part of the National Bowel Cancer Screening Programe (NBCSP) (Figure 2). The National Bowel Cancer Screening Australia and Bowel Cancer Australia guidelines suggest routine FOBT screening every 1-2 years from the age of 50 or 10 years earlier than the youngest family member previously diagnosed with colorectal cancer.
The Rotary Bowelcare test kit involves a brush applicator to simply stir the water around the stool and then a “water” sample is dabbed onto the test card. The Independent has reported that “masturbation can be good for the over-50s” claiming it may remove toxins and reduce the risk of prostate cancer. The research surveyed 431 men who were diagnosed with prostate cancer before the age of 60 and 409 healthy men, asking about sexual habits at various stages of their lives.
This study has a number of limitations, in particular, asking men to accurately recall their sexual habits several decades ago. Sexual functioning is a normal part of healthy adult life and men should not be overly concerned by this study, as more research is needed in this area. It was published in the British Journal of Urology International, a peer-reviewed medical journal. This was a case-control study looking at the association between prostate cancer risk and sexual activity in men. Recent research has reportedly associated sexual activity with risk factors for prostate cancer. It is thought that around 75% of prostate cancer diagnoses are in men over the age of 65, with only a quarter being diagnosed before this age.
The researchers used the Prostate Cancer Research Foundation Study to identify 431 men diagnosed with symptomatic prostate cancer before the age of 60. All participants completed a postal questionnaire on lifestyle and sexual activity throughout adult life. Frequency responses were given in ranges and an overall frequency value for that decade calculated. The researchers then looked at whether there was a link between frequency of sexual activity and risk of prostate cancer. Postal questionnaires were responded to by 73% of the case group and 74% of the control group. Overall, 59% of men reported a sexual activity (sexual intercourse and masturbation) frequency of 12 or more times per month whilst in their 20s, decreasing to 48% in their 30s with this frequency, 28% in their 40s, and 13% in their 50s. In the initial analysis the researchers only adjusted for differences in age and ethnicity: this showed no significant link found between prostate cancer and frequency of overall sexual activity (sexual intercourse and masturbation) in any decade, or lifetime sexual activity.
Masturbation more than once a week in the 20s, 30s and 40s age categories was associated with increased risk of prostate cancer compared to never masturbating. Researchers performed further analysis also taking into account the other differences between cases and controls. There was no link between prostate cancer risk and frequency of sexual intercourse in any decade. The researchers conclude that there seemed to be a risk from more frequent masturbation in the 20s and 30s, but a protective effect in the 50s. They say that this could imply different mechanisms at different ages by which sexual activity is involved in the development of prostate cancer. The study has found a link between increased frequency of masturbation in the 20s and 30s decades and increased risk of prostate cancer, but a seemingly protective effect with the same frequency in the 50s.
However, there are numerous potential limitations which must be considered when interpreting this study.
Asking men to recall their sexual activity and frequency across decades of life from their 20s, 30s, 40s and 50s.
What constitutes a certain sexual activity to one person may not mean the same thing to another person. As with all studies of this type, an association between two factors does not necessarily mean that one causes the other. There was a link found between cancer risk and frequency of masturbation, but no link was found to frequency of sexual intercourse.
These were a specific group of people with prostate cancer who were all diagnosed with cancer prior to the age of 60. With an account you can keep track of pages on the site and save them to this tab, which you can access on every page when you are logged in.
Guidelines on the Management in Cytomegalovirus Monitoring for Patients with Chronic Lymphocytic Leukemia Treated with Alemtuzumab3.5. Cytomegalovirus pneumonia in patients with inflammatory bowel disease: a systematic review. Updated Guidelines on the Management of Cytomegalovirus Reactivation in Patients with Chronic Lymphocytic Leukemia Treated with Alemtuzumab. Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective. Complications, Diagnosis, Management, and Prevention of CMV Infections: Current and Future. Incidence and predictive factors for cytomegalovirus infection in renal transplant recipients. Prevention of Posttransplant Cytomegalovirus Disease and Related Outcomes with Valganciclovir: A Systematic Review.
