Colorectal Cancer in Different Age Groups in a Tertiary Hospital in Nepal

Introduction: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older (>40 years of age) colorectal cancer patients.Methods: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t – test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and p value of <0.05 was considered as significant.Results: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (p <0.001) while older patients mostly presented with per rectal bleeding (p< 0.008).Conclusions: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly. Keywords: carcinoma; colon; per rectal bleeding; younger group. [PubMed]

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Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i1.19373 ◽

2018 ◽

Vol 16 (1) ◽

pp. 89-92 ◽

Cited By ~ 1

Author(s):

Bikal Ghimire ◽

Yogendra Prasad Singh ◽

Goran Kurlberg ◽

Yvonne Wettergren

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Older Patients ◽

Lymph Node Ratio ◽

Clinical Stage ◽

Young Patients ◽

University Teaching ◽

P Value ◽

Younger Patients ◽

Node Ratio

Background: Colorectal cancer is being diagnosed more frequently in the young and it presents in an advanced stage. In TNM staging, stage depends on tumor size and number of positive nodes, which depend on location of tumor as well as the extent of dissection.The lymph node ratio is regarded as a more reliable marker for prognosis. In this study, we compare epidemiology of colorectal cancer in the young (<40 years) and older patients as well as the LNR.Methods: Patients with colorectal cancer operated at the Tribhuvan University Teaching Hospital, Kathmandu, Nepal for a period of 4 years (2012 – 2016) were included in the study. Patients were grouped into young (≤ 40 years) and older (> 40 years) and clinic-pathological data such as site of lesion, clinical stage, and lymph node ratio were compared.Results: Of the 95 patients of colorectal cancer, 25 patients were of age ≤ 40 years (26%) and they had a higher median stage at diagnosis. In patients above 40 years, it was diagnosed at a relatively earlier stage. The mean number of positive nodes was 11.64 in younger patients whereas it was 18.34in those more than 40 years of age,but younger patients had higher lymph node ratio than elderly (0.31 vs 0.13) (P-value ≤ 0.005).Conclusions: Young patients with colorectal cancer tend to have more advanced disease. The lymph node metastasis and lymph node ratio tend to be higher in young patients.

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Colorectal cancer characteristics and outcomes in patients less than age 50: A comparison of an urban university hospital with the NCI SEER database.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3621 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3621-3621 ◽

Cited By ~ 1

Author(s):

Edith P. Mitchell ◽

Allan Topham ◽

Pramila R. Anne ◽

Scott Goldstein ◽

Gerald Isenberg ◽

...

Keyword(s):

Colorectal Cancer ◽

Older Patients ◽

University Hospital ◽

Data Sets ◽

Seer Database ◽

Pathological Features ◽

Younger Patients ◽

The Third ◽

Colorectal Cancer Patients ◽

Better Than

3621 Background: Cancer of the colon and rectum is the third most commonly occurring cancer, as well as the third leading cause of cancer deaths in American men and women. Colorectal cancer in younger patients is believed to have worse pathological features and prognosis than in older patients. The objective of this study was to assess pathological features and outcomes of CRC in patients less than age 50 using an institutional sample and comparing to the Surveillance, Epidemiology and End Results (SEER) database. Methods: Included in the study were a total of 4595 cases from the Tumor Registry at Thomas Jefferson University Hospital (TJUH) over a twenty year period from 1988 through 2007 and 290,338 cases from the Surveillance, Epidemiology and End Results (SEER) database from 1988 through 2004. Patients less than age 50 were compared to those age 50 and older. Results: Patients under age 50 with CRC presented with more advanced stage tumors in both data sets (<0.0001) , and had more poorly differentiated tumors than older patients (PTJUH=0.02754; PSEER<0.0001). Patients under 50 also had more mucinous/signet ring cell tumors with 12 percent to 8.1 percent in the TJUH data (p=0.002916) and 13.2 percent to 10.3 percent in the SEER data (p<0.0001), with younger males having the highest prevalence in both data sets. Younger patients had fewer proximal tumors than patients 50 and over, and a higher proportion of rectal tumors (p<0.001). Patients under age 50 were more likely to have positive nodes at all stages (PSEER <0.0001) relative to 50 and over, as well as more likely to develop peritoneal metastases (PTJUH=0.3507),, but less likely to have lung metastases PTJUH=0.05249) than older pts. Despite their poor pathologic features, patients under age 50 had better than or equal survival to those 50 and older. Conclusions: Colorectal cancer patients under age 50 presented with worse histological characteristics and metastasized much sooner, yet the younger patients had better than or equal survival to those ages 50 and older. Ongoing studies will assess differences in treatment and molecular features between younger and older colorectal cancer patients.

