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At least 397 records · Page 22Linked to original sources
PubMed1996

Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire.

OBJECTIVES: The aims of this study were to (i) estimate the prognosis of a 10-year cohort as expressed by risk of colectomy and risk of development of colorectal cancer, and (ii) assess the impact of long-term sulphasalazine on the natural course of ulcerative colitis. PATIENTS: One hundred and seventy-five patients diagnosed between 1972 and 1981 with either total colitis (n = 143) or with limited ulcerative colitis but deceased (n = 32) were identified. Overall there was 98% case ascertainment and verification. RESULTS: A total of 49 patients underwent a colectomy, 6 as emergency laparotomies, 36 for failed medical management and 7 for known colorectal cancer, giving a crude colectomy rate of 23.2%. The colectomy rate was 7.2% in the year of diagnosis, decreasing in frequency over the next 4 years, then reaching a steady state of approximately 1.7% per year. In the total cohort, colorectal cancer occurred in 10 patients within the study period. The cumulative incidence of colorectal cancer 10 years after diagnosis was 2.1% and at 20 years 7.4% for the total group of patients excluding those with a colectomy. The mean duration of ulcerative colitis before diagnosis was 7.9 years (range 5-12). The crude proportions developing cancer were 5/152 (3%) in the group who took long-term sulphasalazine but 5/16 (31%) in the those who had had their treatment stopped or who did not comply with therapy. This is highly significant using a simple chi 2 test (chi 2 = 20.2, df = 1, P < 0.001). Two methods were used for survival analyses, the log-rank and the generalized Wilcoxon methods. Both give highly significant values for the crude effect of compliance (P < 0.001). CONCLUSION: Patients with ulcerative colitis who were not on long-term sulphasalazine or 5-aminosalicylic acid therapy (either because a doctor stopped it or they did not comply with treatment) were significantly more likely to develop colorectal cancer than their compliant counterparts.

Adult↗
PubMed2002

Colorectal cancer mortality in first-degree relatives of early-onset colorectal cancer cases.

PURPOSE: Estimates of familial colorectal cancer risks are useful in genetic counseling and as a guide to determining entry into screening programs and trials of chemoprevention. Furthermore, they provide an insight into the contribution of the known colorectal cancer genes to the familial risk of the disease. There is a paucity of data about the familial colorectal cancer risk associated with early-onset disease outside the recognized cancer predisposition syndromes. METHODS: This was a retrospective cohort study. The parents and siblings of 205 patients with colorectal cancer aged less than 55 years at diagnosis were studied for mortality and cancer incidence. RESULTS: The overall standardized mortality ratio of colorectal cancer compared with the Northern Irish population was 3.54 (95 percent confidence interval, 2.59-4.79). There was some evidence that a family history of colorectal cancer is associated with a greater risk of colon (4.16; 95 percent confidence interval, 2.83-5.91) rather than rectal cancer (2.62; 95 percent confidence interval, 1.43-4.40). Risks in parents (2.54; 95 percent confidence interval, 1.45-3.72) were lower than in siblings (6.15; 95 percent confidence interval, 3.90-9.23). CONCLUSION: First-degree relatives of patients with early-onset disease are at a marked increase in risk. There is evidence that risks vary depending on the type of affected relative and by the site of colorectal cancer. This information should be considered in formulating screening strategies.

Adenocarcinoma↗
PubMed1997

Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit.

BACKGROUND: To obtain information on the contemporary management of colorectal cancer in the UK to assist in the development of management guidelines, an independent, 1-year population audit was carried out in Trent Region and Wales. METHODS: Data were collected on all patients admitted to hospital with a new diagnosis of colorectal cancer in a 1-year period. RESULTS: Of 3520 patients, 3221 (91.5 per cent) had surgery. Emergency/urgent operations were carried out as the first procedure in 552 (17.1 per cent). Resection of the primary disease was achieved in 2859 (81.2 per cent) and this was deemed curative in 2070 (58.8 per cent). Twenty-one per cent of all patients had metastatic disease at presentation. Overall, 30-day operative mortality was 7.6 per cent (21.7 per cent for emergency/urgent and 5.5 per cent for scheduled/elective procedures). Anastomotic dehiscence occurred in 105 patients (4.9 per cent); this was 3.9 per cent after colonic resections and 7.9 per cent after anterior rectal resections. Elective rectal excision resulted in a permanent stoma in 486 of 1054 patients (46 per cent). CONCLUSION: This initial report from a comprehensive, independent audit of colorectal cancer management shows improvement in some aspects of treatment as evidenced by improved anastomotic dehiscence and stoma rates when compared with previous studies. However, there has been little improvement in the proportion of patients presenting with advanced disease, and curative resection rates remain low.

