Screening for cancer of the colon and rectum A review on incidence, mortality, cost and benefit

Key words: Colorectal cancer, Screening, Incidence, Mortality, Cost-effectiveness In this article the incidence and mortality for cancer of the colon and rectum in Iceland is discussed. The two most common screening methods, faecal immunochemical test (FIT) and colonoscopy are compared and an estimate of cost and benefits for the Icelandic society will be made. The incidence of cancer of the colon and rectum has been increasing in Iceland in last decades but mortality has decreased and survival improved. However, more individuals die from cancer of the colon and rectum than from both breast- and cervical cancer added together. It is likely that screening for cancer of the colon and rectum, could prevent at least 6 of the 28 deaths related to those cancers, occurring yearly in Iceland in screening age, given a screening ages of 50-74 years. The extra cost for the Icelandic community due to the implementation of screening for cancer of the colon and rectum will be acceptable due to the lower cost of simpler treatments, lower cancer incidence and reduced mortality.

Serum anti-laminarin antibodies in colorectal cancer: a prospective pilot study

ntroduction and objectives: Laminarin is a low molecular weight (504 Da) glucose branched polysaccharide which modulates humoral and cellular immune response, both non-specific and specific. Laminarin possesses anti-tumorous activity as it induces apoptosis and modulates the colonic microbio­ta. The aim of our current study was to evaluate anti-laminarin antibodies in colorectal carcinoma. Methods: A total of 46 individuals were enrolled in the prospective study including 14 controls (5 men, 9 women, age 29–80, mean 55 ± 13) and 32 patients with colorectal carcinoma, CRC (14 men, 18 women, age 46–86, mean 66 ± 11). Two outliers were identified in the CRC group. Out of 30 CRC patients, 12 individuals had right-sided CRC (12/30; 40%). Majority of the CRC patients had stage III (13/30; 43%) or IV (13/30; 43%) cancer. Most of the CRC patients had moderately (15/30; 50%) or poorly (11/30; 37%) differentiated CRC. Samples were obtained from the peripheral venous blood and investigation of the serum IgG anti-laminarin antibodies was performed by means of ELISA and measured in U/mL. Results: Serum anti-laminarin antibodies were significantly higher in controls compared to the CRC group (16.23 ± 6.60; 11.41 ± 5.53; p = 0.015) and in controls compared to left-sided carcinoma (11.38 ± 5.39; p = 0.046). A statistically significant difference was observed between controls and CRC stage III (11.01 ± 3.36; p = 0.017) and between controls and CRC stage IV (10.98 ± 6.06; p = 0.049). Anti-laminarin antibodies were significantly lower in moderately differentiated CRC compared to controls (10.78 ± 5.22; p = 0.020), but not in poorly differentiated CRC (12.10 ± 6.28; p = 0.755). No difference was identified between controls and females with CRC (11.94 ± 6.39; p = 0.092). There was a significant difference between controls and males with CRC (10.72 ± 4.32; p = 0.017). Conclusion: Serum anti-laminarin antibodies were significantly lower in the CRC group and CRC subgroups compared to controls. Key words: colorectal cancer– anti-laminarin antibodies – tumorous bio­logy

CLINICAL, ENDOSCOPIC AND PATHOGICAL CHARACTERISTICS OF COLORECTAL CANCER AT DA NANG HOSPITAL FROM 2016 TO 2017

Objective: To study the clinical, endoscopy and pathogical characteristics of colorectal cancer at Da Nang Hospital. Methods: A retrospectively descriptive study, performed from 01/01/2016 to 31/12/2017 at Da Nang Hospital. Results: During two years, there were 205 cases of colorectal cancer patients hospitalized to Da Nang Hospital. Male: 59.51%, female: 40.49%, mean age: 65.8 ± 16.07. Male is higher than female, male/ female ratio is 1.4/1. The period from the first symptoms to admission < 3months predominated (83.8%). The predominant symptoms: Abdominal pain (85.85%), bloody stool (63.41%), defecation (62.44%), anemia (34.63%), weight loss (25.85%), fatigue (17.56%), abdominal distention (12.19%), nausea and vomiting (5.36%). Location of Lesions: Rectum (43.42%), sigmoid colon (20%), right colon (10.73%),cecum (10.73%), transverse colon (7.80%), left-colon (7.32%). Type of lesion on endoscopy: Exophytic (63.41%), ulceration-Exophytic (21.95%), ulceration (7.32%), polyp chemotherapy (7.32). Tumor size: ≥ 3/4 perimeter (39%), occupying the whole circumference (37.0%), occupying ≥ 1/2 perimeter (15.6%), accounting for 1/4 Perimeter (8.4%). The colon completely narrowed rate: 70.73%., incompletely was 29.27%. Histopathological classification: adenocarcinoma (85.85%), Mucinous adenocarcinoma: (9.27%) and non-differentiated epithelial carcinoma was 4.88%. Conclusion: Colorectal cancer was quite popular and was usually detected at advanced stages.Therefore, screening for subjects with risk factors for early detection and treatment is recommended. Key words: Colorectal cancer, endoscopy, pathogical characteristics...

THE RELATION BETWEEN THE CEA, CA19-9 LEVELS AND HISTOPATHOLOGICAL CHARACTERISTICS IN COLORECTAL CANCER

Aim: Studying the combination of CEA and CA 19-9 levels with histopathological characteristics as well as monitoring recurrence and metastasis in patients with colorectal cancer. Materials and method: 66 patients diagnosed and treated for colorectal cancer at Hue Central Hospital from April 2012 to July 2013. The level of CEA > 5 ng/ml was defined as abnormal (CEA (+)), while the cutoff for the CA 19-9 was set at 37 U/mL (CA 19-9 (+)). Results: The positive rates of serum CEA and CA19-9 before surgery was 46.9%, 16.7%. When combination of CEA and CA 19-9, this rate increased to 50 %. The proportion of cancer wale was 77.3 %, tumor size T3 was majority of 65.2%. Adenocarcinoma was the highest percentage of 94.0%, 6.0%. The well differentiated adenocarcinoma was 62.1%, Dukes B (53%). The elevation of serum CEA related to the Dukes stage (p<0.05). CA 19-9 is not. when two marker were used, the preoperative elevation of CEA and CA 19-9 was significantly correlated with the Dukes stages. (p<0.05). The percentage of patients with recurrence was 9.1%, metastases was 18.2%. Conclusions: The measurement of CEA and CA 19-9 had prognostic value in patients with colorectal cancer at the late stage (Dukes C and Dukes D). In addition, CEA and CA 19-9 were an efficient way to detect and monitor patients with recurrence or metastasis. Key words: Colorectal cancer, CEA, CA 19-9, recurrence, metastasis