Our study confirms a low rate of occult cancer in patients with HGD, making endoscopic therapy an attractive alternative to surgery. Footnotes No potential conflict of interest.
The incidence of obesity is increasing worldwide and it has affected a large proportion of population. In Western world, one third of the population is obese and two thirds are overweight and obese (1). Inhibitors,research,lifescience,medical Epidemiological

studies showed that obesity is associated with many cancers including colon cancer (2). Obesity is estimated to be responsible for about 30% of colon cancer incidence (3). Recent studies have also shown that obesity leads to poor BI 2536 supplier prognosis of colon cancer (4)-(6). However, the mechanism for obesity-associated Inhibitors,research,lifescience,medical poorer prognosis of colon cancer is not known. As the activation of PI3K/Akt signal pathway increases the resistance of several cancer cell lines such ovarian, lung cancer to chemotherapeutic drugs (7),(8), it

is possible that PI3K/Akt may also play a role in the poor prognosis of obesity-associated colon cancer. Many altered factors in obesity are known to activate PI3K/Akt pathway including increased blood levels of insulin, Insulin-like growth factor-1, leptin, IL-6, IL-17, TNF-α and decreased blood level of adiponectin (9),(10). Thus, it is possible that these factors can activate PI3K/Akt Inhibitors,research,lifescience,medical pathway which in turn increases Inhibitors,research,lifescience,medical the resistance to chemotherapy in obesity-associated colon cancer (11). Increased insulin in obesity may play a key role in obesity-associated carcinogenesis and prognosis of colon cancer (12). In 1990s, Giovannucci et al proposed that prolonged high blood level of insulin is associated with

increased colon cancer incidence (13),(14). Epidemiological studies have shown that the serum level of C-peptide is associated with the increased risk of colon cancer (15)-(17). A recent prospective Inhibitors,research,lifescience,medical study further demonstrated that fasting blood level of insulin is positively correlated with waist circumference and colon cancer (18). This hypothesis has been demonstrated in animal models. Administration of insulin increased colon cancer cell proliferation and polyp formation in Azoxymethane (AOM)-induced cancer model (19),(20). High level of plasma insulin has also been demonstrated to click here significantly increase the formation of aberrant crypt foci in obese rat model with injection of AOM (21). Insulin can stimulate PI3K/Akt activity to increase the carcinogenesis of colon cancer (9). The activation of PI3K/Akt pathway can increase cell survival, cell growth and proliferation (22)-(24). In addition, insulin can also increase IGF-1 (insulin-growth factor -1) by inhibiting production of IGFBPs 1, 2 and 3 (insulin-like growth factor binding proteins) (25). IGF-1 binds to both insulin and IGF-1 receptors to stimulate PI3K/Akt activity (25).