Colonic Neoplasms↗
PubMed1995

Screening reduces colorectal cancer rate in families with hereditary nonpolyposis colorectal cancer.

BACKGROUND/AIMS: The inherited susceptibility to hereditary nonpolyposis colorectal cancer (HNPCC) provides an opportunity for secondary prevention of colorectal cancer (CRC) in family members who are at 50% lifetime risk. The aim of this study was to evaluate the effectiveness of long-term screening during a 10-year period. METHODS: The CRC and death rates were compared between two groups of asymptomatic at-risk members of 22 families with HNPCC: 133 subjects screened at 3-year intervals by colonoscopy or barium enema and sigmoidoscopy and 118 control subjects without screening. The screening was complete in 118 subjects (89%), whereas 18 control subjects (15%) had screening examinations outside of the study. RESULTS: CRC occurred in 6 study subjects (4.5%) and in 14 controls (11.9%; P = 0.03), a difference of 7.4% in favor of the study group, which corresponds to a reduction by 62% that is presumably because of polypectomies. The tumor stage was more favorable in the screening group with no deaths caused by CRC compared with 5 of 14 cases in controls. Overall, there were 6 and 12 deaths within the 10-year period in the study and control groups, respectively (P = 0.08). CONCLUSIONS: The 3-year interval screening more than halves the CRC rate in at-risk members of families with HNPCC and seems to prevent CRC deaths.

Adult↗
PubMed1999

Colorectal cancer screening.

Colorectal cancer is the second most lethal cancer in the United States. The lifetime risk of developing colorectal cancer in the United States is 5%. Early detection decreases mortality, and involves stratifying individuals by risk factors. Clinicians can use several methods for detection and surveillance of colorectal cancer including the digital rectal exam (DRE), fecal occult-blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. Several groups offer guidelines recommending specific screening techniques and intervals. In general, a combination of an annual FOBT and a flexible sigmoidoscopy every 5 years is recommended for average-risk individuals. Colonoscopy is the gold standard for visualizing the entire colon, and is reserved for abnormal findings on FOBT or flexible sigmoidoscopy or for individuals of greater-than-average risk for colorectal cancer.

Barium Sulfate↗
PubMed1987

Prevention of colorectal cancer. Role of association between gallstones and colorectal cancer.

A significant association was found between colorectal cancer, especially of the right colon, and concomitant gallstones. This was noted especially in female patients and in those over the age of 65. The existence of such an association is of advantage in terms of secondary prevention of colorectal cancer. The possible screening methods are discussed for those gallstone patients at risk.

Adenocarcinoma↗
PubMed2006

Interferon regulatory factor-5-regulated pathways as a target for colorectal cancer therapeutics.

Colorectal cancer is the second most common cause of cancer-related death. A significant obstacle to successful management of patients with colorectal cancer is intrinsic drug resistance or, in patients who initially responded to chemotherapy, acquired drug resistance. Failure in normal apoptotic pathways often contributes to resistance to anticancer drugs or radiotherapy. As a result, the identification of genes that control cell death and apoptosis has come to the forefront of cancer research, leading to new targets and novel therapeutic strategies in the treatment of colorectal cancer. To this effect, the authors have recently identified a new apoptotic signaling pathway that occurs through the transcription factor interferon regulatory factor-5. Here, the different strategies for targeting the interferon regulatory factor-5 signaling pathway in colorectal cancer are discussed. These strategies can be applied to a new generation of cytotoxic agents, as well as to novel biological compounds that are directed at inducing and/or activating interferon regulatory factor-5 or key components of this pathway.

Apoptosis↗
PubMed1996

[Early colorectal cancer].

