Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.

The purpose of tumour staging for colorectal cancer (CRC) is to help define clinical management, facilitate communication between physicians, provide a basis for stratification and analysis of treatment results in prospective studies, and provide some prognostic information for patients and their families. The World Congresses of Gastroenterology, Digestive Endoscopy, and Coloproctology, Working Party on staging for CRC studied six commonly used systems to review their strengths and weaknesses. Although it was concluded that defining a new staging system was unnecessary, it was recognized that there is a need to define a terminology to describe the full anatomic extent of spread of CRC. Furthermore, we note that there are several additional features, derived from both clinical and pathology information, which have had prognostic significance shown by appropriately constructed multivariate analyses and which can be used to formulate a more accurate prognostic index than that provided by a description of anatomical tumour spread. Thus the Working Party came to two principal conclusions. First, a standard format should be adopted for the collection of the essential data required for prospective studies, and we recommend the 'International Documentation System (IDS) for CRC' for this purpose. Second, a nomenclature which describes the full anatomical extent of tumour spread and residual tumour status in CRC has been defined and should be adopted, from which all currently used staging systems can be derived. We have called this nomenclature the 'International Comprehensive Anatomical Terminology (ICAT) for CRC'. In the event that these recommendations are adopted, we envision that there will be improved clarity in the documentation of treatment outcome for patients with CRC and improved communication of results derived from prospective studies. Furthermore, an acceptance of IDS and ICAT would set the scene to develop a prognostic index for individual patients with CRC by the expansion of anatomical clinicopathology staging information to include additional factors which have independent prognostic significance.

The most common cause of microcytic, hypochromnic anaemia in Western society is iron deficiency., In men and postmenopausal women iron deficiency usually results from chronic blood loss.Ù lcerative oesophageal, gastric, or duodenal lesions are commonly detected endoscopically in patients with iron deficiency anaemia, who are often taking non-steroidal anti-inflammatory drugs." Although patients with right sided colonic cancer may present with iron deficiency anaemia, it is not known how commonly such lesions or other colonic diseases coexist in anaemic patients with a benign upper gastrointestinal lesion. Consequently there are no firm guidelines on whether colonic assessment is warranted in these patients. Our aims, therefore, were to determine whether patients with iron deficiency anaemia and benign upper gastrointestinal lesions on endoscopy require colonic assessment; whether the absence of specific colonic symptoms in these patients obviates the need for colonic investigation; and to what extent upper and lower gastrointestinal symptoms can predict the presence of upper and lower gastrointestinal lesions in patients with iron deficiency anaemia. Patients and methodsThe haematological results of all inpatients at this hospital for the 17 months from May 1983 to October 1984 were prospectively screened. Those with a haemoglobin concentration less than 110 g/1 and a mean corpuscular volume less than 80 fl were selected for assessment.Patients were excluded from the study if general debility precluded any investigation or if they were 85 years or older; had confirmed malignancy at the time of admission; had a known cause for blood loss such as recent surgery, trauma, or overt gastrointestinal haemorrhage; were premenopausal women; had an established reason for anaemia such as renal failure requiring haemodialysis or a haemoglobinopathy; or had been fully assessed recently for iron deficiency anaemia.Iron state was assessed by measuring serum iron concentration, transferrin saturation, and serum ferritin concentration. Bone marrow aspiration for assessment of iron stores by Prussian blue staining was performed when results of blood measurements were non-diagnostic. A patient was classified as iron deficient if one or more of the following criteria were fulfilled: transferrin saturation <5%; serum ferritin concentration <30 ug/l (men) or <20 ug/1 (women); bone marrow iron stores absent or notably reduced; haemoglobin concentration and mean corpuscular volume returned to normal after iron treatment (in two patients).A clinical history including documentation of non-steroidal anti-inflammatory drugs ingested and dietary iron intake (by a dietitian) was obtained and a physical examination carried out for all patients with established iron

No abstract

No abstract