Colonoscopic Review and Surgical Approach in the Management of Colorectal Carcinoma–A Retrospective Study of 50 cases

Introduction: There is no exact statistics about the incidence of colorectal cancer in Bangladesh. According to National Cancer Institute, London, it is the 2nd most common cancer affecting more than 30,000 people in each year. As many patients with colon cancer do not develop symptoms until it is advanced and detection in early stage can only be achieved by screening of asymptomatic person. Maximum patients present lately with distance metastases when there is nothing to treat except palliative therapy. Objectives: To identify the risk factors, early symptoms, signs, treatment modalities, operative outcome, morbidity and mortality rate. Materials and Methods: This retrospective study was carried out at CMH Dhaka during August 2002 to August 2004. A total of 50 patients were taken as study sample. All the patients were admitted in different surgical units of CMH Dhaka for surgical treatment. Detailed history were taken on admission by a questionnaire and examined thoroughly and findings regarding Anaemia, Jaundice, Dehydration, Oedema, Lymphadenopathy, Nutritional status and abnormal signs like ascites, distension, rigidity, organomegaly recorded. Digital rectal examination were done in all cases and finally examined by Proctoscope, Sigmoidoscope and with Colonoscope. FOBT (Fecal Occult Blood Test), serum tumour marker was also assessed. Results: Out of 50 cases 22 were rectal carcinoma and next common site was caecum and number was 10. There was a variation in the sex ratio. Out of 50 cases 33 were male and 17 were female. The highest incidence was among people of 6th decade (28%) and next highest was in 4th decade (24%). Majority of patient with right colon cancer presented with abdominal pain 12 out of 22 cases (56%) and weight loss 15 cases (68%). For left colon cancer commonest symptom was weight loss and weakness and altered bowel habit. Almost all cases with rectal carcinoma presented with bleeding per rectum. Conclusion: About 50% of lesions were found in recto-sigmoid junction and male: female ratio was 1.9:1. All efforts and modern technology should be applied for early detection and treatment. The survival rate is usually very poor in rectal carcinoma. In this study most of the cases were subjected to post operative Chemo and Radiotherapy, but more were treated with neoadjuvant chemoradiation for down staging. The need for early detection of Colorectal Carcinoma (CRC) should be stressed in the form of screening patient awareness and understanding about symptomatology. Early diagnosis and definitive treatment are thereby increasing expectation of higher survival and better prognosis in patient of colorectal carcinoma. Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 36-40

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Delay in time from diagnosis to treatment in metastatic melanoma, lung, and colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23186 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23186-e23186

Author(s):

Muhammad Salman Faisal ◽

Ahmed Khattab ◽

Vida Jahangiri ◽

Hira Shaikh ◽

Soorih Shaikh ◽

...

Keyword(s):

Lung Cancer ◽

Colon Cancer ◽

Demographic Data ◽

Tertiary Care ◽

The United States ◽

Definitive Treatment ◽

Metastatic Colon Cancer ◽

Female Ratio ◽

Number Of Patients ◽

Delay In Treatment

e23186 Background: Delay in cancer treatment is anxiety provoking both for the patient and clinician. We conducted the study to evaluate the patterns of delay in treatment of patients with metastatic colon cancer, lung cancer and melanoma from diagnosis to the initiation of the treatment, and to identify the causes of delay. Methods: In this retrospective study, patients with metastatic colon cancer, lung cancer and melanoma diagnosed between 01/01/2016 to 12/31/2016 in a tertiary care network in the United States were studied. Data was collected from electronic health record (EHR) database, ‘Epic’. Variables such as demographic data, including patient age and gender, and type of cancer, and treatment received were analyzed. The causes of the delay were also evaluated when available. Results: Total number of patients in the study was 288. Mean age was 68.3 years (median 69 years) and 36% were alive at the time of data analysis. Male to female ratio was 1.4:1. 66.7% people had lung cancer, 30% had colon cancer and 3% had melanoma. 67 (23.6%) of total analyzed patients had denied definitive treatment and chose to undergo palliative management. Of the rest, most started treatment with chemotherapy (39.5%), followed by surgery (22.6%) and then radiation (14.6%). With the time of pathological diagnosis of the tumor taken as the date of diagnosis, mean delay from the day of diagnosis to the start of treatment in this study population observed was 27.7 days. 67 patients (23.3%) had a delay of more than 30 days, with the most common reason being systemic factors in 39 patients (58.2%), followed by patient factors in 23 patients (34.3%) and physician factors in 5 patients (7.5%). On logistic regression analysis, time from diagnosis to treatment didn’t predict mortality (OR = 0.99, 95% CI P = 0.10(0.97-1.002). Conclusions: Delay in treatment is common and the system factors one of the common reasons as exhibited by our study. Time from diagnosis to treatment didn’t predict mortality.