Early colorectal cancer is situated at the field with a rich stock of topics in Japan. For this reason, there are increasing number of patients with colorectal cancer, many reports of depressed early cancer and rapid advances of molecular biology about colorectal neoplasm. Most of early colorectal cancers are discovered to be the protruded type by all accounts in spite that many cases of depressed type early cancer have been reported in many Japanese institutes. The final diagnosis of early colorectal cancer is usually made by histological examination after endoscopic resection, however invasive cancers with distinct endoscopic appearance of submucosal spread should be treated surgically from the beginning after diagnosis on biopsy specimens.

Colonoscopy↗
PubMed2004

Mutational analysis of OGG1, MYH, MTH1 in FAP, HNPCC and sporadic colorectal cancer patients: R154H OGG1 polymorphism is associated with sporadic colorectal cancer patients.

MYH, OGG1 and MTH1 are members of base excision repair (BER) families, and MYH germline mutations were recently identified in patients with multiple adenomas or familial adenomatous polyposis (FAP). A total of 20 APC-negative Korean FAP patients were analyzed for OGG1, MYH and MTH1 germline mutations. A total of 19 hereditary nonpolyposis colorectal cancer (HNPCC), 86 suspected HNPCC, and 246 sporadic colorectal cancer cases were investigated for OGG1 and MYH mutations. A total of 14 R154H OGG1 polymorphisms were identified in hereditary, sporadic colorectal cancers, and normal controls. For the case-control analysis of OGG1 R154H, a total of 625 hereditary or sporadic colorectal cancer patients and 527 normal controls were screened. R154H was a rare polymorphism associated with sporadic colorectal cancer patents (OR: 3.586, P= 0.053). R154H does not segregate with cancer phenotypes. Upon examining the possibility of recessive inheritance of R154H, we could not identify any complementary mutations in OGG1, MYH or MTH1. Samples with R154H were further screened for mutations of K-ras, beta-catenin, APC, p53, BRAF and the microsatellite instability (MSI) status. Eight somatic mutations were identified in these genes and G:C to T:A transversion mutations were not dominant in samples harboring R154H. This result raises the possibility that OGG1 R154H may function as a low/moderate-penetrance modifier for colorectal cancer development.

Adenomatous Polyposis Coli↗
PubMed2005

Clinicopathologic significance of synchronous and metachronous adenomas in colorectal cancer.

PURPOSE: Colorectal cancers (CRCs) evolve from a multiple-step tumorigenesis and, morphologically, are characterized by adenoma. Colorectal cancers with adenomas have distinct clinical features, including reports of improved survival. It is hypothesized that this survival advantage is related to biologic differences in CRC with adenomas rather than earlier diagnosis or earlier stage of disease presentation. PATIENTS AND METHODS: A retrospective chart review of 569 patients treated from 1983 through 2002 was conducted. Data on age, sex, and survival; CRC stage, location, and recurrence; adenoma number, size, histology, and location; and colonoscopy history were analyzed. RESULTS: The mean patient age was 62 years (range, 17-90 years), and 54% of patients were men. The majority of CRCs were left-sided (67%). The American Joint Committee on Cancer stage distribution was 0/I (12%), II (21%), III (34%), and IV (33%). Colorectal cancer with synchronous adenoma was seen in 33% of cases; overall, CRC with adenoma comprised 42% of cases. The event-free survival and overall survival favored CRC with adenoma. After adjusting for age, disease stage, sex, and total number of colonoscopic examinations, the relative risk for an event was 1.51 (P < 0.003) for patients without adenomas versus those with adenomas. CONCLUSION: Colorectal cancer with adenoma represents a distinct population of patients with CRC. The apparent association seems to confer a survival advantage that is not based on age, sex, or disease stage. The survival benefit, although slightly less dramatic, remained significant even when controlled for the number of colonoscopies.

Adenoma↗
PubMed2000

[New drugs in the treatment of advanced colorectal cancer].

