When mesorectal excision is performed, circumferential margin involvement is more an indicator of advance disease than inadequate local surgery. Patients with an involved margin may die from distant disease before local recurrence becomes apparent.
Summary Tumour markers CEA, were measured in 33 patients undergoing chemotherapy for advanced colorectal cancer. The aim was to determine whether they could be used to accurately monitor the course of the disease, and reduce the need for imaging. Treatment with a 5-fluorouracil based regimen resulted in a partial response in nine patients (27%), whereas the remainder either had disease stabilisation or suffered from progression. Before treatment the CEA was elevated in 85% of patients and the and CA-242 in 78%. All three markers were elevated in 70% and at least one elevated in 93%. (Hammarstrom, 1985;Gupta et al., 1987;Safi et al., 1987;Sagar et al., 1991;Nilsson et al., 1992). Although none of these markers has proved to be of any particular value in screening for the disease, CEA is commonly used to assess the progress of patients following surgical treatment (Minton et al., 1985) and remains the 'gold standard'. Other markers appear less useful in isolation, but when combined as a panel with CEA may be of greater value than any one marker on its own (Safi et al., 1987;Persson et al., 1989). The aim of this study was to assess whether three tumour markers CEA, are of value in monitoring the progress of patients being treated with systemic chemotherapy for advanced colorectal cancer. Patients and methods PatientsThirty-three patients were studied; 24 were male and nine female, mean ages 58 (range 27-76) and 60 (42-78) respectively. All patients had histologically proven colorectal cancer with metastases. Twenty-six had liver metastases, ten locoregional disease, eight lung metastases, and two with disease at other sites. Several of these patients had disease at more than one site. The patients were a consecutive series in chemotherapy studies which required that the disease was measurable on CT scan. The time interval between presentation with the primary tumour and recurrent disease averaged at 16 months with a range of 0-91 months. Performance status was assessed by means of the Karnofsky scale (Karnofsky et al., 1948), the average being 80 with a range of 70-90.The study was approved by Leeds Eastern District Clinical Research (Ethics) Committee.Treatment schedule All patients received chemotherapy with a 5-fluorouracil (5-FU) based regimen as detailed below. Some of these patients were being treated in a multi-centre study comparing 5-FU and interferon alpha with 5-FU and leucovorin. The results of this study will be published separately. In the 5-FU/ interferon based regimen 5-FU was administered as a continuous intravenous infusion over a period of 5 days at a daily dose of 750 mg m2 followed by weekly intravenous bolus doses also of 750 mg m-2 commencing on day fifteen. Interferon alpha-2a 9 MU, was administered as a subcutaneous injection three times weekly. In the 5-FU/ leucovorin based regimen I-leucovorin 200 mg m-2 was infused over 10 min and followed within 5 min by a bolus of 5-FU at 370 mg m-2 for 5 consecutive days. This cycle was repeated every 4 weeks. Tumour markersA 10 ml sample of ...
In a review of cases of colorectal cancer presenting to St. Mark's Hospital over the 16-year period 1970-85, 59 patients were found to have a synchronous carcinoma (3.4 per cent). Although 82 per cent of these synchronous tumours were distal to the splenic flexure (and hence within reach of a 60 cm flexible sigmoidoscope) only 42 per cent were detected pre-operatively: the remaining tumours were noted at surgery (24 per cent) or found incidentally on pathological examination of the resected specimen (34 per cent). Histological examination of these synchronous lesions revealed a high proportion with favourable stage (Dukes' A-75 per cent) and grade (well or moderate differentiation-90 per cent). Over the same 16-year period, 10 patients presented with an 'early' metachronous lesion (less than 3 years from initial surgery). Review of these cases noted negative findings on the initial barium studies in four patients and a failure to conduct full examination of the colon at initial presentation in the remaining six. It is concluded that full examination of the colon in all patients presenting with primary colorectal cancer is mandatory and that, in the light of this experience and recent reports in the literature, this should be by pre- or peroperative colonoscopy.
Results suggest that genetic instability plays an important role in development of multiple primary cancers, particularly from certain cancer subsets. Testing for replication errors may be an appropriate way of identifying individuals at risk of multiple primary cancers.
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