Morden tactic in diagnosis and treatment of early colon cancer (review of literature)

According to the literature review, the use of modern endoscopes with high resolution and a narrow-band imagine function with optical magnification, as well as autofluorescence, chromoscopy, endosonography, makes it possible to establish a diagnosis of early colorectal cancer with a high degree of accuracy. Nowadays, endoscopic submucosal dissection and endoscopic mucosal resection are the methods of choice in the treatment of early (Tis, T1sm1N0M0) colon cancer.

Elective staged proctocolectomy and living donor liver transplantation for colon cancer with sclerosing cholangitis-related ulcerative colitis: a case report

Background Primary sclerosing cholangitis (PSC) is a well-known complication of ulcerative colitis (UC), but it is rare to encounter patients requiring both living donor liver transplantation (LDLT) and proctocolectomy. We report a case of elective two-stage surgery involving proctocolectomy performed after LDLT for a patient with early colon cancer concurrent with PSC-related UC. To our knowledge, this is the first report of concurrent cancer successfully treated with both LDLT and proctocolectomy. Case presentation A 32-year-old Japanese man with colon cancer associated with UC underwent restorative proctocolectomy at 3 months after living donor liver transplantation (LDLT) for PSC. He was diagnosed with PSC and UC when he was a teenager. Conservative therapy was initiated to treat both PSC and UC. He had experienced recurrent cholangitis for years; therefore, a biliary stent was placed endoscopically. However, his liver function progressively deteriorated. Colonoscopic surveillance revealed early colon cancer; hence, surgical treatment was considered. PSC progressed to cirrhosis and portal hypertension; hence, LDLT was performed before restorative proctocolectomy. Three months after LDLT, we performed restorative proctocolectomy with ileal pouch–anal anastomosis. The postoperative course was uneventful. The patient was well, with good liver and bowel functions and without tumor recurrence, more than 1 year after proctocolectomy. Conclusions With strict patient selection and careful patient management and follow-up, elective proctocolectomy may be performed safely and effectively after LDLT for concurrent early colon cancer with PSC-related UC. There are no previous reports of the use of both LDLT and proctocolectomy for the successful treatment of PSC-related UC and concurrent cancer.

High Incidence of Early-Onset Colon Cancer in Ethiopia: Clinical and Therapeutic Evaluation With Genetic Mutational Analyses

PURPOSE Colon cancer has been reported to occur early in certain African regions, but our understanding of the genetic modifications that lead to early disease is incomplete. We aimed to study cases of early colon cancer and the genetic modifications leading to these tumors in Ethiopia. METHODS We evaluated all colon masses detected between 2015 and 2018 at Black Lion Hospital, Addis Ababa, Ethiopia. Clinical, endoscopic, and pathology descriptions were assessed for all cases in patients age 30 years or younger. Subsets of pathology block tissues were evaluated for genetic modifications via multiplex ligation-dependent probe amplification. RESULTS We identified a total of 38 cases of colon cancer in patients age 30 years or younger. These represented 13% of all cases of colon cancer in the 3-year period. Median age was 27 years (interquartile range, 27-30 years), and 50% of individuals were female. None of the cases reported a family history of colon cancer or had evidence of inflammatory bowel disease. The most common presenting symptom was rectal bleeding (57%), followed by a change in bowel habit (22%). All samples but one were identified as adenocarcinoma, 78% were confined to the rectum, and 65% had distant metastasis or locally advanced disease at the time of diagnosis. Longer duration of symptoms correlated with the presence of metastasis on diagnosis ( P = .035). Surgery (23%) and chemotherapy (15%) were the most frequently used treatments. We performed genetic analysis of biopsy tissue in a subset of 3 individuals: a 21-year-old male showed decreased copies of APC, an increase in K-ras, V600F mutation in BRAF, and a decrease in MSH2 and MLH1; a 21-year-old female showed duplication of exon 4 APC, a decrease in K-ras, and decreased copies of MSH-2; and a 30-year-old female showed decreased copies of APC, decreased copies of K-ras and BRAF, and decreased copies of MSH2 and MLH1. CONCLUSION We report a high incidence of early colon cancer in Ethiopia in patients with no family history or inflammatory bowel disease. Genetic analyses in a subset of patients showed APC and K-ras alterations as well as modifications of the mismatch repair pathway.

High microsatellite instability (MSI-H) is associated with distinct clinical and molecular characteristics and an improved survival in early Colon cancer (CC); real world data from the AIO molecular registry Colopredict Plus

Colorectal cancer is one of the leading malignancies and still accounts for almost 25 000 deaths in Germany each year. Although there is accumulating data on the molecular basis, treatment and clinical outcome of patients within clinical trials evidence from the real-world setting is mostly lacking. We started the molecular registry trial Colopredict Plus in 2013 to collect clinical and molecular data from a real-world cohort of patients with early colon cancer stage II and III in 70 German colon cancer centers focusing on the prognostic impact of high microsatellite instability. In this interim report, we characterize a clinical cohort of 2615 patients, of whom 1787 tissue probes were analyzed. Microsatellite status was assessed using immunhistochemistry and fragment length analysis, with a concordance of 91.4 %. These established histopathological methods are sensitive and cost-effective. The median age was 72 years, significantly higher compared to clinical trial populations, with a median Charlson Comorbidity Index of 3. The stage-dependent incidence of microsatellite instability was 23.7 % and was associated with female gender, BRAF-mutation, UICC stage II and localization in the right colon. Survival calculated in disease free, relapse free and overall survival significantly differed between MSI-H and MSS, in favor of MSI-H patients. Multivariate age-adjusted analyses of relapse-free survival, disease-free survival, and overall survival highlighted microsatellite instability as a robust and positive prognostic marker for early colon cancer independent of age.