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High incidence of advanced stage cancer and prolonged rectal bleeding history before diagnosis in young-onset patients with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.3576 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 3576-3576

Author(s):

Gurprataap Singh Sandhu ◽

Rebekah Anders ◽

Amy Walde ◽

Alexis Diane Leal ◽

Gentry Teng King ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Family History ◽

Rectal Bleeding ◽

Clinical Presentation ◽

Advanced Disease ◽

Younger Patients ◽

Young Onset ◽

The Mean ◽

Bleeding History

3576 Background: In contrast to the older population, the incidence of colorectal cancer (CRC) in younger patients (aged < 50 years) has been increasing in the last three decades. Younger patients tend to present with more advanced disease, thought to be in part related to lack of routine screening colonoscopies. The goal of this study was to examine characteristics of young-onset CRC and potentially identify factors that may aid in earlier diagnosis and treatment. Methods: We collected data for patients available through the University of Colorado Cancer Center Cancer Registry. Inclusion criteria included: 1) Diagnosis of colon or rectal cancer between the years 2012-2018 and 2) age at diagnosis of less than 50 years. Pertinent data including baseline characteristics, clinical presentation, family history, pathology, molecular testing, staging, and treatment were collected. Results: 211 patients with young-onset CRC were available for review. Mean age at diagnosis was 42.4 years and 55.5% were males. A total of 42.1% had rectal cancer and a majority of the colon cancer diagnoses had left-sided tumors (66%). Regarding clinical presentation, 52.2% presented with rectal bleeding prior to diagnosis. Of those who presented with rectal bleeding, the average time from the onset of bleeding to diagnosis was 271.17 days. 42.9% of young-onset CRC were stage IV at the time of initial diagnosis. Evaluation of the pathology specimens showed that 89.6% were adenocarcinomas and 63.5% were grade 2 or higher. At diagnosis, the mean BMI was 26.6 and the mean CEA was 135.5. A total of 72.5% of young-onset patients had a positive family history of any cancer. KRAS or NRAS mutations were present in 49.6% of patients, BRAF V600E mutations were present in 3.8%, and 10.8% were MSI-H. Conclusions: Prolonged rectal bleeding history prior to diagnosis was noted in a significant proportion of young-onset patients with colorectal cancer. Patients and primary care physicians should be made aware of this finding in order to facilitate timely referral for colonoscopy which may lead to earlier diagnosis, less advanced disease at diagnosis, and improved outcomes.

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Addition of Bevacizumab to Fluorouracil-Based First-Line Treatment of Metastatic Colorectal Cancer: Pooled Analysis of Cohorts of Older Patients From Two Randomized Clinical Trials

Journal of Clinical Oncology ◽

10.1200/jco.2008.17.7931 ◽

2009 ◽

Vol 27 (2) ◽

pp. 199-205 ◽

Cited By ~ 123

Author(s):

Fairooz F. Kabbinavar ◽

Herbert I. Hurwitz ◽

Jing Yi ◽

Somnath Sarkar ◽

Oliver Rosen

Keyword(s):