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Clinical features and outcome of sporadic colorectal carcinoma in young adults: A single center, cross sectional analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14680 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14680-e14680

Author(s):

Muhammad Nauman Zahir ◽

Eisha Mahpara ◽

Sobia Rafiq ◽

Kulsoom Ghias ◽

Munira Shabbir-Moosajee

Keyword(s):

Colorectal Carcinoma ◽

Rectal Carcinoma ◽

Survival Data ◽

Early Onset ◽

Care Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Cross Sectional ◽

Female Ratio ◽

Significant Difference

e14680 Background: Early onset colorectal carcinoma (CRC), defined as CRC at age below 45 years is rare. However, an increasing incidence has been noted in Southeast Asia. It is hypothesized to be a biologically and clinically distinct entity personifying aggressive disease and a worse survival. Data on this subject is scarce from this part of the world and hence our objective was to study the clinical presentation and outcome of early onset sporadic CRC in patients at a single tertiary care center in Pakistan. Methods: Data was collected by a retrospective chart review. 131 patients were found eligible for the period between January 1, 2004 and December 31, 2011. A pre-designed and coded questionnaire was used and analysis was done using SPSS. Cox proportional hazard model was used to compute prevalence ratios. Results: Early onset sporadic CRC accounted for 32% of all CRC treated in the specified time period. Colon and rectal cancers accounted for 55% and 45% of patients respectively. The median age was 35 years (range 16-45 years) and the male to female ratio was 2:1. 74% of patients presented with advanced stage disease [stages III (45%) and IV (29%)]. On comparison, bleeding per rectum, signet ring morphology, stage and grade of tumor were found to be statistically significant for the rectal cancer group on a univariate analysis. 93% of rectal carcinoma patients received appropriate surgery and/or neoadjuvant/adjuvant therapy as opposed to 69% of colon cancers. Median survival was 19 months (range 0-112.5 months). However, Kaplan-Meier analysis revealed a trend towards an inferior survival for rectal carcinoma 2 years after initial diagnosis (p=0.56). Conclusions: Higher incidence of early onset CRC is noted in our population as compared to the western literature. Rectal carcinoma accounts for almost half the patients in this young CRC population. This group was found to have a higher frequency of poor prognostic factors. However, we have noted a similar 2 year survival between the 2 groups, with a trend towards an inferior prognosis with longer followup. It is possible that a larger sample size may have elucidated a statistically significant difference between the two groups.

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Clinical Features and Outcome of Sporadic Colorectal Carcinoma in Young Patients: A Cross-Sectional Analysis from a Developing Country

ISRN Oncology ◽

10.1155/2014/461570 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Muhammad Nauman Zahir ◽

Eisha Mahpara Azhar ◽

Sobia Rafiq ◽

Kulsoom Ghias ◽

Munira Shabbir-Moosajee

Keyword(s):

Colorectal Carcinoma ◽

Rectal Carcinoma ◽

Early Onset ◽

Multivariable Analysis ◽

Young Patients ◽

Retrospective Chart Review ◽

Cross Sectional ◽

Female Ratio ◽

Colon Cancers ◽

Rectal Cancers

Background. Early onset colorectal carcinoma (CRC) is rare and has been hypothesized to be a biologically and clinically distinct entity personifying aggressive disease and worse survival. Methods. Data for 131 patients was collected by retrospective chart review. Cox proportional hazard model was used to compute prevalence ratios and 95% confidence intervals. Results. Early onset sporadic CRC accounted for 32% of all CRC treated in the specified time period. The mean age was 33.3±7.9 years and the male to female ratio was 2:1. Colon and rectal cancers accounted for 55% and 45% of patients, respectively. 96% of rectal carcinoma patients received appropriate therapy as opposed to 65% of colon cancers. On multivariable analysis, appropriate reception of therapy (PR 4.99; 95% CI, 1.21–20.6) and signet ring morphology (PR 2.40; 95% CI, 1.33–4.32) were significantly associated with rectal cancers as opposed to colon cancer. Kaplan-Meier analysis revealed a trend towards inferior survival for rectal carcinoma 2 years after diagnosis. Conclusion.A high prevalence of early onset CRC was noted in the study. A trend towards inferior survival was seen in patients with rectal cancer. This finding raises the possibility of rectal carcinoma being an aggressive subset of young CRC.

