scholarly journals Differentiation between stercoral perforation and colorectal cancer perforation

2019 ◽  
Vol 65 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Ji Yoon Moon ◽  
Seong Sook Hong ◽  
JiYoung Hwang ◽  
Hae Kyung Lee ◽  
Kyo Chang Choi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Bowel Wall ◽  
Distal Colon ◽  
Proximal Colon ◽  
Wall Thickening ◽  
Colon Wall ◽  
Perforation Site ◽  
Ct Findings ◽  
Stercoral Perforation

SUMMARY OBJECTIVE: To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. MATERIALS AND METHODS: From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. RESULTS: The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). CONCLUSION: Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.

scholarly journals The Relationship between Inflammation Markers (CRP, IL-6, sCD40L) and Colorectal Cancer Stage, Grade, Size and Location

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1382
Author(s):  
Olga Martyna Koper-Lenkiewicz ◽  
Violetta Dymicka-Piekarska ◽  
Anna Justyna Milewska ◽  
Justyna Zińczuk ◽  
Joanna Kamińska
Keyword(s):  
Colorectal Cancer ◽  
Linear Regression ◽  
Tumor Size ◽  
Distal Colon ◽  
Proximal Colon ◽  
Model Parameters ◽  
Grade Group ◽  
Who Grade ◽  
The Mean ◽  
Mean Concentration

The aim of the study was the evaluation whether in primary colorectal cancer (CRC) patients (n = 55): age, sex, TNM classification results, WHO grade, tumor location (proximal colon, distal colon, rectum), tumor size, platelet count (PLT), mean platelet volume (MPV), mean platelet component (MCP), levels of carcinoembryonic antigen (CEA), cancer antigen (CA 19-9), as well as soluble lectin adhesion molecules (L-, E-, and P-selectins) may influence circulating inflammatory biomarkers: IL-6, CRP, and sCD40L. We found that CRP concentration evaluation in routine clinical practice may have an advantage as a prognostic biomarker in CRC patients, as this protein the most comprehensively reflects clinicopathological features of the tumor. Univariate linear regression analysis revealed that in CRC patients: (1) with an increase in PLT by 10 × 103/μL, the mean concentration of CRP increases by 3.4%; (2) with an increase in CA 19-9 of 1 U/mL, the mean concentration of CRP increases by 0.7%; (3) with the WHO 2 grade, the mean CRP concentration increases 3.631 times relative to the WHO 1 grade group; (4) with the WHO 3 grade, the mean CRP concentration increases by 4.916 times relative to the WHO 1 grade group; (5) with metastases (T1-4N+M+) the mean CRP concentration increases 4.183 times compared to non-metastatic patients (T1-4N0M0); (6) with a tumor located in the proximal colon, the mean concentration of CRP increases 2.175 times compared to a tumor located in the distal colon; (7) in patients with tumor size > 3 cm, the CRP concentration is about 2 times higher than in patients with tumor size ≤ 3 cm. In the multivariate linear regression model, the variables that influence the mean CRP value in CRC patients included: WHO grade and tumor localization. R2 for the created model equals 0.50, which indicates that this model explains 50% of the variance in the dependent variable. In CRC subjects: (1) with the WHO 2 grade, the mean CRP concentration rises 3.924 times relative to the WHO 1 grade; (2) with the WHO 3 grade, the mean CRP concentration increases 4.721 times in relation to the WHO 1 grade; (3) with a tumor located in the rectum, the mean CRP concentration rises 2.139 times compared to a tumor located in the distal colon; (4) with a tumor located in the proximal colon, the mean concentration of CRP increases 1.998 times compared to the tumor located in the distal colon; if other model parameters are fixed.

scholarly journals Subsite-Specific Dietary Risk Factors for Colorectal Cancer: A Review of Cohort Studies

2013 ◽  
Vol 2013 ◽  
pp. 1-14 ◽  
Author(s):  
Anette Hjartåker ◽  
Bjarte Aagnes ◽  
Trude Eid Robsahm ◽  
Hilde Langseth ◽  
Freddie Bray ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Cohort Studies ◽  
Distal Colon ◽  
Proximal Colon ◽  
Risk Estimates ◽  
Specific Risk ◽  
Dietary Components

