scholarly journals 1542 An Audit of Rates of Lynch Testing in Confirmed Colorectal Cancer Cases

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Cribb ◽  
F Liccardo ◽  
S Crisford ◽  
N Pawa
Keyword(s):  
Colorectal Cancer ◽  
Lynch Syndrome ◽  
Mismatch Repair ◽  
Service Provision ◽  
Oncological Treatment ◽  
Cancer Services ◽  
Significant Difference ◽  
Nice Guidance ◽  
The Uk ◽  
The Impact

Abstract Introduction 12% of cancers in the UK are colorectal in origin1 with 1-3% secondary to genetic mismatch repair due to Lynch syndrome2, for which the 2017 NICE guidance recommended that patients with colorectal cancer (CRC) be tested3. It increases the risk of developing other cancers such as endometrial, ovarian and small bowel1, changes the oncological treatment offered to CRC patients4,5, and prompts investigation of their relatives for the condition. In this audit we assessed our rates of trust wide Lynch testing. Method Patients with a diagnosis of CRC from 2017-2019 were identified from records held by our cancer services department. Histology results were obtained from an online results portal. Results 345 were included in the analysis, 79% of which were tested for Lynch, with time taken from biopsy to results ranging from 2 to 276 days (average 45). 54% had results within 30 days, 34% between 30 and 90 days and 12% exceeded 90 days. There was no significant difference of Lynch testing rates between each year. The proportion of results returned within 30 days increased by year, with rates of 30% (2017), 55% (2018) and 71% (2019). The median days from biopsy to results also improved, from 39 to 28 and 16 days, respectively. Conclusions Rates and efficiency of our screening for lynch syndrome need improvement to meet the target suggested by NICE. The impact of the recent centralisation our regions pathology department on Lynch testing service provision requires further investigation.

scholarly journals Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases

2010 ◽  
Vol 92 (3) ◽  
pp. 225-230 ◽  
Author(s):  
J Tiernan ◽  
CD Briggs ◽  
GRB Irving ◽  
MT Swinscoe ◽  
M Peterson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Disease Free Survival ◽  
District Hospitals ◽  
Significant Difference ◽  
Specialist Centre ◽  
The Uk ◽  
The Impact

INTRODUCTION In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. SUBJECTS AND METHODS Analysis of prospective liver resection database between 1997 and 2004 and after the introduction of standardised guidelines between January 2005 and April 2008. RESULTS A total of 362 patients underwent liver resection for CRC metastases between 1997 and 2008, 237 prior to the introduction of the referral guidelines and 125 after. Liver resection rates according to referring hospital varied from 0.92 to 2.32 per 100,000 population before guidelines were introduced. After 2005, resection rates from the four district hospitals standardised (1.68–1.84 per 100,000 population), but the central unit rate (Sheffield) remained significantly higher (2.67 per 100,000 population). No significant difference in 1-year disease-free survival between patients from Sheffield and the outlying hospitals was found (P = 0.553). CONCLUSIONS Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.

scholarly journals Beyond Microsatellite Instability: Evolving Strategies Integrating Immunotherapy for Microsatellite Stable Colorectal Cancer

2021 ◽  
Vol 22 (8) ◽  
Author(s):  
Federica Pecci ◽  
Luca Cantini ◽  
Alessandro Bittoni ◽  
Edoardo Lenci ◽  
Alessio Lupi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Microsatellite Instability ◽  
Mismatch Repair ◽  
Cancer Progression ◽  
Checkpoint Inhibitors ◽  
Tnm Classification ◽  
Standard Of Care ◽  
First Line Therapy ◽  
Combination Strategies ◽  
The Impact

Opinion statementAdvanced colorectal cancer (CRC) is a heterogeneous disease, characterized by several subtypes with distinctive genetic and epigenetic patterns. During the last years, immune checkpoint inhibitors (ICIs) have revamped the standard of care of several tumors such as non-small cell lung cancer and melanoma, highlighting the role of immune cells in tumor microenvironment (TME) and their impact on cancer progression and treatment efficacy. An “immunoscore,” based on the percentage of two lymphocyte populations both at tumor core and invasive margin, has been shown to improve prediction of treatment outcome when added to UICC-TNM classification. To date, pembrolizumab, an anti-programmed death protein 1 (PD1) inhibitor, has gained approval as first-line therapy for mismatch-repair-deficient (dMMR) and microsatellite instability-high (MSI-H) advanced CRC. On the other hand, no reports of efficacy have been presented in mismatch-repair-proficient (pMMR) and microsatellite instability-low (MSI-L) or microsatellite stable (MSS) CRC. This group includes roughly 95% of all advanced CRC, and standard chemotherapy, in addition to anti-EGFR or anti-angiogenesis drugs, still represents first treatment choice. Hopefully, deeper understanding of CRC immune landscape and of the impact of specific genetic and epigenetic alterations on tumor immunogenicity might lead to the development of new drug combination strategies to overcome ICIs resistance in pMMR CRC, thus paving the way for immunotherapy even in this subgroup.

scholarly journals Cancer risk and overall survival in mismatch repair proficient hereditary non-polyposis colorectal cancer, Lynch syndrome and sporadic colorectal cancer

