Colorectal Cancer

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Colorectal Cancer

Diagnosis, Imaging, and Screening

NEWS:

Experience Counts in Colonoscopy: Study "Experience is key to successful colonoscopies, and doctors who perform these procedures need to do more than 150 before they become proficient. … Some other findings: Increased risk of colon cancer in men is linked with high levels of the blood inflammatory marker C-reactive protein; discomfort during colonoscopy among the elderly is a myth; newer high-resolution colonoscopes miss cancers at the same rate as standard scopes; and sedation and thorough bowel-cleansing make for a successful colonoscopy."

Initial Colonoscopy Key to Cancer Detection "A first-time colonoscopy to remove precancerous polyps plays a bigger role in reducing the risk of dying from colon cancer than do follow-up screenings done years later, a new study suggests."

Lymph Node Evaluation Linked to Improved Survival for Colon Cancer Patients "Lymph node evaluation is important for determining the prognosis and future treatment of patients with colon cancer because the greater the number of lymph nodes that contain cancer cells, the more likely it is that the cancer will return. But most patients do not get an adequate number of lymph nodes tested. Some experts currently recommend that at least 12 lymph nodes be examined."

ARTICLES:

Fecal occult blood tests reduce colorectal cancer mortality.

JOURNAL ARTICLES:

Characteristics of advanced adenomas detected at CT colonographic screening: implications for appropriate polyp size thresholds for polypectomy versus surveillance. (AJR Am J Roentgenol. 2007)

Clinical value of manual fusion of PET and CT images in patients with suspected recurrent colorectal cancer. (AJR Am J Roentgenol. 2007) "CONCLUSION: Interpreting fused images provided more accurate diagnoses than interpreting CT, PET, or PET + CT images. This method of manually fusing separately obtained PET and CT images increased the diagnostic certainty for detecting colorectal cancer recurrence and decreased the number of equivocal cases."

Colon Cancer Survival Better When More Lymph Nodes Removed "Among patients with colon cancer undergoing surgery, better survival is seen in those who have a larger number of lymph nodes removed and examined than in patients who have fewer lymph nodes evaluated. This finding comes from a review of 17 studies involving a total of 61,371 patients and is reported in the March 21 issue of the Journal of the National Cancer Institute. The researchers suggest that the number of lymph nodes evaluated could be used as a measure of quality of care in colon cancer."

Colonoscopy in the very elderly: a review of 157 cases. (Surg Endosc. 2007) "CONCLUSIONS: Our data suggest that colonoscopy can be safely and successfully performed in the very elderly. In patients with symptoms or suggestive radiographic findings, cancer was detected in 4.0%-60% of cases. No cases of cancer were discovered in those patients who were asymptomatic."

Colorectal cancer screening using fecal occult blood test and subsequent risk of colorectal cancer: A prospective cohort study in Japan. (Cancer Detect Prev. 2007)

[Diagnosis and staging of colorectal cancer.] (Tidsskr Nor Laegeforen. 2007)

Differentiation between Diverticulitis and Colorectal Cancer: Quantitative CT Perfusion Measurements versus Morphologic Criteria--Initial Experience. (Radiology. 2007) "Conclusion: CT perfusion measurements enable differentiation and better discrimination, in comparison with morphologic criteria, between cancer and diverticulitis."

DNA Image Cytometry Is a Useful Adjunct Tool in the Prediction of Disease Outcome in Patients with Stage II and Stage III Colorectal Cancer. (Oncology. 2007) "Conclusion: The DNA image cytometry with careful analysis of the histograms may provide valuable prognostic information in CRC, with potential clinical implications in patient management, particularly in predicting the patients at high risk for recurrence who should be considered as candidates for adjuvant therapy."

