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Colorectal cancer incidence and death rates have been declining over the past 10 years. However, it remains the second leading cause of death in men ages 60-79 and the third leading cause of death in men over 80 and in women over 60 years old. However, there is little data specific to the treatment of the elder patient, since few of these patients are included in trials. With the advent of improved therapies, there are many alternative options available. Still, no definitive consensus or guidelines have been defined for this particular patient population. The goal of this study is to review the literature on the management of rectal cancer in the elderly and to propose treatment algorithms to help the oncology team in treatment decision-making.

Prior studies examining the risk of second primary malignancy (SPM) after a first primary cancer generally have used large datasets such as the Surveillance, Epidemiology, and End Results (SEER) registry and excluded survivors of previous primaries and developers of synchronous primaries. The goal of this study was to provide a more complete representation of multiple cancer risk in squamous cell carcinoma of the anus (SCCA) patients. A single-institution retrospective study of 46 patients treated definitively for SCCA between January 2006 and July 2017 was conducted. Of the 46 patients, 18 (39%) had either a primary malignancy before SCCA (n=9) or SPM after an index SCCA (n=9). Six patients had ≥3 total malignancies. In our cohort, patients without SPMs tended to die from SCCA recurrence, while patients with SPMs were more likely to die from their SPM than from SCCA. Our study suggests that patients with SCCA are often either survivors of previous cancers or develop later malignancies. Several risk factors may play a role including HPV infection, HPV-related or treatment-related immunosuppression, somatic mutations due to chemotherapy, and genetic factors. Patients with SCCA require lifelong surveillance given their elevated risk of malignancy. Future work should focus on identifying genomic or immunologic factors that may predispose SCCA patients to develop multiple primary malignancies.

Unilateral crossed renal ectopia without fusion is an uncommon anatomic anomaly, which often goes undiagnosed. We report a case of this renal variant discovered incidentally during colostomy reversal after Hartmann's procedure for diverticular stricture.

The 8-year updated results of RTOG-0529 reported that 5/52 patients developed second primary malignancies (SPMs), of which 4/5 died of the SPM. Prior studies examining risk of SPM after a first primary cancer generally use large datasets such as the SEER registry and exclude survivors of previous primaries and developers of synchronous primaries. The goal of this study was to provide a more complete representation of multiple cancer risk in squamous cell carcinoma of the anus (SCCA) patients. Materials/Methods: A single-institution retrospective review of 46 patients treated definitively for SCCA between January 2006 and July 2017 was conducted. Patients received definitive chemoradiotherapy, except one patient who received curative local excision. An "index primary malignancy" (IPM) was defined as the first diagnosed cancer. A "second primary malignancy" was defined as a biopsy-confirmed distinct primary cancer that developed after diagnosis of an IPM. Patients were classified into one of three groups: prior IPM before SCCA, SCCA only, and SPM after an index SCCA. Univariate logistic regression was used to assess associations between baseline characteristics and multiple primary malignancy status. Overall survival was estimated with the Kaplan-Meier method. Results: Of 46 patients, 18 (39.2%) had either an IPM before SCCA (n Z 9) or SPM after an index SCCA (n Z 9). Six patients had 3 total malignancies. No baseline characteristics (age, gender, race, stage, smoking status) correlated with presence of 2 malignancies (among all patients) or development of an SPM (among index SCCA patients). The most common prior IPMs were breast (n Z 4) and gynecologic cancers (endometrial (n Z 2) and vulvar (n Z 1)). Radiotherapy was not used as treatment for malignancies in the pelvic radiation field (gynecological and rectal); other IPMs were outside of the field, so subsequent development of SCCA was not clearly related to radiotherapy. The SPMs were neither found to be in the radiation field nor HPV-related cancers. Of the 9 patients who developed SPMs, 6 (67%) developed lung cancers. Three of these patients had no smoking history, of which 2 developed multiple primary lung cancers. In our cohort, patients without SPMs tended to die from SCCA recurrence, while those with SPMs were more likely to die from their SPM than from SCCA. Conclusion: Our study suggests that patients with SCCA are often either survivors of previous cancers or develop later malignancies. These patients require lifelong surveillance given their elevated risk of malignancy. Future work should focus on identifying genetic or immunologic factors that may predispose SCCA patients to develop multiple primary malignancies.

Background: This study seeks to quantify and compare bone marrow tolerance during postoperative chemotherapy therapy between rectal cancer vs. colon cancer patients. During rectal cancer treatment, patients receive neoadjuvant chemoradiation (CRT) irradiation which can exacerbate the hematologic toxicity (HT) via incidental irradiation of the pelvic bone marrow (PBM) during myelosuppressive postoperative chemotherapy.In contrast, colon cancer patients receive the same postoperative myelosuppressive chemotherapy but do not routinely receive preoperative chemoradiation therapy. This comparison will help elucidate the lasting myelosuppressive effects of incidental pelvic bone marrow (PBM) irradiation on rectal cancer patients during neoadjuvant preoperative chemoradiation therapy.Methods: Rectal cancer patients treated with preoperative CRT followed by postoperative 5-Fluorouracil and oxaliplatin (OxF) chemotherapy (n=35) were compared to colon cancer patients who received only postoperative OxF chemotherapy (n=42). End points were ≥ grade 3 hematologic toxicity (HT3) or hematologic event (HE) defined as ≥ grade 2 HT and a dose reduction in OxF. Wilcoxon rank sum test tested continuous variables and Chi-squared test measured differences in categorical variables. HT3 and HE probability during postoperative chemotherapy was estimated with Kaplan-Meier curves and Cox regression analysis.Results: During OxF chemotherapy, 40.0% (n=14) of rectal cancer patients experienced HT3 compared to 26.1% (n=11) of colon cancer patients (P=0.4). HE was experienced by 48% (n=17) of rectal cancer patients compared to 36% (n=15) of colon cancer patients (P=0.36). Rectal cancer patients were likelier to experience HT3 on multivariable cox regression analysis, controlling for several clinical covariates, with a hazard ratio (HR) of 2.49, [(95% CI: 1.02-6.02), P=0.045] than colon cancer patients. While rectal cancer patients were more likely to experience HE than colon cancer patients on multivariable Cox regression analysis with a HR of 1.8 (95% CI: 0.95-3.75), this only trended in statistical significance, P=0.07. Conclusions:Rectal cancer patients are more likely than colon cancer patients to experience hematologic toxicities impacting the tolerance of standard of care chemotherapeutics during adjuvant therapy. Focused PBM sparing during radiation therapy for rectal cancer patients may improve tolerance of myelosuppressive chemotherapeutic agents delivered in the postoperative setting.

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