Long-Term Outcomes of CMV Disease Treatment with Valganciclovir Versus IV Ganciclovir in Solid Organ Transplant Recipients.
Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Spectrum of infection, risk and recmmendations for prophylaxis and screening among patients with lymphoproliferative disorders treated with alemtuzumab.
Cyclophosphamide, fludarabine, alemtuzuman, and rituximab as salvage therapy for heavily pretreated patients with chronic lymphocytic leukemia.
It involves the passage of a flexible tube (colonoscope) about the thickness of a pen into the colon (also called the ‘large intestine’) via the back passage (anus) to allow for careful examination of the entire colon and the detection and removal of bowel polyps, as well as the identification of bowel cancer. The Sun reported that “solo sex” during one’s younger life might increase the risk of prostate cancer.
It was found that frequent masturbation during one’s 20s and 30s was associated with an increased risk of prostate cancer, while men who masturbated more frequently in their 50s had a lower risk. Also, because sex is a highly personal matter some men may have felt uncomfortable revealing such personal details about their lives, or may have defined sexual activities differently. This included asking about the number of sexual partners, age of first sexual experience, any sexually transmitted infections, and frequency of sexual intercourse or masturbation in their 20s, 30s, 40s and 50s. Frequency of activities was categorised as never, less than once per month, one to three times per month, once a week, two to three times per week, four to six times per week, and daily. In their analyses they took into account factors that might affect results, which included age and ethnicity, as well as other factors found to differ between cases and controls. After these adjustments the significantly increased risk of prostate cancer remained for those who masturbated more than once weekly whilst in their 20s and 30s.
More frequent overall sexual activity in the 50s significantly decreased prostate cancer risk, but there was no link with overall sexual activity in any other decade. They also suggest that part of the effect seen in the 50s might be a result of “reverse causality” where prostate cancer affected the men’s sexual activity, rather than the other way around.
The principle limitation is the reliability of the estimates of sexual activity, though it should be noted that the researchers attempted to minimize this bias through use of a long and extensive questionnaire.
Some men may feel uncomfortable revealing such personal detail and may therefore have either over- or underestimated their activity, depending on their feeling to answering. Other factors (confounders) that have not been adjusted for may affect the links found to masturbation.


As more tests and combinations are made, the more likely it is that a result that occurs by chance will appear to be significant. When both masturbation and intercourse were combined to give the variable of overall sexual activity, decreased risk was found with increased sexual activity in the 50’s, but no link was found for any other age group.
The men in this study are not typical of the vast majority of people with prostate cancer, who are generally diagnosed over the age of 65. Prostate cancer has been linked to ethnicity, with men of African-American origin believed to be at increased risk. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer.
Arias-Merino1[1] From the Infectious Disease Department Specialities Hospital, West Medical Center, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico1.
These claims are based on research exploring prostate cancer and sex drive, which some suggest are both linked to high levels of male hormones.
No link was found in the 40s age category, whilst masturbation more than once weekly in the 50s category decreased risk. Therefore there may be particular unknown characteristics of these people that makes them more predisposed to prostate cancer at a younger age.
Although the researchers did make careful attempts to adjust for ethnicity in their analysis, a wider ethnic representation may have given different results.
In the stomach, the food is ground into smaller particles and then enters the small intestine in a carefully controlled manner.
The results may also not be representative of what would be seen in men who develop prostate cancer later in life.
Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College.
In the small intestine, final digestion of food and absorption of the nutrients contained in the food occurs.
We also present the conditions for the development of CMV disease in these patients.In the overall population, the seroprevalence of CMV (IgG) is 30 to 100%. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.
The food that is not digested and absorbed enters the large intestine or colon and finally the rectum. CMV disease is a major cause of death in bone marrow and organ transplant recipients and persons with AIDS. The large intestine is about six feet long and acts primarily as a storage facility for waste; however, additional water, salts, and some vitamins are further removed. In adult patients with cancer and leukemia (except T cell leukemia) who have not undergone transplantation, the frequency of CMV disease is lower than 3%, but mortality can reach 82% [1-5].The direct clinical effects of CMV are CMV viral syndrome and end-organ diseases. In addition, some of the undigested food, for example, fiber, is digested by colonic bacteria and some of the products of digestion are absorbed from the colon and into the body.