Objective. A shift in the total incidence from left- to right-sided colon cancer has been reported and raises the question as to whether lifestyle risk factors are responsible for the changing subsite distribution of colon cancer. The present study provides a review of the subsite-specific risk estimates for the dietary components presently regarded as convincing or probable risk factors for colorectal cancer: red meat, processed meat, fiber, garlic, milk, calcium, and alcohol.Methods. Studies were identified by searching PubMed through October 8, 2012 and by reviewing reference lists. Thirty-two prospective cohort studies are included, and the estimates are compared by sex for each risk factor.Results. For alcohol, there seems to be a stronger association with rectal cancer than with colon cancer, and for meat a somewhat stronger association with distal colon and rectal cancer, relative to proximal colon cancer. For fiber, milk, and calcium, there were only minor differences in relative risk across subsites. No statement could be given regarding garlic. Overall, many of the subsite-specific risk estimates were nonsignificant, irrespective of exposure.Conclusion. For some dietary components the associations with risk of cancer of the rectum and distal colon appear stronger than for proximal colon, but not for all.

GEWF Solution

2001 ◽  
Vol 125 (5) ◽  
pp. 642-645 ◽  
Author(s):  
Ken J. Newell ◽  
Barry W. Sawka ◽  
Brian F. Rudrick ◽  
David K. Driman
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Glacial Acetic Acid ◽  
Bowel Wall ◽  
Health Centre ◽  
Lymph Node Status ◽  
Regional Health ◽  
Tumor Penetration ◽  
Colorectal Cancer Resection ◽  
Positive Lymph Nodes

Abstract Background.—Lymph node status is an important prognostic factor in the staging of colorectal carcinoma. Several adjunctive solutions have been used to increase the yield of pericolic lymph nodes from colorectal cancer resection specimens. Methods.—During 1998 at the Grey Bruce Regional Health Centre (Owen Sound, Ontario), 67 colonic resections were performed for colorectal cancer. Lymph nodes were identified using GEWF solution (glacial acetic acid, ethanol, distilled water, and formaldehyde) in 35 cases, and by the conventional method of sectioning, inspection, and palpation in 32 cases. Results.—There were no significant differences between GEWF and non-GEWF cases with respect to patient age, length of resection, size of tumor, tumor histologic type, tumor differentiation, or depth of tumor penetration into the bowel wall. Use of GEWF led to a significant increase in the number of lymph nodes found (10.2 ± 4.9 per case) compared with non-GEWF cases (6.8 ± 3.9 per case) (P = .002). In GEWF cases 358 lymph nodes were identified, 82 with metastases, whereas in the non-GEWF cases 218 lymph nodes were found, 41 with metastases. The size of positive lymph nodes in the GEWF group (0.5 ± 0.2 cm) was significantly smaller than in the non-GEWF group (0.7 ± 0.4 cm) (P = .046). A greater percentage of positive lymph nodes in the GEWF cases (49/82, 60%) were 0.5 cm or smaller compared with the non-GEWF cases (17/41, 41%). Conclusions.—GEWF increases the yield of lymph nodes recovered from colorectal cancer specimens and may lead to improved staging of this cancer; it is inexpensive and simple to use.

scholarly journals Giant villous adenoma of the sigmoid colon: an unusual cause of homogeneous, segmental bowel wall thickening

2020 ◽  
Vol 6 (4) ◽  
pp. 20200016
Author(s):  
Jeffrey Sacks ◽  
Seymour Atlas ◽  
Alar Enno ◽  
Leonardo Santos ◽  
Jeremy Humphries ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sigmoid Colon ◽  
Malignant Transformation ◽  
Villous Adenoma ◽  
Bowel Wall ◽  
Wall Thickening ◽  
Colonic Adenomas ◽  
Bowel Wall Thickening ◽  
Villous Adenomas

Colonic adenomas are commonly encountered lesions that are a precursor of colorectal cancer. Of these, villous adenomas are a rarer, more advanced subtype that are larger in size than tubular adenomas and have a higher risk of malignant transformation. We present a patient with a giant villous adenoma of the sigmoid colon identified on CT as homogeneous segmental bowel wall thickening.