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EP.FRI.253 Outcomes of treatment of anal squamous cell carcinoma over a 10-year period

British Journal of Surgery ◽

10.1093/bjs/znab312.046 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Abraham Ayantunde ◽

Khaled Noureldin ◽

Daniel Edison ◽

Hafizul Haq ◽

Bandipalyam Praveen

Keyword(s):

Squamous Cell Carcinoma ◽

Survival Rate ◽

Cell Carcinoma ◽

Squamous Cell ◽

Carcinoid Tumour ◽

Palliative Therapy ◽

Treatment Modalities ◽

Curative Intent ◽

Anal Squamous Cell Carcinoma ◽

Female Ratio

Abstract Background We evaluated our 10-year experience with the treatment and outcomes of patients with anal squamous cell carcinoma (ASCC). Patients and Method Clinical and pathological data of patients with ASCC were analysed between January 2011 and December 2019. All patients underwent the standard workup according to the anal cancer network guidelines and treated accordingly. Patients were followed up clinically and with imaging according to the network protocol. The outcome measures were clinicopathological characteristics, treatment modalities, recurrent disease, disease-free and overall survival. Results 117 patients were diagnosed with ASCC over the 10-year period. 14 patients with adenocarcinoma(11), melanoma(1), Paget disease(1) and carcinoid tumour(1) were excluded. Median age of 103 patients included was 68 (38-101) years with a Male to female ratio of 1:2. Four patients were HIV positive and 42.7% of the patients had AIN of varying degree of dysplasia. 66% (68/103) of the patients had radical chemoradiotherapy with curative intent while 9 patients with tumour ≤2cm underwent wide local excision. Six patients underwent palliative therapy and the remaining 20 were on supportive palliative care. 61.2% of the patients treated with radical chemoradiotherapy had complete response while 10.7% had partial response. Four patients with incomplete response underwent salvage APER. 13% (10/77) of the patients treated with curative intention developed recurrence. The overall mean survival time was 77.9 (95% CI 66.73-89.06) months with 5-year survival rate of 59%. The overall mortality rate was 42.7% and disease-specific mortality was 26.2%. Conclusion ASCC responds well to radical chemoradiotherapy with enhanced survival rate.

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Continuation of weight loss treatment is associated with the number of self-selected treatment modalities.

International Journal of Behavioral Consultation and Therapy ◽

10.1037/h0100814 ◽

2007 ◽

Vol 3 (3) ◽

pp. 394-402 ◽

Cited By ~ 1

Author(s):

Corby K. Martin ◽

Danae L. Drab-Hudson ◽

Emily York-Crowe ◽

Stephen B. Mayville ◽

Ying Yu ◽

...

Keyword(s):

Weight Loss ◽

Treatment Modalities ◽

Weight Loss Treatment

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Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

Surgical Endoscopy ◽

10.1007/s00464-021-08573-0 ◽

2021 ◽

Author(s):

Szabolcs Ábrahám ◽

Illés Tóth ◽

Ria Benkő ◽

Mária Matuz ◽

Gabriella Kovács ◽

...

Keyword(s):

Hospital Mortality ◽

Acute Cholecystitis ◽

Conversion Rate ◽

Clinical Success ◽

Definitive Treatment ◽

Success Rates ◽

Female Ratio ◽

Gallbladder Drainage ◽

Percutaneous Transhepatic Gallbladder Drainage ◽

Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

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Colorectal cancer screening using a stool DNA-based SDC2 methylation test: a multicenter, prospective trial

BMC Gastroenterology ◽

10.1186/s12876-021-01759-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Woo Kim ◽

