Colorectal Cancer Initial Diagnosis: Screening Colonoscopy, Diagnostic Colonoscopy, or Emergent Surgery, and Tumor Stage and Size at Initial Presentation

Moreno, Courtney C.; Mittal, Pardeep K.; Sullivan, Patrick S.; Rutherford, Robin E.; Staley, Charles A.; Cardona, Kenneth; Hawk, Natalyn; Dixon, William J.; Kitajima, Hiroumi D.; Kang, Jian; Small, William; Oshinski, John N.; Votaw, John R.

doi:10.1016/j.clcc.2015.07.004

Cited by 105 publications

(68 citation statements)

References 19 publications

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“…Previous studies suggested that solid tumors including gastrointestinal tumors can obtain the potential of dissemination during the process of growing both horizontally and vertically [16]. Currently, although many investigators have confirmed the negative prognostic role of tumor size, the value of tumor size in survival prediction is still underappreciated [3][4][5][6][7][8][9][10][11][12][13]. However, the vertical growth index reflected by T stage has been established as one of the dominating prognostic factors and has been incorporated into the widely accepted TNM staging system in colon cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor size, defined as the maximal horizontal tumor diameter, has been studied for decades, and large horizontal tumor extent has generally been considered to be negatively associated with prognosis in many solid tumors, including colonic malignancies [3][4][5][6][7][8][9][10][11][12][13]. However, because of the vertical index of infiltration depth reflected by T stage, tumor size has not been recognized as a valuable factor in predicting prognosis in colon cancer.…”

Section: Introductionmentioning

confidence: 99%

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The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Dai

Xiang

et al. 2019

The Oncologist

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Background The role of horizontal growth index of tumor size in survival prediction is still underappreciated in colon cancer because of the identification of vertical infiltration index reflected by T stage. We sought to reveal the impact of T stage on the prognostic and predictive value of tumor size in colon cancer. Materials and Methods Data of patients with stage I–III colon cancer were extracted from Surveillance, Epidemiology, and End Results Program (SEER) and Fudan University Shanghai Cancer Center (FUSCC) databases. Harrell's concordance index (c‐index) and time‐dependent receiver operating characteristic curve (ROC) were used to analyze the discriminative ability of prognostic factors. Results Stratified analyses based on T stage found that the increase of T stage significantly and negatively repressed the effect of tumor size on death and recurrence risk. In addition, tumor size showed the greatest hazard ratio of cancer‐specific death and relapse in T1 colon cancer. Even more importantly, the discriminatory ability of tumor size outperformed any other widely accepted prognostic clinical features in predicting cancer‐specific survival (SEER: c‐index 0.637, area under the ROC [AUC] 0.649; FUSCC: c‐index 0.673, AUC 0.686) and disease‐free survival (FUSCC: c‐index 0.645, AUC 0.656) in T1 stage colon cancer. Conclusion Tumor size is a critical clinical factor with considerable prognostic and predictive value for T1 colon cancer, and it should be selectively incorporated into the current staging system to facilitate prediction of death and recurrence risk. Implications for Practice To date, no consensus has been reached about the prognostic and predictive value of tumor size in colon cancer. Although tumor size is an independent prognostic factor for patients with colon cancer, the impact of tumor size on death or recurrence risk decreased notably with the increase of T stage. More importantly, the discriminative ability of tumor size outperformed any other clinical factors including N stage in patients with T1 colon cancer. Therefore, tumor size should be recommended to be incorporated into current staging systems to facilitate prognosis prediction for patients with T1 colon cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Dai

Xiang

et al. 2019

The Oncologist

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“…Patients frequently present with changes in bowel habits, rectal bleeding, anemia, and abdominal pain accompanying these findings. Patients may also suffer from weight loss, fatigue, nausea, vomiting, obstruction and perforation [65][66][67][68][69]. Clinical findings vary according to the tumor location.…”