scholarly journals Chronic Active Epstein-Barr Virus-Associated Enteritis: CT Findings and Clinical Manifestation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Bo Zhang ◽  
Xia Wang ◽  
Xiaoyan Tian ◽  
Yongping Cai ◽  
Xingwang Wu
Keyword(s):  
Epstein Barr Virus ◽  
Bowel Wall ◽  
Clinical Symptoms ◽  
Wall Thickening ◽  
Barr Virus ◽  
Ct Findings ◽  
Pathologic Findings ◽  
Bowel Wall Thickening ◽  
Epstein Barr ◽  
Fat Stranding

Aim. To improve the identification and computed tomography (CT) diagnostic accuracy of chronic active Epstein-Barr virus (EBV)-associated enteritis (CAEAE) by evaluating its CT findings and clinical manifestation. Methods. The data of three patients with pathologically and clinically confirmed CAEAE who underwent CT enterography (CTE) were retrospectively reviewed from January 2018 to October 2019. The following data were evaluated: imaging characteristics (length of involvement, pattern of mural thickening, pattern of attenuation, perienteric abnormalities), clinical symptoms, endoscopic records, laboratory examinations, and pathologic findings. Results. Based on CT findings, two patients demonstrated segmental bowel wall thickening (involvement length >6 cm), asymmetric thickening, layered attenuation, fat stranding, and adenopathy, whereas the remaining one had no positive finding. The endoscopic results of all patients showed numerous irregular ulcers in the colon, and one patient had a focal esophageal ulcer. The major clinical symptoms were abdominal pain (n=3), retrosternal pain (n=1), fever (n=3), diarrhea (n=2), hematochezia (n=1), and adenopathy (n=3). The main laboratory examination indicators were increased serum EBV DNA load (n=1) and increased inflammatory markers (n=3). With regard to the main pathologic findings, all patients showed positive EBV-encoded RNA (EBER) situ hybridization in the colonic biopsy specimen, with one patient being positive in the esophagus. Conclusion. CAEAE is rare and is usually misdiagnosed as inflammatory bowel disease (IBD). The imaging features of CAEAE overlap with those of Crohn’s disease and ulcerative colitis. The presence of segmental and asymmetric bowel wall thickening, layered attenuation, and fat stranding in the CTE image may be helpful in differentiating CAEAE from IBD.

S1549: Association Between Serum Albumin Levels and Computed Tomography (CT) Findings of Colon Wall Thickening (CWT)

2010 ◽  
Vol 71 (5) ◽  
pp. AB191-AB192
Author(s):  
Hiral Shah ◽  
Bikram S. Bal ◽  
Raman Battish ◽  
Michael D. Crowell ◽  
Rohini R. Vanga ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Serum Albumin ◽  
Wall Thickening ◽  
Colon Wall ◽  
Ct Findings

Early colorectal cancer detection on routine CT to improve patient's 5-year survival.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 593-593
Author(s):  
Ricky Rodriguez ◽  
Bryce Daniel Perkins ◽  
Peter Yong Soo Park ◽  
Phillip Koo ◽  
Madappa N. Kundranda ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Early Colorectal Cancer ◽  
Wall Thickening ◽  
Imaging Features ◽  
Ascending Colon ◽  
Abdominal Ct ◽  
Diagnostic Ct

593 Background: Prognosis of colorectal cancer (CRC) is greatly influenced by stage at diagnosis. Early colorectal cancer can be subtle on CT scans showing only mild wall thickening, small polyps, or subtle lymph nodes. Identifying these lesions on CT performed for nonspecific symptoms can help identify interval CRC and improve patient outcome. The purpose of the present study is to classify missed CRC on abdominal CT by their imaging features and whether early identification can downstage CRC patients. Methods: A retrospective analysis was conducted of patients (pts) diagnosed with CRC. Data collection included age, gender, ECOG, KRAS mutation status, overall survival (OS). CT obtained prior to and at diagnosis were evaluated. Images were reviewed for multiple CT features including appearance of mass, mesenteric infiltration, abnormal draining lymph nodes, contrast enhancement relative to adjacent mucosa, and intralesional calcifications. Staging was evaluated using available CT scan and based on the TNM staging system for CRC. Results: The 41 pts with 51 prediagnostic CTs from 1/1/2012 - 12/31/2015 had mean age of 68 years (range:44-90 ) Mean ECOG status for the population was 1.46. 41% of the prediagnostic CTs had missed findings. 52 and 43 % of the missed findings were in the rectosigmoid and ascending colon respectively. Of the 15 missed masses, 9 appeared as asymmetric wall thickening, 3 as concentric wall thickening, and 3 as polyps. Of the 14 missed lymph node groups, 2 were excluded due to stability or nonrelated condition. The remaining lymph nodes were found in the associated draining station and averaged 3±1.2 mm in size. On average, the stage at prediagnostic CT was 3A and the diagnostic CT was 3C (p = 0.0015). Average time lapse between prediagnostic and diagnostic CT was 21 months (3-64 months). Conclusions: High percentage of CRC findings are missed on abdominal CT due to their subtle feature, with most misses in the rectosigmoid and ascending colon. A dedicated search can improve detection by specifically looking for polyps, wall thickening, and small lymph nodes in the draining station. Early detection of CRC can improve survival by lowering the stage from 3C to 3A, thus providing 36% improvement in 5-year survival.