Hyunjin Kim ◽

Hyoung Rae Kim ◽

Bong-Hyeon Kye ◽

Hyung Jin Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Early Detection ◽

Prospective Trial ◽

Screening Colonoscopy ◽

Quantitative Detection ◽

Screening Programs ◽

Crc Screening ◽

Stool Dna ◽

Dna 2

Abstract Background Prevention and early detection of colorectal cancer (CRC) is a global priority, with many countries conducting population-based CRC screening programs. Although colonoscopy is the most accurate diagnostic method for early CRC detection, adherence remains low because of its invasiveness and the need for extensive bowel preparation. Non-invasive fecal occult blood tests or fecal immunochemical tests are available; however, their sensitivity is relatively low. Syndecan-2 (SDC2) is a stool-based DNA methylation marker used for early detection of CRC. Using the EarlyTect™-Colon Cancer test, the sensitivity and specificity of SDC2 methylation in stool DNA for detecting CRC were previously demonstrated to be greater than 90%. Therefore, a larger trial to validate its use for CRC screening in asymptomatic populations is now required. Methods All participants will collect their stool (at least 20 g) before undergoing screening colonoscopy. The samples will be sent to a central laboratory for analysis. Stool DNA will be isolated using a GT Stool DNA Extraction kit, according to the manufacturer’s protocol. Before performing the methylation test, stool DNA (2 µg per reaction) will be treated with bisulfite, according to manufacturer’s instructions. SDC2 and COL2A1 control reactions will be performed in a single tube. The SDC2 methylation test will be performed using an AB 7500 Fast Real-time PCR system. CT values will be calculated using the 7500 software accompanying the instrument. Results from the EarlyTect™-Colon Cancer test will be compared against those obtained from colonoscopy and any corresponding diagnostic histopathology from clinically significant biopsied or subsequently excised lesions. Based on these results, participants will be divided into three groups: CRC, polyp, and negative. The following clinical data will be recorded for the participants: sex, age, colonoscopy results, and clinical stage (for CRC cases). Discussion This trial investigates the clinical performance of a device that allows quantitative detection of a single DNA marker, SDC2 methylation, in human stool DNA in asymptomatic populations. The results of this trial are expected to be beneficial for CRC screening and may help make colonoscopy a selective procedure used only in populations with a high risk of CRC. Trial registration: This trial (NCT04304131) was registered at ClinicalTrials.gov on March 11, 2020 and is available at https://clinicaltrials.gov/ct2/show/NCT04304131?cond=NCT04304131&draw=2&rank=1.

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Health Insurance Status as a Predictor of Mode of Colon Cancer Detection but Not Stage at Diagnosis: Implications for Early Detection

Public Health Reports ◽

10.1177/0033354921999173 ◽

2021 ◽

pp. 003335492199917

Author(s):

Lindsey A. Jones ◽

Katherine C. Brewer ◽

Leslie R. Carnahan ◽

Jennifer A. Parsons ◽

Blase N. Polite ◽

...

Keyword(s):

Colon Cancer ◽

Health Insurance ◽

Early Detection ◽

Late Stage ◽

Early Stage ◽

Insurance Status ◽

Stage At Diagnosis ◽

Health Insurance Status ◽

Percentage Point Increase ◽

Point Increase

Objective For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. Methods Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. Results After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. Conclusions For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection.

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Cyst(e)ine in nutrition formulation promotes colon cancer growth and chemoresistance by activating mTORC1 and scavenging ROS

Signal Transduction and Targeted Therapy ◽

10.1038/s41392-021-00581-9 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Jiao Wu ◽

Sai-Ching Jim Yeung ◽

Sicheng Liu ◽

Aiham Qdaisat ◽

Dewei Jiang ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Weight Loss ◽

Cancer Patients ◽

Cancer Cell ◽

Cancer Progression ◽

Colorectal Cancer Patient ◽

Nutrition Support ◽

Immunodeficient Mice ◽

The Impact

AbstractWeight loss and cachexia are common problems in colorectal cancer patients; thus, parenteral and enteral nutrition support play important roles in cancer care. However, the impact of nonessential amino acid components of nutritional intake on cancer progression has not been fully studied. In this study, we discovered that gastrointestinal cancer patients who received cysteine as part of the parenteral nutrition had shorter overall survival (P < 0.001) than those who did not. Cystine indeed robustly promotes colon cancer cell growth in vitro and in immunodeficient mice, predominately by inhibiting SESN2 transcription via the GCN2-ATF4 axis, resulting in mTORC1 activation. mTORC1 inhibitors Rapamycin and Everolimus block cystine-induced cancer cell proliferation. In addition, cystine confers resistance to oxaliplatin and irinotecan chemotherapy by quenching chemotherapy-induced reactive oxygen species via synthesizing glutathione. We demonstrated that dietary deprivation of cystine suppressed colon cancer xenograft growth without weight loss in mice and boosted the antitumor effect of oxaliplatin. These findings indicate that cyst(e)ine, as part of supplemental nutrition, plays an important role in colorectal cancer and manipulation of cyst(e)ine content in nutritional formulations may optimize colorectal cancer patient survival.

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