BACKGROUND: Colorectal cancer is one of the leading cancers in industrialised countries in terms of incidence and mortality. Advanced colorectal cancer has traditionally been treated with 5-fluorouracil, alone or in combination with leucovorin. This treatment has shown response rates of 10-25%; however, little effect has been observed on survival. MATERIAL, METHODS AND RESULTS: In recent years, a number of new drugs for advanced colorectal cancer have been developed and tested. We have made a comprehensive survey of the literature and find that phase II and phase III clinical studies show improved response rates compared to the traditional use of 5-fluorouracil and leucovorin. Thymidylate-synthase inhibitors, oxaliplatine and topoisomerase inhibitors, used singly or in combination, improve response rates and show a significant effect on survival in patients with metastatic colorectal disease. INTERPRETATION: Several new drugs now available in hospital treatment of metastatic colorectal cancer show improved response and increased survival compared to traditional 5-fluorouracil regimens.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Tobacco use and increased colorectal cancer risk in patients with hereditary nonpolyposis colorectal cancer (Lynch syndrome).

BACKGROUND: The marked variability in age at onset of colorectal cancer (CRC) in patients with hereditary nonpolyposis colorectal cancer (HNPCC) makes management decisions difficult. Environmental factors governing the phenotypic variability of cancer-associated syndromes such as HNPCC have not been elucidated. METHODS: We determined whether tobacco use would alter CRC risk in carriers of HNPCC-associated mutations, using a retrospective cohort study of germline mutation (hMLH1 or hMSH2) carriers from the Hereditary Cancer Institute at Creighton University, one of the oldest and largest registries of HNPCC patients. The main outcome measure was age at CRC onset, estimated by means of Cox proportional hazards modeling. RESULTS: Tobacco use, hMLH1 mutation carriage (as opposed to hMSH2), and male sex were significantly associated with increased risk of CRC (hazard ratios, 1.43, 2.07, and 1.58, respectively). Alcohol use did not alter CRC risk. CONCLUSIONS: Smoking cessation should be an integral part of HNPCC management. This study underscores the gene x environment interactions in cancer development.

Adaptor Proteins, Signal Transducing↗
PubMed2001

The role of inadequate health literacy skills in colorectal cancer screening.

Colorectal cancer is ideally suited for early detection strategies that are likely to improve survival rates. Screening with either a fecal occult blood test (FOBT) or flexible sigmoidoscopy has been shown to identify precancerous polyps or cancers in early stages. However, persons with limited education and of lower socioeconomic status infrequently participate in screening programs in general and have very low rates of colorectal screening. Low literacy, which is common among persons with limited education and low income, may be an overlooked factor in understanding patients' decision making about colorectal cancer screening. This article provides information from focus groups about colorectal cancer screening, which we examine in the context of relevant literature on cancer screening and literacy. Using the health belief model, we examine the association between inadequate health literacy skills and low rates of colorectal cancer screening. The theoretical model also provides insights into strategies for improving knowledge, attitudes, and beliefs and screening rates for this challenging patient population.

Colorectal Neoplasms↗
PubMed2003

Review article: colorectal cancer chemotherapy.

Colorectal cancer is a leading cause of cancer death world-wide. There have been important advances in the chemotherapeutic management of colorectal cancer as a result of a deliberate collaborative process of well-designed clinical trials. From the earlier standard of 5-fluorouracil-based therapy alone, the recent availability of newer agents, including capecitabine, irinotecan and oxaliplatin, has significantly expanded the options available for the management of patients with advanced colorectal cancer, with consequent improvements in survival. For patients with resected, high-risk, localized disease, adjuvant systemic chemotherapy improves survival. The identification of new chemotherapy regimens, the use of predictive testing and the integration of novel targeted therapies with cytotoxic chemotherapies are areas of active clinical investigation. A review of the chemotherapeutic management of colorectal cancer is presented.

Antineoplastic Agents↗
PubMed2002

Serum progesterone levels in patients with gastric and colorectal cancers.