Colorectal Cancer ◽

Adverse Events ◽

Older Patients ◽

Statistical Power ◽

Randomized Clinical Trials ◽

Objective Response ◽

Progression Free Survival ◽

Pooled Analysis ◽

First Line ◽

Younger Patients

PurposeColorectal cancer (CRC) occurs predominantly in older persons. To provide more statistical power to assess risk/benefit in older patients, we examined the clinical benefit of bevacizumab (BV) plus fluorouracil-based chemotherapy in first-line metastatic CRC (mCRC) treatment in patients aged ≥ 65 years, using data pooled from two placebo-controlled studies.Patients and MethodsPooled efficacy data for 439 patients ≥ 65 years old randomized to BV plus chemotherapy (n = 218) or placebo plus chemotherapy (n = 221) in study 1 and study 2 were retrospectively analyzed on an intent-to-treat basis for overall survival (OS), progression-free survival (PFS), and objective response. Safety analysis was based on reports of targeted adverse events in treated patients.ResultsMedian OS with BV plus chemotherapy was 19.3 v 14.3 months with placebo plus chemotherapy (hazard ratio [HR] = 0.70; 95% CI, 0.55 to 0.90; P = .006). Patients treated with BV plus chemotherapy had a median PFS of 9.2 v 6.2 months for placebo plus chemotherapy patients (HR = 0.52; 95% CI, 0.40 to 0.67; P < .0001). The objective response rate was 34.4% with BV plus chemotherapy versus 29.0% with placebo plus chemotherapy (difference not statistically significant). Rates of BV-associated adverse events in the pooled BV plus chemotherapy group were consistent with those reported in the overall populations for the two studies.ConclusionAnalysis of pooled patient cohorts age ≥ 65 years from two similar trials in mCRC indicates that adding bevacizumab to fluorouracil-based chemotherapy improved OS and PFS, similar to the benefits in younger patients. Also, the risks of treatment do not seem to exceed those in younger patients with mCRC.

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Adjuvant or Palliative Chemotherapy for Colorectal Cancer in Patients 70 Years or Older

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.8.2412 ◽

1999 ◽

Vol 17 (8) ◽

pp. 2412-2412 ◽

Cited By ~ 193

Author(s):

R. A. Popescu ◽

A. Norman ◽

P. J. Ross ◽

B. Parikh ◽

D. Cunningham

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Older Patients ◽

Palliative Chemotherapy ◽

Performance Status ◽

Age Groups ◽

Response Rates ◽

The Elderly ◽

Younger Patients ◽

Royal Marsden Hospital

PURPOSE: The surgical treatment of colorectal cancer (CRC) in elderly patients (age 70 years or older) has improved, but data on adjuvant and palliative chemotherapy tolerability and benefits in this growing population remain scarce. Elderly patients are underrepresented in clinical trials, and results for older patients are seldom reported separately. PATIENTS AND METHODS: Using a prospective database, we analyzed demographics, chemotherapy toxicity, response rates, failure-free survival (FFS), and overall survival (OS) of CRC patients receiving chemotherapy at the Royal Marsden Hospital. The cutoff age was 70 years. RESULTS: A total of 844 patients received first-line chemotherapy with various fluorouracil (5-FU)-containing regimens or raltitrexed for advanced disease, and 543 patients were administered adjuvant, protracted venous infusion 5-FU or bolus 5-FU/folinic acid (FA) chemotherapy. Of the 1,387 patients, 310 were 70 years or older. There was no difference in overall or severe (Common Toxicity Criteria III to IV) toxicity between the two age groups, with the exception of more frequent severe mucositis in older patients receiving adjuvant bolus 5-FU/FA. For patients receiving palliative chemotherapy, no difference in response rates (24% v 29%, P = .19) and median FFS (164 v 168 days) were detected when the elderly were compared with younger patients. Median OS was 292 days for the elderly group and 350 days for the younger patients (P = .04), and 1-year survival was 44% and 48%, respectively. The length of inpatient hospital stay was identical. CONCLUSION: Elderly patients with good performance status tolerated adjuvant and palliative chemotherapy for CRC as well as did younger patients and had similar benefits from palliative chemotherapy.

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BSA dosing and suboptimal 5-FU exposure among colorectal cancer patients of varying gender and age.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.579 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 579-579

Author(s):

Abebe Haregewoin ◽

Stephanie A. Hamilton ◽

Charles E. Grier ◽

Rajesh R. Kaldate

Keyword(s):