Early detection of lower GI tract tumors by dedicated assessment of the colon on routine computed tomography (CT) imaging: An observational study.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 510-510
Author(s):  
John Chang ◽  
Russell Pluhm ◽  
Ashley Lutrick ◽  
Jessica Guerra ◽  
Phillip Koo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Early Detection ◽  
Lymph Nodes ◽  
Tertiary Care ◽  
Transitional Cell ◽  
Wall Thickening ◽  
Average Risk ◽  
Care Hospital ◽  
Early Features

510 Background: We have previously reported that up to 48% of the early features of colorectal cancer (subtle wall thickening, pericolonic stranding, and small lymph nodes in the draining nodal station) were not identified on the original CT abdomen and pelvis (CTAP) reports. This resulted in a 36% decrease in five-year survival based on historical data. In this report, we assessed whether dedicated assessment of the colon on routine CT scans could lead to early detection of colorectal cancer. Methods: 210 CTAPs over a three-month period were screened from the emergency room records at a tertiary care hospital. 194 scans met eligibility. Exclusion criteria included: cases known to the evaluating radiologist and age ≤ 19 or > 89 years. No study was excluded for suboptimal image quality. The original report was reviewed for abnormalities involving the colon, mesentery and bowel and was recorded. A blinded evaluation of the eligible case was then performed by a board-certified radiologist with attention specifically to the colon and the mesentery for the suspicious early features of CRC. The concordance and discordance was then tabulated. Discordant findings were re-evaluated to determine if the discordance was true. Results: 72/194 patients were male, median age 44.5 years (range 20 - 89). 55/194 patients (29.1%) included in the study were noted to have suspicious features. 26 had abnormal lymph nodes, 24 had abnormal colonic wall thickening and 16 had pericolonic stranding and/or wall edema. 45/55 studies were truly discordant from the original interpretation. These included one missed colorectal cancer (confirmed), one likely small bowel neuroendocrine tumor (no follow up), and one likely transitional cell carcinoma of the right renal pelvis (no follow up). Conclusions: Dedicated search of the colon and mesentery on CTAP can identify subtle findings, although their true relevance is being evaluated in a larger future study. Our observational data does indicate that there maybe a potential role for a focused evaluation of the colon and mesentery on routine CTAP in an attempt to potentially increase the rate of cancer detection especially in younger low-average risk patients.

Limited time Interval between Symptomatic Presentation in Primary Care and Colorectal Cancer Diagnosis

2021 ◽  
Author(s):  
Josephina G. Kuiper ◽  
Myrthe P.P. Herk-Sukel ◽  
Valery E.P.P. Lemmens ◽  
Ernst J. Kuipers ◽  
Ron M.C. Herings
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Cancer Diagnosis ◽  
Drug Users ◽  
Index Date ◽  
Distal Colon ◽  
Proximal Colon ◽  
New Drugs ◽  
Time Interval