Their arrival into the rectum initiates a bowel movement that empties the colonic contents from the body as stool.Most of the large intestine rests inside a cavity in the abdomen called the peritoneal cavity.
Parts of the colon are able to move quite freely within the peritoneal cavity as the undigested food is passing through it. As the colon heads towards the rectum, it becomes fixed to the tissues behind the peritoneal cavity, an area called the retroperitoneum.
The appearance of de novo specific antibodies in a seronegative patient may also be acceptable for the diagnosis of CMV [2,7].Secondary (Reactivation) infection occurs with the reactivation of endogenous latent CMV, in a CMV seropositive patient, who has (cancer, chronic lymphocytic leukemia, solid organ transplantation, or bone marrow transplantation) with diminished immunity after immunosuppressive therapy or a patient with HIV. The end portion of the large intestine, the part that resides in the retroperitoneum, is the rectum. Unlike much of the rest of the colon, the rectum is fixed in place by the tissues that surround it.
The first is an inner layer of cells that line the cavity through which the undigested food travels, called the mucosa. The mucosa is attached to a thin second layer, the submucosa, that is attached itself to a layer of muscle, the muscularis. Following a study in which CMV DNA was found in 83% of liver transplant recipients at a mean of 13 days before the onset of symptomatic CMV infection, it has become apparent that the preemptive therapy decreases the morbidity and mortality of CMV infection [2]. The most common cancers of the large intestine (the type called adenocarcinoma) arise from the mucosa, the inner layer of cells.
These cells are exposed to toxins from food and bacteria as well as mechanical wear and tear and are constantly dying off and being replaced.
Hemopoietic Stem Cell Transplantation (HSCT)CMV infections may be more frequently caused by reactivation of the virus in the recipient rather than a primary infection.
For reasons that are poorly understood, sometimes mistakes occur that escape our editing systems.
When this occurs, these cells begin to divide independently of the normal checks and balances that control growth. As these abnormal cells grow and divide, they can lead to growths within the colon called polyps. Polyps vary in type, but many are precancerous tumors that grow slowly over the course of years and do not spread. As polyps grow, additional genetic mutations further destabilize the cells and can make the cells more bizarre.
When these precancerous tumors change direction (growing into the wall of the tube rather than into the space in the middle of it) and invade other layers of the large intestine (such as the submucosa or muscular layer), the precancerous polyp has become cancerous. In most cases this process is slow, taking at least 8 to 10 years to develop from those early aberrant cells to a frank cancer.Once a colorectal cancer forms, it begins to grow in two ways. First, the cancer can grow locally and extend through the wall of the intestine and invade adjacent structures, making the mass (called the primary tumor) more of a problem and harder to remove. Local extension can cause additional symptoms such as pain or fullness, perforation of the colon, or blockages of the colon or nearby structures. Second, as the cancer grows it begins the process of metastasis, shedding thousands of cells a day into the blood and lymphatic system that can cause cancers to form in distant locations. The incidence of CMV pneumonia after autologous bone marrow transplantation and peripheral blood SCT ranges from 1% to 6% [8,14].Gastrointestinal disease is the most common disease, after CMV pneumonia, which can escape blood-based surveillance by PCR in approximately 25 % of patients.
Colorectal cancers most commonly spread first to local lymph nodes before traveling to distant organs. There is presently no consensus on how to use molecular methods to diagnose CMV gastrointestinal and pneumonia disease because there are no data on what level of CMV DNA in brochoalveolar lavage (BAL) fluid or tissue that correlates best with CMV disease. Late CMV disease in HSCT patientsLate CMV disease (after 100 days) occurs in 15% to 20% of seropositive allograft recipients, and it occurs between months 4 and 12 after HSCT, with a mortality rate of 46%. Solid Organ Transplant (SOT)CMV infection is most common during the first 3 to 12 weeks after transplantation, this is because in this period is more intense immunosuppression to prevent rejection [2].