2013 ◽  
Vol 13 (1) ◽  
pp. 109-119 ◽  
Author(s):  
Pilar Garre ◽  
Lorena Martín ◽  
Inmaculada Bando ◽  
Alicia Tosar ◽  
Patricia Llovet ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cancer Risk ◽  
Lynch Syndrome ◽  
Mismatch Repair ◽  
Sporadic Colorectal Cancer

scholarly journals Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer

2008 ◽  
Vol 26 (35) ◽  
pp. 5783-5788 ◽  
Author(s):  
Heather Hampel ◽  
Wendy L. Frankel ◽  
Edward Martin ◽  
Mark Arnold ◽  
Karamjit Khanduja ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lynch Syndrome ◽  
Mismatch Repair ◽  
Cancer Surveillance ◽  
Study Cohort ◽  
Entire Study ◽  
Gene Testing ◽  
Revised Bethesda Guidelines ◽  
Repair Genes ◽  
Entire Study Cohort

Purpose Identifying individuals with Lynch syndrome (LS) is highly beneficial. However, it is unclear whether microsatellite instability (MSI) or immunohistochemistry (IHC) should be used as the screening test and whether screening should target all patients with colorectal cancer (CRC) or those in high-risk subgroups. Patients and Methods MSI testing and IHC for the four mismatch repair proteins was performed on 500 tumors from unselected patients with CRC. If either MSI or IHC was abnormal, complete mutation analysis for the mismatch repair genes was performed. Results Among the 500 patients, 18 patients (3.6%) had LS. All 18 patients detected with LS (100%) had MSI-high tumors; 17 (94%) of 18 patients with LS were correctly predicted by IHC. Of the 18 probands, only eight patients (44%) were diagnosed at age younger than 50 years, and only 13 patients (72%) met the revised Bethesda guidelines. When these results were added to data on 1,066 previously studied patients, the entire study cohort (N = 1,566) showed an overall prevalence of 44 of 1,566 patients (2.8%; 95% CI, 2.1% to 3.8%) for LS. For each proband, on average, three additional family members carried MMR mutations. Conclusion One of every 35 patients with CRC has LS, and each has at least three relatives with LS; all of whom can benefit from increased cancer surveillance. For screening, IHC is almost equally sensitive as MSI, but IHC is more readily available and helps to direct gene testing. Limiting tumor analysis to patients who fulfill Bethesda criteria would fail to identify 28% (or one in four) cases of LS.

scholarly journals TP10.2.11The consequences of COVID-19 on the colorectal red-flag cancer pathway- A 3 month review 2019 to 2020

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
R Sarah Small ◽  
Rachael Coulson ◽  
Ian Mcallister
Keyword(s):  
Colorectal Cancer ◽  
Definitive Treatment ◽  
Data Sets ◽  
Patient Demographics ◽  
Cancer Services ◽  
Information Time ◽  
Co Morbidity ◽  
Red Flag ◽  
Time To First Treatment ◽  
The Impact

Abstract Aim The COVID-19 pandemic is an evolving healthcare challenge introducing greater burden on existing resources. With 1,100 people in Northern Ireland diagnosed with colorectal cancer (CRC) per annum, concerns over disruption of cancer services and secondary consequences have been highlighted. We aim to evaluate the impact of COVID-19 on the CRC red flag pathway in comparison to the pre-COVID era. Methods Two comparative data sets were compiled through retrospective analysis of red-flag colorectal referrals over a 3-month period for both April to June 2019 and 2020. A comprehensive review of each patient’s electronic care record and medical notes was completed. Patient demographics, co-morbidity, referral information, time to hospital appointment and investigation modality were documented. For patients identified with CRC the stage and time to first definitive treatment was documented. Results A total of 47 CRCs were identified from both red-flag referral groups; 25 CRCs 2019 compared to 22 in 2020. Median age at time of referral was 79 years in 2019 compared to 71 years in 2020. Time to outpatient review was significantly less during 2020 compared to 2019; 16 days and 31 days respectively (p < 0.05). Time to first treatment was 103 days 2019 compared to 75 days 2020 (p < 0.05). Advanced diagnostic stage or increased number of emergency hospital presentations in the COVID-19 period was not demonstrated. Conclusion Despite disruption of established colorectal cancer services during the COVID-19 pandemic, we demonstrated patients waited less time to outpatient review and intervention. With comparative cases of CRC to the pre-COVID era diagnosed.

Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway

2020 ◽  
pp. bmjqs-2019-009975
Author(s):  
Philippa Orchard ◽  
Nitin Arvind ◽  
Alison Wint ◽  
James Kynaston ◽  
Ann Lyons ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Dramatic Improvement ◽  
Hospital System ◽  
Cancer Data ◽  
Cancer Pathways ◽  
Referral Criteria ◽  
Nice Guidance ◽  
Referral Form ◽  
The Impact

BackgroundThe 2-week wait referral pathway for suspected colorectal cancer was introduced in England to improve time from referral from a general practitioner (GP) to diagnosis and treatment. Patients are required to be seen by a hospital clinician within 2 weeks if their symptoms meet the criteria set by the National Institute for Health and Care Excellence (NICE) and to start cancer treatment within 62 days. To achieve this, many hospitals have introduced a straight-to-test (STT) strategy requiring hospital-based triage of referrals. We describe the impact and learning from a new pathway which has removed triage and moved the process of requesting tests from hospital to GPs in primary care.MethodAn electronic STT pathway was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. The hospital identified referrals as being on a cancer pathway and dealt with all ongoing management. Routinely collected cancer data were used to identify time to cancer diagnosis compared with national dataResults11357 patients were referred via the new pathway over 3 years. Time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway.ConclusionWe have changed the way patients with suspected colorectal cancer are managed within the National Health Service by giving GPs the ability to order tests electronically within a monitored cancer pathway halving time from referral to diagnosis

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