Abstract Background: Timely recognition of colorectal cancer related symptoms is essential to reduce time to diagnosis. This study aims to investigate the primary healthcare use preceding a colorectal cancer diagnosis.Methods: A population-based case-control study was conducted using data from a cohort of linked data from the Netherlands Cancer Registry (NCR) and the PHARMO General Practitioner (GP) Database (NCR-PHARMO GP cohort). Primary healthcare use among colorectal cancer cases before diagnosis was compared with matched cancer-free controls. Information on primary health care use was derived from the GP Database of the PHARMO Database Network and included all GP consultations and prescribed medication. Mean monthly number of GP consultations and new drugs users was assessed in the year before index date (diagnosis date for cases). Results were stratified by colorectal cancer site: proximal colon cancer, distal colon cancer and rectal cancer.Results: While mean monthly number of GP consultation were stable through the year among cancer-free controls, a statistical significant increase was seen among colorectal cancer cases in the last 4-8 months before diagnosis. Proximal colon cancer cases showed the longest time interval of increased mean monthly number of GP consultations. This increase was largely driven by a consultation for malignant neoplasm colon/rectum. The number of new drug users was stable around 120 per 1,000 persons per month until 8 months before index date for proximal colon cancer cases, 4 months before index date for distal colon cancer cases and 3 months for rectal cancer cases. This increase was mainly driven by the prescription of laxatives drugs.Conclusion: A relatively short time interval of increased GP consultations and new drug users was seen before colorectal cancer diagnosis. The longest period of increased GP consultations and new drugs users was seen among patients diagnosed with proximal colon cancer. This can be explained by the difficultly to diagnose proximal colon cancer given the more subtle signs compared to distal colon cancer and rectal cancer. Therefore, faster diagnosis for this specific tumour subtype is only possible when clear clinical signs and symptoms are present.

scholarly journals CD24 can be used to isolate Lgr5+ putative colonic epithelial stem cells in mice

2012 ◽  
Vol 303 (4) ◽  
pp. G443-G452 ◽  
Author(s):  
Jeffrey B. King ◽  
Richard J. von Furstenberg ◽  
Brian J. Smith ◽  
Kirk K. McNaughton ◽  
Joseph A. Galanko ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Stem Cells ◽  
Epithelial Cells ◽  
Distal Colon ◽  
Proximal Colon ◽  
Egfp Expression ◽  
Colonic Epithelium ◽  
Epithelial Stem Cells ◽  
Normal Colonic Epithelium ◽  
Crypt Base

A growing body of evidence has implicated CD24, a cell-surface protein, as a marker of colorectal cancer stem cells and target for antitumor therapy, although its presence in normal colonic epithelium has not been fully characterized. Previously, our group showed that CD24-based cell sorting can be used to isolate a fraction of murine small intestinal epithelial cells enriched in actively cycling stem cells. Similarly, we hypothesized that CD24-based isolation of colonic epithelial cells would generate a fraction enriched in actively cycling colonic epithelial stem cells (CESCs). Immunohistochemistry performed on mouse colonic tissue showed CD24 expression in the bottom half of proximal colon crypts and the crypt base in the distal colon. This pattern of distribution was similar to enhanced green fluorescent protein (EGFP) expression in Lgr5-EGFP mice. Areas expressing CD24 contained actively proliferating cells as determined by ethynyl deoxyuridine (EdU) incorporation, with a distinct difference between the proximal colon, where EdU-labeled cells were most frequent in the midcrypt, and the distal colon, where they were primarily at the crypt base. Flow cytometric analyses of single epithelial cells, identified by epithelial cell adhesion molecule (EpCAM) positivity, from mouse colon revealed an actively cycling CD24+ fraction that contained the majority of Lgr5-EGFP+ putative CESCs. Transcript analysis by quantitative RT-PCR confirmed enrichment of active CESC markers [leucine-rich-repeat-containing G protein-coupled receptor 5 (Lgr5), ephrin type B receptor 2 (EphB2), and CD166] in the CD24+EpCAM+ fraction but also showed enrichment of quiescent CESC markers [leucine-rich repeats and immunoglobin domains (Lrig), doublecortin and calmodulin kinase-like 1 (DCAMKL-1), and murine telomerase reverse transcriptase (mTert)]. We conclude that CD24-based sorting in wild-type mice isolates a colonic epithelial fraction highly enriched in actively cycling and quiescent putative CESCs. Furthermore, the presence of CD24 expression in normal colonic epithelium may have important implications for the use of anti-CD24-based colorectal cancer therapies.

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