The clinical presentations may be asymptomatic, fever or affect the transplanted organ, as a glomerulopathy or nephritis [2,7,15].
Amongst liver transplant patients, 29% present CMV infection manifesting as CMV hepatitis [2,6].Amongst heart transplant patients, 25% present with CMV infection manifesting as myocarditis [2,7]. However, late-onset CMV disease may occur after 100 days or several years after transplantation, coinciding with discontinuation of antiviral prophylaxis. Ninety-two percent of the patients with CMV disease in the prophylactic group were late-onset disease. In contrast, prophylactic studies reported the proportion of patients with opportunistic infections was 7.8%. CMV recurrence may be related to incomplete suppression of viral replication or the duration of treatment (often 2-4 weeks) may have been insufficient. Some authors suggest treatment for 3 months for pneumonitis, retinitis and gastrointestinal CMV disease. Approximately 40% of HIV-infected patients with advanced disease suffered from one of several manifestations of CMV infection during their life. CMV disease in patients with rheumatic diseasesThe incidence of CMV in rheumatic patients was 50% for systemic lupus erythematosus (SLE), 10% for dermatomyositis, 8.8% for microscopic polyangitis, and less than 5% for rheumatoid arthritis, rheumatoid vasculitis, Behcet?s disease, Chung-Strauss syndrome. The fever was the most common symptom, respiratory symptoms were the second most common, followed by gastrointestinal symptoms. CMV infection was most common among patients under strong immunosupressive therapy (eg: 500-1000 mg pulsed methylprednisolone per day, 60-100 mg oral prednisolone, or intravenous or oral cyclophosphamide within a year before CMV diagnosis [19]. Cyclophosphamide suppresses lymphocyte proliferation and function which increasing the risk of CMV reactivation and replication [1,20-22].


The mortality rate among the patients with leukemia, myelodysplastic syndrome or lymphoma was 82%, and the 63% of the fatal cases was due to, relapse of leukemia, refractory leukemia, or that these patients were in accelerated or blast phase [1,23].In 2001, serious CMV disease, (primarily pneumonia) was found at autopsy in 17%-75% of patients dying with T cell leukemia. Guidelines on the management of CMV reactivation in patients with chronic lymphocytic leukemia treated with alemtuzumabChronic lymphocytic leukemia (CLL) is a disease of progressive with an accumulation of clonal B lymphocytes in peripheral blood, marrow, and lymphoid organs.
This is generally incurable, except the patients who receive an allogeneic cell transplant, and it is the most common form of adult leukemia in Western countries.
CD52 is a glycoprotein of unknown function that is expressed on the surfaces of normal and malignant B and T lymphocytes. Binding of alemtuzumab to CD52 on lymphocytes induces complement-dependent cytotoxicity, antibody-dependent cell-mediated cytotoxicity (which results in a rapid and profound reduction of lymphocytes, and this produces viral replication and reactivation CMV) and direct cytotoxicity (likely apoptotic cell death) [9,24,25,27-29]. Viral infections often are presented at the third week after the initiation of alemtuzumab, which coincides with the nadir in T-cell numbers.
The CMV reactivation is the most common opportunistic infection observed in alemtuzumab-treated patients and it is observed at the beginning of the 4 - 6 weeks of alemtuzumab [30]. CMV reactivation which frequently presents as fever of unknown origin or respiratory symptoms [9,24,28,31,33].Updated management guidelines for using alemtuzumab in CLL. The prophylaxis is administrated entire duration of Alemtuzumab therapy and until 2 months after end the therapy and the frequency of CMV PCR is every 2 weeks. The valganciclovir prophylaxis may be used in patients with elevated risk for CMV reactivation [9, 28]. Crohn disease (CD) was underlying disease in 77% of cases possibly because immunosuppression is more common in CD compared to Ulcerative colitis (UC) [6].4. CMV Pneumonia (CMVp)“CMVp” is defined as the occurrence of clinical and radiographic evidence of pneumonia, in association with the isolation of CMV in BAL, or lung-tissue specimens or with the identification of CMV in lung tissue by histopathology, immunohistochemistry or PCR [1].CMVp represents a major cause of morbidity and mortality in highly immunosuppressed patients, the clinical presentation resembles Pneumocystis jiroveci pneumonia (PCP), the presence of extrapulmonary CMV disease could suggest the diagnosis of CMV pneumonia [37].