Section: Clinical Findings Of Colon Cancermentioning

confidence: 99%

Colon Cancer

Koç¹,

Çelik²,

Akyol³

2019

Current Trends in Cancer Management

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Colorectal cancers (CRCs) are commonly diagnosed malignancy in both men and women. Although it is a common disease, mortality rates decrease with widespread use of screening methods and novel developments in surgery. Physical examination, abdomen and pelvic computerized tomography, and chest imaging are necessary for preoperative staging and surgical planning of a newly diagnosed colon cancer. CRCs usually develop from adenomatous polyps. Although curative treatment of localized colon cancer is surgery, endoscopic polypectomy is sufficient when severe dysplasia or carcinoma in situ is detected on a polyp surface. Total mesorectal excision and neoadjuvant chemoradiotherapy in rectum cancers resulted in significant reductions in morbidity, mortality, and recurrence rates. Recently, complete mesocolic excision and central vascular ligation method has been described in the surgical treatment of colon cancer to achieve similar results. Unfortunately, metastatic colon cancer rate at presentation is approximately 20%. Surgery is a potentially curative option in selected patients with liver and lung metastasis. Pathologic stage of the tumor at presentation is the most important prognostic factor after resection. Therefore, early diagnosis of colon cancer by screening methods and new surgical techniques will lead to better results in survival rates.

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“…Most CRCs (70 to 90 percent in two contemporary series) 6,7 are diagnosed after the onset of symptoms. Symptoms of CRC are typically due to growth of the tumour into the lumen or adjacent structures, and as a result, symptomatic presentation usually reflects relatively advanced CRC.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Study of Distribution of Colorectal Cancers in North Coastal Andhra Pradesh

Kumar¹,

Koppolu²,

Ramavath³

et al. 2019

jebmh

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BACKGROUND Colorectal cancers are the third most common cancers in India. Indian data on epidemiological factors and site of distribution of colorectal cancers is very limited. Colorectal cancer is the fourth most common newly diagnosed cancer after ca prostate, ca breast, and ca lung. Age standardized incidence rate of colorectal cancer in developed countries is between 25 to 30 per 100,000 population. In India it is 3 to 4 per 100,000 population. High ratios of colon to rectal cancer (≥2: 1) prevail in high-risk areas such as North America. Ratios below 1 are often found in low-risk Asian and African populations. Temporal trends in western studies showed increase in proximal colon malignancies and decrease in distal colon and rectal malignancies. Western studies showed increase in rectal cancer in individuals less than 50 yrs. probably attributable to dietary changes. Screening Guidelines-Faecal occult blood test every 3 yrs, Sigmoidoscopy every 5 yrs., Colonoscopy every 10 yrs. MATERIALS AND METHODS This is a retrospective study of all diagnostic colonoscopies of patients aged 18 and above who presented to Department of Gastroenterology, KGH between 2007 and 2014. Data is drawn to age, sex and site of cancer and analysed. RESULTS 1045 oncoscopies were done. 129 cases were diagnosed as colorectal malignancies and confirmed by biopsy. 52 cases were seen in rectum. 42 cases were seen in ascending colon. 10 malignancies in transverse colon, 12 in descending colon, 13 in sigmoid colon, 65 cases approximating 50% were seen in rectum and sigmoid colon. CONCLUSION Colorectal malignancies are not as frequent in India as in western world. Observational studies show increasing incidence of colorectal malignancies probably related to increased fatty diet and decreased fibre diet. Carcinoma rectum is more common than ascending colon cancers in India which is also found in studies done in other geographical regions. This could be attributed to genetics, environmental factors and dietary habits. Routine colonoscopy as a screening method for colorectal cancers need not be enforced in our geographical area. This observation needs to be confirmed by further studies.

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Colorectal Cancer Initial Diagnosis: Screening Colonoscopy, Diagnostic Colonoscopy, or Emergent Surgery, and Tumor Stage and Size at Initial Presentation

Cited by 105 publications

References 19 publications

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer

Colon Cancer

Retrospective Study of Distribution of Colorectal Cancers in North Coastal Andhra Pradesh

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