The classification of cancer of the rectum

Dukes, Cuthbert E.

doi:10.1002/path.1700350303

Cited by 1,259 publications

(203 citation statements)

References 3 publications

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“…The association between loss of hMLH1 expression and wild-type genotype at the three genes evaluated is significant (P ϭ 0.01, Fisher's exact text), and loss of expression of MMR genes may therefore rationalize tumor formation in a small proportion of the tumors in our series. We further investigated whether the accumulation of multiple mutations was attributable to differences in Dukes' stages (23). There was no significant correlation among Dukes' stages and the number of tumor mutations (correlation coefficient ϭ 0.07) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Mutations in APC, Kirsten-ras, and p53—alternative genetic pathways to colorectal cancer

Smith

Carey

Beattie

et al. 2002

Proc. Natl. Acad. Sci. U.S.A.

429

318

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Colorectal cancer is one of the most significant causes of cancer death. A genetic model for colorectal cancer has been proposed in which the sequential accumulation of mutations in specific genes, including adenomatous polyposis coli (APC), Kirsten-ras (K-ras), and p53, drives the transition from healthy colonic epithelia through increasingly dysplastic adenoma to colorectal cancer. We have characterized tumor mutation spectra in a large cohort of colorectal cancer patients. In marked contrast to the predictions of the sequential model of mutation accumulation, only 6.6% of tumors were found to contain mutations in APC, K-ras, and p53, with 38.7% of tumors containing mutations in only one of these genes. The most common combination of mutations was p53 and APC (27.1%), whereas mutations in both p53 and K-ras were extremely rare. Statistical analysis (two-sided Fisher's exact test) confirmed that mutations in K-ras and p53 co-occurred less frequently than expected by chance (P < 0.01, Fisher's exact test). This finding suggests that these mutations lie on alternate pathways of colorectal tumor development. The heterogeneous pattern of tumor mutations in our patient cohort suggests that multiple alternative genetic pathways to colorectal cancer exist and that the widely accepted genetic model of cancer development is not representative of the majority of colorectal tumors.

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Section: Resultsmentioning

confidence: 99%

Mutations in APC, Kirsten-ras, and p53—alternative genetic pathways to colorectal cancer

Smith

Carey

Beattie

et al. 2002

Proc. Natl. Acad. Sci. U.S.A.

429

318

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“…Tumours proximal or distal to the left branch of the middle colic artery were considered as right-sided or left-sided tumours, respectively. Staging was performed according to Dukes’ classification, with stage D indicating extralymphatic spread [9]. Tumour staging could be established in 82 patients.…”

Section: Methodsmentioning

confidence: 99%

Obstructing Colorectal Carcinoma: Outcome and Risk Factors for Morbidity and Mortality

et al. 2005

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Background/Aims: Emergency surgery for colorectal cancer is widely thought to be associated with high morbidity and mortality. The aim of this study was to assess the operative results of patients who had emergency operations for obstructing colorectal cancer. Clinical factors that might influence the outcome were also evaluated. Patients and Methods: This is a retrospective study including 83 patients who underwent emergency operations for completely obstructing colorectal cancers from 1991 to 2002. Demographic, clinical, and pathological variables were examined. Their influence on major morbidity and mortality was assessed using univariate and multivariate analyses. Results: The overall and major morbidity rate was 67.5 and 32.5%, respectively. Mortality was 10.8%. Univariate analysis showed that high ASA class and perioperative blood transfusion were significantly associated with major complication, whereas older age and high APACHE II were linked to mortality. Independent risk factors for major morbidity were perioperative blood transfusion and high ASA class. The only independent predictor of postoperative death was high APACHE II score. Conclusions: Emergency surgery for obstructing colorectal carcinoma carries a negative impact on outcome. Patients with risk factors should undergo safe and least risky procedures. Moreover, their presence might help in selecting patients for intensive treatment after surgery.

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“…O estádio dos LN no CCR foi iniciado por DUKES (13) , em 1932, modifi cado para o sistema ASTLER e COLLER (2) em 1954. Atualmente, tem-se como alternativa o sistema TNM (29) , revisto em 2002 e que utiliza o número de LN envolvidos para estádio.…”

Section: Discussionunclassified

“…O acometimento metastático dos linfonodos (LN) regionais é, isoladamente, o fator prognóstico mais importante do CCR (21) , sendo incorporado a todos os sistemas de estádio (2,10,13,29) . O acometimento linfonodal metastático relaciona-se a fatores de pior prognóstico, como doença mais avançada e presença de metástase em órgãos à distância (2,4,9,13) . Assim, a avaliação de metástases é fundamental no estádio do CCR, sendo de importância primária na decisão de administração de quimioterápicos para o tratamento dos pacientes (17,26) .…”

Section: Introductionunclassified