The symptoms are fever, nonproductive cough, dyspnea, or worsening dyspnea that progresses to hypoxemia, and necessitates assisted mechanical ventilation [6]. The signs can include normal breath sounds at auscultation or basal crepitations [6].On chest radiograph the infiltrates are usually bilateral and may be interstitial and diffuse (figure 2), or nodular, or alveolar and occasionally small pleural effusions [37]. The most common manifestations of CMVp on conventional radiographs are parenchymal consolidation and multiple nodules measuring less 5 mm in diameter [38].In patients having AIDS, the most frequent finding was dense consolidation and mass-like opacities. The most frequent computed tomography (CT) pattern in immunocompromised patients without AIDS was ground-glass opacities which were bilateral patchy, diffuse distribution. Interlobular septal thickening and pleural effusion [38,39].Coinfections were other potentially life-threatening infections that occurred within 90 days of the episode of CMVp.
The median duration of time from the diagnosis of leukemia to the occurrence of CMVp ranged from 6 months and 9 months in patients with AML and ALL, respectively, to 25 months and 54 months in patients with CML, and CLL respectively [1,23]. The CMVp among patients with leukemia, lymphoma and myelodysplastic syndrome, the mortality rate was 57%, and the death occurred 15 (2-36) days after onset of illness.
Among patients treated before the occurrence of respiratory failure, the mortality rate was 48%. When therapy was initiated after the occurrence of respiratory failure that required mechanical ventilation, the mortality rate was 57-100 % [1,23].Chemaly et al.
In the 92% of the patients, chemotherapy had been administered to the patients within 6 months before the onset of CMVp. A study of cancer patients receiving chemotherapy placed the incidence of CMVp below 3%, in patients with head and neck cancers, nasopharyngeal cancer (NPC), hypopharyngeal cancer (HPC), lung cancer, lymphoma and rectal cancer. The mean length of treatment with azathioprine before the appearance of respiratory symptoms was 19 months, with 6-mercaptopurine was 18 months, infliximab was 10 days to 3 weeks, and cyclosporine was 3 days. These patients had hematological findings such as pancytopenia, lymphopenia, neutropenia, leucopenia, severe anemia, hemophagocytic lymphohistiocytosis or thrombocytopenia. CMV gastrointestinal (GI) diseasesSymptoms range from low-grade fever, weight loss, anorexia, abdominal pain, and bloody diarrhea to a fulminant colitis. In HIV patients can have present esophageal ulcer, esophagitis, gastritis, duodenitis, jejunal and ileal perforation, peritonitis secondary, odynophagia, and bowel obstruction. GI CMV disease is estimated to affect about 20% of adults with AIDS, and it can be involved all parts of the gastrointestinal tract, but the colon and esophagus are the most common sites [4, 41]. Within patients with severe ulcerative colitis (UC), CMV disease may occur more commonly in patients over age 55, and in patients treated with steroids. Infliximab has not been associated with an increased risk of CMV in patients with inflammatory bowel disease (IBD) [4].The prevalence of CMV colitis in resected IBD specimens ranged from 0 to 22% [39], the prevalence assessed using CMV DNA in colon biopsy was 81% in UC patients, and 66% prevalence in Crohn?s disease patients [3].
Domenech et al, showed a prevalence of colonic CMV of 32% in patients with steroid-refractory UC [10].CMV colitis has occurred primarily in patients with pre-existing UC, with documented disease for as long as 20-30 years [3]. The challenge is differentiating the innocent bystanders from the pathogenic strains, so most patients are treated with antivirals, as the possible cost of delaying antiviral therapy is colectomy or even death. Refractory IBD colitis have been associated with CMV inclusions bodies, and these patients have a colectomy rate of 62% and a mortality rate of 44% [3].CMV reactivation exacerbates disease severity in those with active intestinal inflammation. Patients with IBD have impaired NK cell activity and defects in mucosal immunity, which may enhance susceptibility to CMV reactivation).