Colorectal Cancer ◽

Older Patients ◽

Target Range ◽

Large Clinical Trial ◽

Younger Patients ◽

Gender And Age ◽

Wide Range ◽

Male Patients ◽

Colorectal Cancer Patients ◽

To Receive

579 Background: 5-Fluorouracil (5-FU) remains the cornerstone of colorectal cancer (CRC) therapy and its dosing is based on body surface area (BSA). Although convenient, BSA dosing disregards factors that impact 5-FU PK such as genotype, age, gender, etc. Thus, patients receiving the same BSA based dose show a wide range of 5-FU plasma levels (measured as AUC in mg·h/L), resulting in ineffective or toxic doses affecting therapy outcome. An optimal therapeutic AUC target range of 20-30 mg·h/L has been proposed. Methods: Plasma samples from the initial treatment cycle of 927 CRC patients who received 2400 mg/m2 continuous infusion of 5-FU over 44-48 hours, with or without bevacizumab, were tested for 5-FU exposure using an immune-based assay (OnDose). AUC results were analyzed to evaluate gender and age effects. Results: There are 391 (42.2%) female and 536 (57.8%) male patients with age ranging from 17-93 years (mean/SD: 58.5/11.8). These analyses indicate that in comparison to the proposed optimal AUC target range of 20-30 mg·h/L, females receive supra-optimal doses compared to males (p=0.0083). Age also affects the 5-FU AUC (p=0.0002), with younger patients more likely to receive sub-optimal doses than older patients. Conclusions: BSA dosing is an unreliable indicator of exposure and may lead to under dosing in males and younger patients, and overdosing in females and older patients, potentially resulting in corresponding diminished efficacy or increased toxicity. Data suggest that therapy could be optimized by 5-FU dose adjustment in subsequent cycles based on PK monitoring so that AUC values will converge towards the target range irrespective of gender or age. A large clinical trial is in progress to validate these findings.

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Primary rectal melanoma - a case report

Medical Journal of Indonesia ◽

10.13181/mji.v23i4.1006 ◽

2015 ◽

Vol 23 (4) ◽

pp. 229-31 ◽

Cited By ~ 1

Author(s):

Somak Das ◽

Tuhin S. Mandal ◽

Souvik Paul ◽

Purnendu Datta ◽

Aloke K. Sinhababu

Keyword(s):

Case Report ◽

Malignant Melanoma ◽

Rectal Bleeding ◽

Polypoid Lesion ◽

Bowel Habit ◽

Radical Excision ◽

Common Site ◽

Altered Bowel Habit ◽

Rectal Melanoma ◽

Anorectal Region

The most common site for malignant melanoma is skin, then eye and third is anorectal region. Primary anorectal malignant melanoma is still very uncommon. It is usually very aggressive and presents with altered bowel habit and rectal bleeding. Proctoscopy shows non-pigmented or lightly pigmented polypoid lesion. Histopathology is confirmatory. Early radical excision is mandatory. A 56 year-old female was presented with malignant melanoma of the lower third of rectum. We report this case for its rarity.

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Clinico-demographic Characteristics of Colorectal Carcinoma in Bangladeshi Patients

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v3i1.29388 ◽

2016 ◽

Vol 3 (1) ◽

pp. 22-25

Author(s):

AKM Maruf Raza ◽

Mohammed Kamal ◽

Ferdousy Begum ◽

Md. Abdullah Yusuf ◽

Din Mohammad ◽

...

Keyword(s):

Abdominal Pain ◽

Colorectal Carcinoma ◽

Rectal Bleeding ◽

Clinical Information ◽

Cross Sectional Study ◽

Demographic Characteristics ◽

Bowel Habit ◽

Cross Sectional ◽

Altered Bowel Habit ◽

Common Clinical Presentation

Background: Colorectal carcinoma is one of the most common human malignancies worldwide. Objectives: The purpose of the present study was to see the clinico-demographic Characteristics of colorectal carcinoma. Methodology: This cross sectional study was carried out in the Department of Pathology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of November 2009 to July 2010. Patients with colorectal carcinoma from all ages and both sexes were included in the study. Detailed clinical information was obtained by taking history from patient's attendants statement. Fresh unfixed specimens were obtained after surgical resection. Result: A total of 50 cases of colorectal adenocarcinoma from all ages and both sexes were included in the study. The mean age of the 50 cases was 47±14.8 years. Per rectal bleeding was the most common clinical presentation of colorectal carcinoma which was 20(40.0%) cases followed by abdominal pain, altered bowel habit, generalized weakness, anorexia and pallor and p/r bleeding and abdominal pain which were 8(16.0%) cases, 7(14.0%) cases, 6(12.0%) cases and 6(12.0%) cases respectively. Conclusion: In conclusion middle age male patients are the most vulnerable for colorectal carcinoma with common presenting features of per rectal bleeding, abdominal pain and altered bowel habit. Journal of Current and Advance Medical Research 2016;3(1):22-25

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