Long-term survivors after adjuvant pelvic irradiation in rectal and sigmoid carcinoma: an assessment of late results

Twenty-six patients with adenocarcinomas of the rectum, rectosigmoid, or sigmoid colon given adjuvant pre- or postoperative pelvic radiation therapy followed at least 5 years were retrospectively reviewed to evaluate late tumor control and complication rates. The overall 7-year survival rate was 80 +/- 8% with B2,3 patients faring better than C2,3 (94 +/- 6% versus 43 +/- 19%, p less than 0.005). Local pelvic tumor control was achieved in 23/26 patients (88%); patients with high-stage (C2,3) or poorly-differentiated adenocarcinomas had a higher postirradiation pelvic relapse rate (3/11) versus low stage, well or moderately-well differentiated tumors (0/15). A major complication (none fatal) occurred in 2 of 26 patients (8%) and was not correlated with either irradiation dose nor volume. Long-term follow-up is now available on patients who received adjuvant pelvic irradiation for rectal or sigmoid carcinomas and indicates a high pelvic tumor control rate. The 8% major complication rate may be decreased in the future by more sophisticated irradiation treatment planning.     

Are there two sides to colorectal cancer?

Colorectal carcinomas (CRC) that arise proximal (right) or distal (left) to the splenic flexure exhibit differences in incidence according to geographic region, age and gender. Together with observations that tumours in the hereditary cancer syndromes HNPCC and FAP occur predominantly in the right and left colon, respectively, the existence of 2 categories of CRC based on site of origin in the large bowel was proposed more than a decade ago. Differences between normal right and left colonic segments that could favour progression through different tumourigenic pathways are summarized in this review. Accumulating evidence suggests that the risk of CRC conferred by various environmental and genetic factors is different for proximal and distal tumours. Right- and left-sided tumours also exhibit different sensitivities to fluorouracil-based chemotherapy. Such differences are probably related to the molecular characteristics of the tumours, with the microsatellite instability and CpG island methylator phenotypes being associated with right-sided tumours and chromosomal instability with left-sided tumours. Future molecular-based classification systems for CRC that rely upon distinctive gene expression patterns may allow a clearer discrimination of subgroups than that provided by tumour site alone. Until then however, the existence of 2 broadly different groups of cancer defined by site of origin in the colon should be considered in the design of future epidemiologic studies as well as in the design of new clinical trials aimed at testing novel adjuvant therapies.     

内镜检查在结直肠癌防治中的应用及研究进展

摘 要：结直肠癌作为全球常见的恶性肿瘤,其发病率和死亡率均居高位。内镜筛查,尤其是结肠镜检查,被证实为结直肠癌预防和早期发现的有效手段。通过定期的内镜筛查,及时发现并切除结直肠进展期腺瘤,可显著提高患者的生存率。然而,内镜筛查在实际应用中面临诸多挑战,包括患者依从性和技术人员水平等,这些因素限制了内镜筛查的效果。全文描述了内镜筛查技术在结直肠癌预防、早期发现和治疗中的应用。阐述了结直肠癌内镜筛查技术的发展现状,包括从早期硬管式内镜到最新的胶囊内镜的演进,并探讨了各种内镜技术的优势与局限。此外,还讨论了国内外结直肠癌筛查指南及其内镜筛查推荐,以及提高筛查依从性的策略和挑战,旨在为结直肠癌的防控提供参考依据。通过持续的技术创新和筛查策略的优化,期望未来能进一步提升内镜筛查的精确性和普及率,从而在全球范围内降低结直肠癌的疾病负担。     

Neighborhood socioeconomic status and behavioral pathways to risks of colon and rectal cancer in women

BACKGROUND:

Neighborhood amenities and resources plausibly determine individual modifiable risk factors for colon and rectal cancer. Evidence on the associations between neighborhood socioeconomic status (SES) and incident colon and rectal cancer is limited.

METHODS:

The authors analyzed a prospective cohort of 111,129 women in the Nurses' Health Study with no history of cancer in 1986 followed to 2006. Neighborhood SES was based on Census‐derived characteristics of block groups of residence. Cox models were used to estimate the multivariate‐adjusted associations between neighborhood SES and incident colon and rectal cancer, and to examine for effect modification. For significant associations, path models were estimated with behavioral risk factors included as potential mediators.

RESULTS:

Neighborhood SES was unassociated with colon cancer among all women. However, among women with college or greater education, higher neighborhood SES was inversely related to colon cancer (P for trend = .01; P for interaction between neighborhood SES and education = .03). Path analysis suggested mediation by red meat intakes and body mass index (BMI). Higher neighborhood SES was inversely related to rectal cancer among all women (relative risk in highest quintile, 0.64; 95% confidence interval, 0.44‐0.93; P for trend = .08). Path analysis was consistent with mediation by multivitamin use and BMI.

CONCLUSIONS:

These findings suggest that living in a higher‐SES neighborhood may protect against rectal cancer in women and colon cancer in higher‐educated women, mediated by selected behavioral risk factors. Risk factor differences between colon and rectal cancer may account for discrepancies in estimated neighborhood effects by cancer site. Cancer 2010. © 2010 American Cancer Society.     