Patients described as “steroid-refractory” show CMV detectable by immunohistochemistry (IHC) in 20%-40% of both endoscopic biopsies and colectomy specimens.
Local reactivation of CMV can be detected in actively inflamed colonic tissue in about 30% of cases [3].CMV has tropism for dysplastic colonic tissue (adenomas and adenocarcinomas) and may play a significant role in cancer progression.
CMV colitis may exclusively affect the right colon in up to 30% of cases [3].CMV antigenemia is being supplanted by leukocyte CMV PCR. A “cut off” level of viremia for distinguishing infection from disease is required for CMV colitis in patients with IBD [4]. Most studies in patients with IBD have reported a correlation between identification of CMV by PCR in blood, and colonic detection in tissue by hematoxylin and eosin (H&E) or IHC [3,4]. Likewise, they recommend the discontinuation of immunosuppressive agents only in cases of severe systemic CMV disease[4]. Treatment with antiviral therapy has allowed some patients with severe colitis to avoid colectomy despite poor response to conventional IBD therapies.
CMV pancreatitisRequires the detection of CMV infection by immunohistochemical analysis together with the identification in a pancreatic biopsy. CMV retinitisRetinitis can appear more than 6 months after solid organ transplantation, mainly heart transplant recipients. The patients can be asymptomatic, or they may experience blurring of vision, scotomata, or decreased visual acuity.
In HIV-infected patients, retinitis is the single most common manifestation of CMV disease, accounting for 85% of all cases.
In developing countries, CMV retinitis is still the most frequent cause of visual loss in HIV-infected patients. CMV Guillain–Barre Syndrome (GBS)GBS has become the most frequent cause of acute flaccid paralysis in Western countries, following the near-elimination of poliomyelitis.
Infectious agents have been suggested as possible triggers of GBS, as some form of respiratory or gastrointestinal infection precedes nearly two-thirds of GBS cases. Infection with CMV is the most common antecedent virus infection, as identified by the presence of IgM antibodies in 10–15% of patients at the onset of GBS. However, antiviral therapy is currently not recommended in cases of GBS, since the disease is considered to be post infectious. CMV NephritisIt can be defined by the detection of CMV infection by immunohistochemical analysis together with the identification of histological features of CMV infection in a kidney biopsy.
This infection is defined by the detection of CMV infection by immunohistochemical analysis together with the identification of conventional histological features of CMV infection in a heart biopsy specimen and CMV PCR. CMV and others organisms such as Chlamydia pneumoniae, Epstein Barr virus, herpes simplex virus-1, Mycoplasma pneumoniae and Helicobacter pylori are implicated, but evidence is strongest with CMV and Chlamydia pneumoniae. There is a correlation between CMV seropositivity and the presence of atherosclerosis, restenosis following and coronary angioplasty and transplant vascular sclerosis. CMV antigens and nucleic acids have been detected in atherosclerotic lesions in the different layers of the human aorta. Patients suffering from acute myocardial infarction have been found to develop CMV antigenaemia, reflecting either a primary infection or reactivation of a latent infection [44].CMV infects cells in vessels on endotelial cells, smooth muscle cells and macrophages contribute to the slow progression and aggravation of atherosclerosis. CMV associated Hemophagocytic Syndrome (HPS)CMV hemophagocytic syndrome, also referred as macrophage activation syndrome (MAS) or haemophagocytic lymphohistiocytosis (HLH), is a reactive disorder, characterized by generalized histiocytic proliferation, with marked hemophagocytosis. There are two forms of HPS, familial erytrocytic lymphohistiocytosis and the secondary or reactive HPS [34,46,47].Reactive or secondary HPS may develop during systemic infections, immunodeficiencies or malignancies.



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