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Query: UMLS:C0009402 (colorectal cancer)
 53,228 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Poor survival in patients following resection for early stage colorectal cancer is thought to be due in part to the presence of occult micrometastases at the time of surgery. The MUC2 mucin gene is highly expressed in the colon and associated colorectal tumors and may be a candidate marker for colorectal cancer micrometastases. We have used RT-PCR to detect expression of MUC2 mRNA transcripts in order to identify possible lymph node micrometastases in node negative (Stage I and II, or Dukes A and B) colorectal cancer patients. A total of 396 nodes (histologic stage N0) from 34 colon and nine rectal cancers were studied by RT-PCR analysis with nested primers for MUC2 (an average of 7.6 nodes per case). In the primary tumors, 42/43 (98.1%) were positive for MUC2 by RT-PCR. Evidence of the presence of MUC2 was demonstrated in nodes from 0 of 10 (0%) patients with Tis or T1, one of six (16.7%) from T2, 10 of 25 (40.0%) from T3, and one of two (50%) from T4 tumors. MUC2 RT-PCR was negative in six nodes from three patients with non-malignant colon disease and positive in histologically positive lymph nodes from six of six (100%) stage III colon cancers. In this study, using RT-PCR to detect the presence of MUC2 transcripts, we have found preliminary evidence for possible micrometastatic disease in approximately a third of histologically negative N0 colorectal cancer patients. The increased presence of MUC2 expression also correlated with more advanced T stage. We conclude that MUC2 RT-PCR may be a sensitive and specific marker for occult micrometastases. This technique has the potential to identify a group of colorectal cancer patients at risk for early cancer recurrence.
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PMID:Evidence for colorectal cancer micrometastases using reverse transcriptase-polymerase chain reaction analysis of MUC2 in lymph nodes. 1075 25

Colorectal cancer is an important cause of death in the Western world, with a propensity of cancer recurrence even after resection with curative intent. Active follow-up has been advocated as a means to detect cancer recurrence at an earlier stage and thereby improve the survival of colorectal cancer patients. The present study assesses published evidence on the effectiveness of follow-up. Articles were obtained from a 20-year Medline search and from cross-references between articles. Articles were included, scored for quality, and extracted by explicit criteria. Regression analysis and chi-squared analysis was performed to assess (1) whether detection of recurrence at earlier asymptomatic disease stage leads to better post-treatment prognosis, and (2) whether active follow-up does improve overall (quality adjusted) survival, as compared to symptom-guided care only. The relationship between disease stage of recurrence (symptoms, number and size) and survival was analysed from 42 articles, 10 of which provided adequate data. Absence of symptoms and small number of recurrence were significantly related to better survival, smaller size insignificantly so. The potential of active follow-up seemed related to a marginally better outcome, larger gains being found in lower quality studies. Available data do suggest that survival gains vary between 0.5 and 2%, 1% seeming to be a best estimate of overall survival gain. Neither the notion that earlier detection of recurrences does significantly improve outcome, nor the hope that active follow-up provides a statistically and clinically significant gain in (quality adjusted) survival, are so far supported by adequate evidence. Colorectal cancer follow-up still fails to meet the criteria for evidence based medicine.
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PMID:Colorectal cancer follow-up: a reassessment of empirical evidence on effectiveness. 1103 24

It is necessary to assume the colorectal cancer follow-up after curative operation to detect cancer recurrence and new polyps or cancers. A good follow-up by endoscopy is also necessary for patients with colorectal polyps and for patients with familial adenomatous polyposis.
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PMID:[Long term surveillance of polyps and colorectal cancers]. 1168 Jan 80