BACKGROUND: It is known that various malignant tissues possess progesterone receptors. It has been reported that the serum progesterone levels increase and show a prognostic significance in gastric carcinoma. We carried out a study to determine the serum progesterone level in gastric cancer, and colorectal cancer. METHODS: 140 of our patients were male and 56 female. We determined serum progesterone level in patients with gastric cancer, and colorectal cancer. Patients with benign diseases participated in the study as control group. RESULTS: In male patients with gastric cancer (n = 90) and colorectal cancer (n = 50) the serum progesterone level was not significantly higher than in the control group (n = 80) (mean: 1.08 +/- 0.73, 1.08 +/- 0.32 and 1.01 +/- 0.38 ng/ml, respectively). Among the female patients with gastric cancer (n = 26) and colorectal cancer (n = 30), the serum progesterone level was also not significantly higher than in the control group (n = 30) (mean: 1.19 +/- 0.77, 1.21 +/- 0.72 and 1.12 +/- 0.61 respectively). In males, the sensitivity of progesterone for gastric cancer was 55.5% and 64% for colorectal cancer with a specificity of 37.5%. In females, the sensitivity of progesterone for gastric cancer was 54% and 57% for colorectal patients with a specificity of 40%. CONCLUSIONS: Serum progesterone level does not correlate with the presence or absence of gastric cancer or colorectal cancer, and it is not a useful tumour marker.

Adenocarcinoma↗
PubMed2002

Serum HCG beta, CA 72-4 and CEA are independent prognostic factors in colorectal cancer.

In colorectal cancer, stage is considered to be the strongest prognostic factor, but also serum tumour markers have been reported to be of prognostic value. The aim of our study was to investigate the prognostic value of serum carcinoembryonic antigen (CEA), CA 19-9, CA 242, CA 72-4 and free beta subunit of human chorionic gonadotropin (hCG beta) in colorectal cancer. Preoperative serum samples were obtained from 204 colorectal cancer patients, including 31 patients with Dukes' A, 70 with Dukes' B, 49 with Dukes' C and 54 with Dukes' D cancer. The serum levels of CEA, CA 19-9, CA 242 and CA 72-4 were measured with commercial kits with cut-off values of 5 microg/L for CEA, 37 kU/L for CA 19-9, 20 kU/L for CA 242 and 6 kU/L for CA 72-4. The serum hCG beta was quantitated by an immunofluorometric assay (IFMA) with 2 pmol/L as a cut-off value. Survival analyses were performed with Kaplan-Meier life tables, log-rank test and Cox proportional hazards model. The sensitivity was 44% for CEA, 26% for CA 19-9, 36% for CA 242, 27% for CA 72-4 and 16% for hCG beta. The overall 5-year survival was 55%, and in Dukes' A, B, C and D cancers the survival was 89%, 77%, 52% and 3%, respectively. Elevated serum values of all markers correlated with worse survival (p < 0.001). In Cox multivariate analysis, the strongest prognostic factor was Dukes' stage (p < 0.001), followed by tumour location (p = 0.002) and preoperative serum markers hCG beta (p = 0.002), CA 72-4 (p = 0.003) and CEA (p = 0.005). In conclusion, elevated CEA, CA 19-9, CA 242, CA 72-4 and hCG beta relate to poor outcome in colorectal cancer. In multivariate analysis, independent prognostic significance was observed with hCG beta, CA 72-4 and CEA.

Adult↗
PubMed1998

Colorectal cancer--chemoprevention.

Colorectal cancer is the second leading cause of death from cancer in The United States. During the last fifteen years, emphasis has been placed on identification of high risk patients and families and outline of appropriate surveillance regimens for normal and high risk patients for colorectal cancer. Parallel to this effort, abundant clinical data has been accumulated that chemoprevention of colorectal cancer with nonsteroidals and aspirin may be possible. Interruption of prostaglandin metabolism appears to be one of the mechanisms of action but not the only therapeutic arm. Currently, sulindac, aspirin, calcium and selenium supplementation are attractive recommendations to at risk patients awaiting results of clinical trials. Other agents in development add excitement to the concept of colorectal cancer chemoprevention.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

[Evidence-based colorectal cancer screening].

Colorectal cancer has been identified as an appropriate candidate for early detection and treatment of both asymptomatic individuals and those at risk of the disease. The lifetime incidence of colorectal cancer among persons at average risk is sufficiently high to justify screening the general population. This review presents the latest strategies employed in early detection of the colorectal cancer. An ideal screening test should satisfy some basic criteria: must be simple, secure, accepted by the population with valid and reproductive results. Despite the demonstrated benefits of colorectal cancer screening, incidence and mortality rates of this common cancer remain high. More optimally tailored screening tools are needed that combine the features of a potentially ideal screening test.

Colonoscopy↗