Tag Archives: colorectal cancer

Colorectal Carcinoma in a Patient with Situs Inversus Totalis

DOI: 10.1515/amma-2017-0039

Introduction: Colorectal cancer is one of the most common types of malignant tumors worldwide. In patients with situs abnormalities such as situs inversus totalis or situs ambiguus, the presence of this tumor could be a challenge for the surgeon, especially in cases in which the laparoscopic approach is considered.
Case presentation: We report the case of a 69-year-old male patient with situs inversus totalis. This particular case of situs inversus totalis was not a classical type because the patient had bilateral bilobed lungs, polysplenia, preduodenal portal vein in association with midgut malrotation. The pathology report after surgery revealed moderately differentiated adenocarcinoma of the sigmoid colon, stage pT3 N1c M1a, liver metastases but without metastases in the eight resected lymph nodes. We compared this rare association of diseases of particular anatomic aspects with other reports in the specialty literature.
Conclusion: The identification of situs abnormalities or other malformations in patients with resectable colorectal cancer is essential, thus preoperative imaging studies are imperative for a proper surgical management. Colorectal cancer metastasizing patterns in patients with intestinal malrotation need to be further investigated.

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The Role of Smoking in the Development of Colorectal Cancer

DOI: 10.1515/amma-2016-0046

Introduction. Smoking is an important public health issue nowadays. It causes a lot of diseases and represents also a source of carcinogenic substances. Recent studies showed an increased incidence of colorectal cancer in smokers. The aim of our study is to assess the association between smoking and colorectal cancer and to establish the prevalence of heavy smokers among the patients operated on for colorectal cancer.
Methodology. We run a retrospective study of the charts belonging to the patients diagnosed with colorectal cancer and operated on in our department between 2004 and 2013. The patients were classified in smokers, former smokers and nonsmokers. The amount of tobacco was evaluated according to the number of smoked cigarettes per day, the smoking period, respectively the pack-years. The data were corroborated with the location of the tumor and analyzed using the online version of Graphpad.
Results. From 982 patients diagnosed with colorectal cancer, we found 297 smokers (30.24%). Among these, 106 patients (35.69%) have smoked for over 30 years, at least 20 cigarettes per day, more than 30 pack-years. The number of heavy smokers was significantly greater (p=0.0001) in the group with rectal cancer compared to the group with colon cancer. The association of smoking with rectal cancer was also important (p=0.0015) among the former smokers.
Conclusions. Smoking is related to higher incidence of colorectal cancer. Our data sustain the hypothesis of increased risk of developing rectal cancer in heavy smokers. We recommend the screening for colorectal cancer among the heavy smoker population.

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Smoking and the Risk of Colorectal Cancer and Colorectal Polyps

Purpose: Tobacco is one of the risk factors in colon cancer and colon polyps. We have studied the connection between smoking and the risk of developing the colorectal cancer and colorectal polyps.
Materials and methods: Our study refers to patients with mucosal modifications at the colon level, hospitalized and colonoscopy investigated in the 1st Clinic of Gastroenterology, Tg Mures between 2008–2010.
Results: There were 193 patients with colorectal cancer and colorectal polyps compared with 206 control patients investigated in the same hospital. From the study group, 53 patients (27.46%) were ‘current smokers’ compared with ‘control patients’ 27 patients (13.10%). As a result of this comparison there was a significant association with an increased risk for colorectal cancer and colorectal polyps (OR = 2.77, CI: 1.64–4.67). It was also observed a significant increased tendency of the risk for the colorectal polyps and colorectal cancer in parallel with the increase of the number of smoked cigarettes per day and years of cigarette smoking (< 10 cigarettes/day – OR = 1.03, CI: 0.45–2.33; 10-20 cigarettes/day – OR = 4.47, CI: 1.73–10.55; > 20 cigarettes/day – OR = 5.41, CI: 2.13–13.72 and < 10 years of cigarette smoking OR = 1.41, CI: 0.63–3.16; 10–20 years of cigarette smoking OR = 3.63, CI: 1.46-8.98; > 20 years of cigarette smoking OR = 4.43, CI: 1.83–10.74).
Conclusions: A high exposure to cigarette smoking is strongly associated with an increased risk of colorectal cancer and colorectal polyps.

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Multimarker Phenotypes of Colorectal Cancer

Objective: We tried to correlate the clinico-pathologically features of colorectal cancer (CRC) to expression of eight immunohistochemically (IHC) markers and microsatellite instability (MSI) in order to realyze a molecular subdivision of these tumors.
Methods: 300 CRC, surgical specimens, were statistically and IHC evaluated. MSI status was analyzed in 52 cases, with Real Time PCR, melting point analysis. The following IHC markers have been used: CD8, E-cadherin, HER-2, p53, Ki67, bcl-2, MLH-1, CEA. The molecular phenotypes have been reported to the node status (pN) and MSI.
Results: Based on statistically analyses, we revealed that CEA and Ki67 were not prognostic factors. MLH-1 may indicate the MSI status and the number of tumor inflitrated lymphocytes stained with CD8 seems to be higher in the MSI cases and tumors of the proximal colon. HER-2 expression was correlated to number of the lymph node metastatses and bcl-2 was negative is most of the CRC diagnosed in advanced stages.
Conclusions: The CRC may be subdivided in six molecular prognostic groups, the best prognosis showing the MSI/p53-/bcl-2+/HER-2- and the worst MSS/p53+/bcl-2±/HER-2+. These molecular subdivision may be the basis for targeted therapy in node negative CRC.