Follow-up after curative treatment of patients with colorectal cancer has as its main aims the quality assessment of the treatment given, patient support, and improved outcome by the early detection and treatment of cancer recurrence. How often, and to what extent, the final aim, improved survival, is indeed realised is so far unclear. A literature search was performed to provide quantitative estimates for the main determinants of the effectiveness of the follow-up. Data were extracted from a total of 267 articles and databases, and were aggregated using modern meta-analytic methods. In order to provide one more colorectal cancer patient with long-term survival through follow-up, 360 positive follow-up tests and 11 operations for colorectal cancer recurrence are needed. In the remaining 359 tests and 10 operations, either no gains are achieved or harm is done. As the third aim of colorectal cancer follow-up, improved survival, is realised in only few patients, follow-up should focus less on diagnosis and treatment of recurrences. It should be of limited intensity and duration (3 years), and the search for preclinical cancer recurrence should primarily be performed by carcino-embryonic antigen (CEA) testing and ultrasound (US). The focus of colorectal cancer follow-up should shift from the early detection of recurrence towards quality assessment and patient support. As support that is as good or even better can be provided by a patient's general practitioner (GP) or by specialised nursing personnel, there is no need for routine follow-up to be performed by the surgeon.
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PMID:Follow-up of patients with colorectal cancer: numbers needed to test and treat. 1197 24

A comparative analysis of cancer prevalence in France, Spain and Italy is presented as part of the EUROPREVAL project. The three countries are culturally and sociologically relatively homogeneous compared with Europe as a whole. However, in all three countries, the cancer registries (CRs) providing the data for prevalence calculation cover only small fractions of the populations, and have been operating for relatively short periods. This leads to problems of representativity and to prevalence underestimates as surviving cases diagnosed before operation of the CR are not recorded. Partial prevalences obtained directly from CR data were therefore corrected using a completeness index obtained by modelling to provide estimates of the complete prevalence. For CRs operating for only 5 years, only approximately half the prevalence was observed. Thus, due to the rather recent start of most of southern European CRs, the role of correction is very important. The prevalence of all cancers was highest in Italy for women and in France for men, while lowest in Spain. Differences in the age structures of the populations were the major cause of these discrepancies and after age adjustment only the prevalence of stomach cancer remained highest in Italy, although differences in incidence also contributed to the prevalence differences. Survival varied little between the three countries and differences in incidence are more important determinants of prevalence. Prevalence of cancer in the elderly represents an increasing load for the community, particularly for France, Italy and Spain due to the ageing population in these countries. Elderly patients with cancer frequently suffer from problems of co-morbidity and disability factors, thus placing a burden on the local medical system where this proportion is high. Prevalent cases diagnosed 1-5 years before the prevalence date formed approximately one-third of the total prevalence, with higher proportions for melanoma, and prostate cancer in males and breast and colorectal cancer in females, and lower proportions for uterine cancer. This subset of the prevalent population consists of those probably on intensive follow-up, or being treated for cancer recurrence or sequelae to primary therapy.
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PMID:A comparative analysis of cancer prevalence in cancer registry areas of France, Italy and Spain. 1217 94

At time of diagnosis, most cancer patients present with laboratory evidence of systemic coagulation activation. After treatment with curative intent, these hemostatic alterations seemingly disappear as seen in colorectal cancer with regard to prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and soluble fibrin (SF). The aim of this study was to investigate whether coagulation activation recurs with cancer recurrence and to study whether preoperative coagulation tests have any prognostic value in colorectal cancer. Plasma F1+2, TAT, and SF levels were prospectively recorded from 113 patients followed after curative resection of colorectal cancer. The patients were seen in clinic after 3, 6, 12, and 18 months, and after 2, 3, 4, and 5 years. Coagulation reactivation was observed at the time of recurrence, as demonstrated by significantly increased plasma TAT and SF, along with a non-significant increase (P = 0.09) in F1+2. Preoperative values of F1+2, TAT, and SF did not show association with prognosis.
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PMID:Systemic coagulation reactivation in recurrence of colorectal cancer. 1266 28

We previously proved that p16 promoter methylation present in the tumors of colorectal cancer patients can be detected in the serum of those same patients using methylation-specific PCR (MSP). To seek the possibility that this technique could be applied to the monitoring of cancer recurrence, we examined the p16 methylation using MSP. We detected tumor DNA in the serum of 31 of 45 (69%) patients with recurrent colorectal cancer. No methylation was found in serum DNA of 50 patients with colorectal cancers whose corresponding tumor DNA had no methylation in p16 promoter. These results suggested that MSP might be a sensitive and useful method to detect recurrent colorectal cancer in serum.
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PMID:Molecular detection of p16 promoter methylation in the serum of recurrent colorectal cancer patients. 1271 39