Early Initiation of Colorectal Cancer Screening in Individuals with Affected First-degree Relatives. (J Gen Intern Med. 2007)

Faecal screening of colorectal cancer. (Int J Clin Pract. 2007)

Five-Year Colon Surveillance After Screening Colonoscopy. (Gastroenterology. 2007)

Flat colorectal neoplasms: definition, importance, and visualization on CT colonography. (AJR Am J Roentgenol. 2007)

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population. (Arq Gastroenterol. 2007) "BACKGROUND: Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. … CONCLUSIONS: The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older with an apparently normal distal colon has advanced proximal neoplasia. Sigmoidoscopy is not an adequate exam for symptomatic patients aged 50 years or older."

Magnetic resonance colonography vs computed tomography colonography for the diagnosis of colorectal cancer: an indirect comparison. (Colorectal Dis. 2007) " Conclusion This meta-analysis suggested that CTC and MRC have similar diagnostic accuracy for detecting CRC. Study quality, size and intravenous/intra-luminal contrast agents affect diagnostic accuracies. For an exact comparison to be made, studies evaluating CTC, MRC and colonoscopy in the same patient cohort would be necessary."

Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy. (Am J Med. 2007) "CONCLUSIONS: CT colonography has a reasonable sensitivity and specificity for detecting large polyps but was less accurate than endoscopic colonoscopy for smaller polyps. Thus, CT colonography may not be a reasonable alternative in situations in which a small polyp may be clinically relevant."

Modes of presentation and pathways to diagnosis of colorectal cancer in Queensland. (Med J Aust. 2007)

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study. (Cancer Epidemiol Biomarkers Prev. 2007) "CONCLUSIONS: The incidence rates for chronic fatigue and chronic fatigue syndrome in this adolescent sample were relatively high, but the prognosis for these conditions was good. This prospective study provides evidence for an association between emotional/behavioral problems and subsequent onset of fatigue/chronic fatigue."

Predictive value of common symptom combinations in diagnosing colorectal cancer. (Br J Surg. 2007)

Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. (bdom Imaging. 2007) "The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. For the evaluation of patients with colorectal cancer, CT has relative advantages over PET/CT in regard to the depth of tumor invasion through the wall, extramural extension, and regional lymph node metastases. PET/CT should be performed on selected patients with suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrast-enhanced PET/CT and PET/CT colonography, may replace the diagnostic CT for the preoperative staging of colorectal cancer."

Screening for Colorectal Cancer in Elderly Persons: Who Should We Screen and When Can We Stop? (J Aging Health. 2007) “RESULTS: The relative proportion of deaths from colorectal cancer compared to all other causes was greatest at the age of 62 and diminished thereafter. A total of 80% of the maximal benefit from screening was achieved by screening till the age of 82. The impact of prematurely stopping screening varied with gender and race. DISCUSSION: The maximal societal benefit will be achieved by screening at younger ages because of competing causes of mortality among older people. Gender and ethnicity should be considered in individual decisions to stop screening at a given age.”

Screening for colorectal cancer using the faecal occult blood test, Hemoccult. (Cochrane Database Syst Rev. 2007) " AUTHORS' CONCLUSIONS: Benefits of screening include a modest reduction in colorectal cancer mortality, a possible reduction in cancer incidence through the detection and removal of colorectal adenomas, and potentially, the less invasive surgery that earlier treatment of colorectal cancers may involve.Harmful effects of screening include the psycho-social consequences of receiving a false-positive result, the potentially significant complications of colonoscopy or a false-negative result, the possibility of overdiagnosis (leading to unnecessary investigations or treatment) and the complications associated with treatment."

Screening patients with a family history of colorectal cancer. (J Gen Intern Med. 2007) "CONCLUSIONS: More efforts are needed to translate information about family history of colorectal cancer into the care of patients"

Sentinel Lymph Node Evaluation Does Not Improve Staging Accuracy in Colon Cancer. (Ann Surg Oncol. 2007)

The relationship of lymph node dissection and colon cancer survival in the Veterans Affairs Central Cancer Registry. (Am J Surg. 2007)

Tumor size is associated with the systemic inflammatory response but not survival in patients with primary operable colorectal cancer. (J Gastroenterol Hepatol. 2007)

Who should be sent for genetic testing in hereditary colorectal cancer syndromes? (J Clin Oncol. 2007)

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