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Liver Metastases: Incidence and Clinicopathological Data

Aim: To investigate the clinicopathological features of liver metastases diagnosed in Mureș County, Romania.
Material and method: We performed a retrospective study based on data collected from histopathological reports stored in the archives of the Pathology Laboratories of Emergency Mures County Hospital, Romania. We selected those patients’ data that were diagnosed with liver metastases during January 2004 – August 2011. The acquired data were collected and processed statistically by using the GraphPad InStat Demo 3 statistical software.
Results: We identified 748 liver tumours out of which 484 were liver metastases. The liver metastases: primary liver tumours ratio was 1.833:1. In cases of liver metastases, the male:female ratio was 1.45:1. The mean age of male patients was 62.13 (±10.79 years) as for female patients it was 61.61 (±10.82 years). In most of the cases (34.71%) the primary tumor was colorectal carcinoma followed by pancreatic carcinomas (16.52%).
Conclusions: Most cases of liver metastases are carcinomas, whereof the most frequent ones originate from the digestive area, respectively gastrointestinal tract and pancreas. Independently by the primary tumour, liver metastases occur more frequent in males, in their 7th decade of life.

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Imaging the Adverse and Late Effects in the Treatment of Colorectal Cancer

Side effects are common in the clinical practice and its diagnosis and radiologic manifestations are not always evident or known. Adverse effects may cause medical complications of a disease or a procedure and negatively affect its prognosis. Several typical patterns can be recognized on imaging and making a correct diagnosis has relevant clinical and therapeutic implications.
In this article we present a part of our preliminary results of the retro- and prospective study started in 2009 in the National Institute of Oncology. The aim of the study is to evaluate the imaging diagnostic examinations (US, CT, MR, PET/CT) of patients who have been diagnosed, treated and operated in the Hungarian National Institute of Oncology from 01 January, 2008. In this part we analyze the post-therapeutic consequence symptoms, side- and late effects during the treatment of colorectal cancer patients.

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Obesity and Metabolic Syndrome as Risk Factors of Colorectal Polyps and Colorectal Cancer

Purpose: Obesity and metabolic syndrome, each represent one of the risk factors in colon cancer and colon polyps. We have studied the association between obesity, metabolic syndrome and the risk of developing colorectal cancer and colorectal polyps.
Materials and methods: Our study refers to patients with mucosal modifications at the level of the colon, hospitalized and investigated through colonoscopy in the Gastroenterology Clinic 1, Tîrgu Mureș between 2008–2011.
Results: There were 324 patients with colorectal cancer and colorectal polyps, compared with 345 control patients investigated in the same hospital. In the study group, 69 patients (21.29%) were overweight (BMI 25–29.99 kg/m2) and 71 patients (30.90%) were obese (BMI> 30 kg/m2), compared with the control group, where 53 patients (15.36%) were overweight and 32 patients (9.26%) were obese. There was a significant association between obesity and risk for colorectal cancer and colorectal polyps: BMI >30 kg/m2 – OR = 2.89, CI: 1.64–5.10. We also observed a significant increase in the risk for colorectal polyps and colorectal cancer in parallel with the increase of the number of metabolic syndrome components: 1 component – OR = 1.55, CI: 1.09–2.20; 2 components OR = 2.42, CI: 1.54–3.81; 3 components OR = 2.37, CI: 1.16–4.81; 4 or more components OR = 5.27, CI: 1.07–25.85.
Conclusions: The results of our study showed that obesity and metabolic syndrome are associated with an increased risk for the development of colorectal polyps and colorectal cancer.

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Alcohol Consumption and the Risk of Developing Colorectal Cancer and Colorectal Polyps

Purpose: Among other risk factors in the developing of colorectal polyps and colorectal cancer, alcohol consumption represents a real risk factor. We have studied the association between alcohol consumption and the risk of developing colorectal cancer and colorectal polyps.
Materials and methods: We conducted a retrospective study reviewing the medical records of all consecutive patients hospitalized with mucosal modifications at the colon level, investigated by colonoscopy in the 1st Clinic of Gastroenterology of Tîrgu Mureș between 2008 and 2011.
Results: We analyzed 324 patients with colorectal cancer and colorectal polyps, compared with 352 control patients investigated in our medical institution. We had 87 patients with colorectal cancer, out of which 1 patient was an ex-drinker, 31 were occasional drinkers and 17 regular drinkers. We found a strong positive association between alcohol consumption and the risk of colorectal cancer: ex drinkers – statistically insignificant; occasional drinkers – OR = 4.04, CI: 2.31–7.06; regular drinkers – OR = 5.45, CI: 2.65–11.18. Concerning the 237 patients with colorectal polyps we obtained similar results: 5 ex-drinkers – statistically insignificant; 76 occasional drinkers – OR = 3.46, CI: 2.28–5.23; 47 regular drinkers – OR = 5.25, CI: 3.05–9.13.
Conclusions: Our results suggest that alcohol consumption elevates the risk of colorectal polyps and colorectal cancer.

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The Association of Cholelithiasis and Colorectal Cancer

DOI: 10.2478/amma-2014-0004

Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group.
Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1st, 2005 – December 31st, 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor.
Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39–88 years), females were more affected. The most common locations were: the sigmoid colon (26.5%), rectum (36.3%) and the most common histological form was moderately differentiated adenocarcinoma.
Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship.

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