Hepatectomy with concomitant resection of the inferior vena cava (IVC) has become common for hepatic malignancies involving the IVC. However, diagnosing IVC invasion and the procedure of choice have yet to be standardized. Medical records of nine patients with liver cancer (five metastatic tumors from colorectal cancer and four intrahepatic cholangiocarcinomas) believed to have directly invaded the IVC wall were retrospectively abstracted for data on preoperative radiologic studies, surgical procedures, histology of the resected specimen, and treatment outcome. All nine patients underwent hepatectomy: Five did not undergo IVC resection because the IVC could be isolated from the tumor; the remaining four underwent combined IVC resection (wedge and segmental resections in two each). The segmentally resected IVC was reconstructed using an external iliac vein graft. Total hepatic vascular exclusion, venovenous bypass, and the ex vivo technique were not used. Interestingly, the tumor was smaller and the percentage of the IVC circumference in contact with tumor as seen on computed tomography (CT) was less in patients with IVC invasion than in those without it (40 +/- 11 vs. 134 +/- 61 mm, p < 0.05; 30% +/- 8% vs. 60% +/- 20%, p < 0.05). The length of the IVC compressed by tumor on cavography was similar in the two patient groups (47 +/- 9 vs. 55 +/- 8 mm). All patients were discharged from the hospital in good condition: Seven died of cancer recurrence, and the remaining two are currently alive and disease-free 15 and 73 months after surgery, respectively. In conclusion, imaging modalities demonstrating caval deformation, such as CT and cavography, are unreliable for diagnosing direct invasion of the IVC wall. Even when IVC invasion is strongly suggested by conventional radiologic studies, the surgeon should endeavor to peel the tumor from the IVC. This strategy is important to avoid unnecessary resection of the IVC, use of a prosthetic graft, or ex vivo hepatectomy.
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PMID:Diagnosis and treatment of inferior vena caval invasion by hepatic cancer. 1273 90

This study asks whether the experience of cancer motivates healthy behavior change. Further, we asked whether such changes relate to risk perceptions and worry, as suggested by Leventhal's Parallel Processing Model. Male (n=41) and female (n=40) survivors of colorectal cancer were interviewed 1-14 years after they first completed treatment. Younger age was associated with stronger risk perceptions, more worry, and greater anxiety. Shorter-term, compared to longer-term survivors, reported higher risk perceptions and more frequent intrusive thoughts. Greater perceived risk, worry and anxiety correlated positively with intentions to make positive health behavior changes. Overall, these survivors did not report exaggerated risk perceptions, and they were not overly worried or anxious about cancer recurrence. However, low-level risk perceptions, worry, and anxiety motivated interest in adopting protective health behaviors.
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PMID:Coping after cancer: risk perceptions, worry, and health behaviors among colorectal cancer survivors. 1518 44

Laparoscopic surgery has been associated with less postoperative pain, an early return of bowel function, a shorter period of hospitalization and disability, and better cosmetic results. In the past decade laparoscopic techniques are increasingly being applied to colorectal surgical procedures. Diagnostic laparoscopy, the creation of stomas, and limited resections are becoming reasonable indications for benign diseases. However, the application of laparoscopic techniques to the curative resection of colorectal cancer is still controversial, owing to reports of cancer recurrence at the port site wounds. Port-site recurrence remains a leading concern regarding the widespread acceptance of laparoscopic resection for colorectal carcinoma. The last reports has presented that with careful technique, training and experience wound recurrences are rarely seen, suggesting that this phenomenon is primarily technique and advanced cancer stages related. The final results of the large randomized prospective studies may well determine the role of laparoscopy for colorectal cancer in the near future.
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PMID:[Future of laparoscopy in colorectal cancer surgery]. 1555


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