Cancer mortality in the European Union, 1988-1997: the fall may approach 80,000 deaths a year

After the peak rate of cancer mortality reached in 1988 in the European Union, steady declines were observed: 9.1% for both sexes combined over the period 1988-1997 (from 147.0 to 133.6/100,000, world standard), corresponding to the avoidance of about 80,000 deaths in 1997 (approximately 39,000 below age 65 and 41,000 above). In 1997, the total number of cancer deaths also declined, for the first time. The major determining cancers for these favorable trends were stomach (-30%), lung (-10%), intestines (-15%), breast (-10%), uterus (mainly cervix; -22%), leukemias (-10%) and, after 1995, prostate (-3%).     

Survival of colorectal cancer patients in Europe during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with colorectal cancer. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 47 and 43% for cancers of the colon and rectum, respectively. Survival decreased with increasing age: the relative risk of dying for the oldest patients (75+) was 1.39 for rectum and 1.54 for colon compared with the youngest patients (15-44 years). In 1985-1989 survival from colorectal cancer differed significantly between different European countries: the Nordic countries (Denmark excluded), The Netherlands, Switzerland, France and Austria were characterised by high survival, whilst Eastern European countries, the U.K. and Denmark were characterised by low survival. There was a general improvement in survival over the period 1978-1989: from 40 to 48% for colon cancer and 38 to 46% for rectal cancer. For neither cancer site did between-country survival differences narrow over the study period. Intercountry and time differences in survival differences are probably related to stage at diagnosis and postoperative mortality.     

Prospective study on alcohol consumption and the risk of cancer of the colon and rectum in the Netherlands

The association between alcohol consumption and cancer of the colon and rectum was investigated in a prospective cohort study, conducted in the Netherlands from 1986 onwards among 120,852 men and women, aged 55 to 69 years. During 3.3 years of follow-up, 312 and 166 cases of colon and rectal cancer had accumulated, respectively. After exclusion of cases diagnosed in the first year of follow-up the analysis was based on 217 incident cases of colon cancer (107 men and 110 women) and 113 cases of rectal cancer (75 men and 38 women). For colon cancer, no association with total intake of alcohol nor with the consumption of beer and wine, specifically, could be demonstrated; for liquor intake, a significant (P=0.04) decreasing risk with increasing consumption was observed. For rectal cancer in men, positive trends were observed for total alcohol intake (P=0.04), beer (P=0.05), and liquor (P=0.06). Results for rectal cancer in women were consistent with those in men, but data were too sparse to provide stable estimates. Simultaneous adjustment for beverage type and quantity appeared to strengthen the association of rectal cancer with drinking beer (relative rate (yes/no)=2.0, 95 percent confidence interval=1.1–3.9), although, a dose-response effect was not observed. When alcohol intake from beer, wine, and liquor were included as continuous variables, the association was somewhat stronger for liquor than for beer, but none of the associations were statistically significant. It is concluded that consumption of alcoholic beverages (beer, in particular) is associated with an increased risk for rectal but not colon cancer.This project was funded by the Dutch Cancer Society (grants CIVO 86-1 and 90-3).     

Descriptive epidemiology of CNS tumors in France: results from the Gironde Registry for the period 2000-2007

An increase in the incidence of CNS tumors has been observed in many countries in the last decades. The reality of this trend has been much debated, as it has happened during a period when computer-assisted tomography and MRI have dramatically improved the detection of these tumors. The Gironde CNS Tumor Registry provides here the first data on CNS tumor incidence and trends in France for all histological types, including benign and malignant tumors, for the period 2000-2007. Incidence rates were calculated globally and for each histological subtype. For trends, a piecewise log-linear model was used. The overall annual incidence rate was found to be 17.6/100 000. Of this rate, 7.9/100 000 were neuroepithelial tumors and 6.0/100 000 were meningiomas. An overall increase in CNS tumor incidence was observed from 2000 to 2007, with an annual percent change (APC) of +2.33%, which was explained mainly by an increase in the incidence of meningiomas over the 8-year period (APC = +5.4%), and also more recently by an increase in neuroepithelial tumors (APC = +7.45% from 2003). The overall increase was more pronounced in women and in the elderly, with an APC peaking at +24.65% in subjects 85 and over. The increase in the incidence rates we observed may have several explanations: not only improvements in registration, diagnosis, and clinical practice, but also changes in potential risk factors.     

Colorectal cancer in Nigeria: 40 years on. A review

This paper is a review of work done on colorectal cancer in Nigeria over the last 40 years showing geographic spread, age and sex ratios, predominant histopathology and paucity of polyposis coli syndromes. The male/female ratio is averagely equal, the peak age remains around 44 years, there is a significant subgroup of the under-30s and there are more rectal cancer cases than colon cancer cases. Of the colon cancer cases, the caecum seems to be the more favoured site. There seems to be quite a significant incidence of mucin-secreting adenocarcinoma subgroups which are said to carry a worse prognosis. Almost all the authors have stated the rarity of polyposis coli syndromes; a few have looked into the possibility of mismatch repair mutations as an aetiological factor.