Adenocarcinoma Of Transverse Colon Research Articles

New findings in prognostic factor assessment for adenocarcinoma of transverse colon: a comparison study between competing-risk and COX regression analysis.

Competing-risk analysis was used to accurately assess prognostic factors for cancer-specific death in patients with adenocarcinoma of transverse colon (ATC), and the results were compared with those from a conventional Cox regression analysis. Patients diagnosed with ATC between 2000 and 2019 were selected from the Surveillance, Epidemiology, and End Results database. The crude mortality rates of patients with ATC were calculated and their differences were tested using the Gray's test, respectively. In performing multivariate analysis, the Cox regression model and the subdistribution hazard function (SD) in competing risk analysis were utilized, respectively. This study included 21,477 eligible patients. The SD model indicated that age, etc. are actual independent prognostic factors. In contrast to previous recognition, the results of the Cox regression showed false-positives for sex and Carcinoembryonic antigen, and underestimated point-estimates in the stage and American Joint Committee on Cancer stage due to competing events. A detailed comparison of treatment revealed that the larger surgical scopes were prognostic risk factors compared with the smaller scope of local tumor excision, partial colectomy, or segmental resection. Patients treated with external proton beam radiotherapy had an increased risk compared with those with no radiotherapy and internal radiotherapy. After comparing the results of the two methods and mitigating the significant bias introduced by Cox regression, we found independent factors that really affect the prognosis of ATC. On the other hand, in terms of ATC, a larger surgical scope and external proton beam radiotherapy may not improve the long-term survival of patients. Therefore, when faced with ATC patients, these differences should be noted and treated differently from common colorectal cancer patients. Thus, clinicians are able to give more targeted treatment plans and prognostic assessments.

Abdominal Wall Abscess: An Infrequent Presentation of Colon Adenocarcinoma

Introduction: Colonic carcinoma has a variety of clinical presentations, however, invasion of the abdominal wall arising from the transverse colon is a rare one, as seen in this case report. Case report: 62-year-old patient with diffuse high intensity abdominal pain, fever, nausea, vomiting and an epigastric abscessed heterogeneous mass (8 x 7 x 7cm). A water-soluble contrast enema was performed, showing diverticula, absence of distal colon contrast transition and the apple core sign, compatible with transverse colon obstruction. A transverse colectomy was performed, with primary colo-colonic end-to-end anastomosis, including omentectomy and complete en-bloc resection of the affected abdominal wall area. The histopathological findings showed a transverse colon adenocarcinoma with abdominal wall invasion; all surgical margins were free of disease (R0), and 24 lymph nodes were retrieved. Patients’ recovery was successful. Discussion: Locally advanced colorectal cancers invade adjacent organs without distant metastases. They may result in abscess formation even in unusual locations like the abdominal wall, which is a rare complication (0.3 to 4%). Colon cancer diagnosis before surgery may not always be possible; and a flawed diagnosis can determine an incomplete treatment because the intraoperative macroscopic malignancy recognition is not always achievable. En-bloc resection is the gold standard treatment to accomplish a complete resection, with histologically negative margins and no residual tumor (R0). Conclusion: Colon adenocarcinoma may rarely present as an abdominal wall abscess. Image studies may include CT, radiography, etc. but the patient’s clinical status should always be prioritized; those who present abdominal obstruction with a high risk of sepsis and mortality should be offered immediate surgical treatment. En-bloc resection is the gold standard to accomplish histologically negative margins and no residual tumor.

Laparoscopic radical transverse colectomy with transrectal specimen extraction: A novel natural orifice specimen extraction procedure: A case report.

Transverse colon cancer accounts for about 10% of all colonic cancers. The resection of cancers in the transverse colon is technically more challenging, compared with other cancer locations in the colon because the variable anatomy of the middle colic vessels demands excellent surgical skills and the anatomical location of the transverse colon is related to major organs. We report a novel laparoscopic technique for the first time used in surgery of transverse colon cancer which combines a total intracorporeal anastomosis with natural orifice specimen extraction to solve the problems of traditional laparoscopic surgery. A 48-year-old male patient, whose diagnosis was transverse colon adenocarcinoma, was admitted to the hospital. The surgery was performed in accordance with the procedure of totally laparoscopic right hemicolectomy and the specimen was extracted by opening the rectum. Natural orifice specimen extraction surgery has many advantages, including less pain, better cosmesis and minimising risks of complications and also has comparable long-term outcomes compared to conventional laparoscopic surgery.

Transverse colon adenocarcinoma with direct cutaneous extension: complex multidisciplinary surgical management.

Article Transverse colon adenocarcinoma with direct cutaneous extension: complex multidisciplinary surgical management was published on June 1, 2022 in the journal Journal of Osteopathic Medicine (volume 122, issue 6).

Endoscopic Findings in Patients With PTEN Hamartoma Tumor Syndrome Undergoing Surveillance.

Phosphatase and tensin homolog hamartoma tumor syndrome (PHTS) is an inherited disorder that increases the risk for cancer in multiple organ systems, including breast, endometrial, thyroid, and the gastrointestinal tract. Surveillance is recommended however there lacks data to describe the change in polyposis phenotype and cancer incidence over surveillance. Our aim is to describe the polyposis phenotype and cancer incidence in PHTS patients undergoing endoscopic surveillance. PHTS patients, ages 17 through 89, who underwent at least 2 esophagogastroduodenoscopy (EGDs) or colonoscopies were identified. Number and sizes of polyps were noted, from which 5 categories were recreated. Incidence of colorectal and gastric cancer was evaluated. Seventy patients were included. Patients were clustered and classified into 1 of 5 categories: no polyps, few small polyps (<1 cm, < 10 polyps), few large polyps (≥1 cm, < 10 polyps), many small polyps (<1 cm, ≥10 polyps), many large polyps (≥1 cm, ≥10 polyps). There was no significant difference in polyp number or size on EGD (P=0.47 and 0.83, respectively) or colonoscopy (P=0.49 and 0.10, respectively) over the surveillance period (4.8±3.9 y for stomach and 5.6±4.4 y for colon). The average interval between endoscopies was 28±24 months for EGDs and 29±23 months for colonoscopies. A stage II transverse colon adenocarcinoma and stage IV gastric adenocarcinoma were identified. Standardized incidence rates for gastric and colon cancers were 5427 (P=0.0002) and 353 (P=0.002), respectively. PTHS individuals can be classified into polyposis phenotypes which do not change over an endoscopic surveillance period. Two cancers were associated with a large size polyp phenotype. Surveillance intervals should be determined by polyp size ≥1 cm and pathology.

Hypertriglyceridemia induced by S-1: A novel case report and review of the literature

S-1, a compounding agent of tegafur, gimeracil, and oteracil potassium, is one of the most effective chemotherapeutic agents for colorectal cancer. In this case, following S-1 administration, we observed predominant elevation of serum triglyceride. A 49-year-old man with stage IV transverse colon adenocarcinoma received S-1 + irinotecan + bevacizumab. At the end of the S-1 administration period in every course, his serum triglyceride level was found to be elevated. Finally, it reached grade 4, without any symptoms of acute pancreatitis in the fifth course, and fenofibrate 80 mg once a day was administered.Management & outcome: Interestingly, the elevation spontaneously normalized without any pharmacotherapy 14 days after S-1 withdrawal, and this elevation did not occur when S-1 was not administered. Further, fenofibrate administration attenuated the hypertriglyceridemia to grades 1-3, with no complications. S-1 administration induced hypertriglyceridemia owing to the elevated serum triglyceride; however, a contrasting result was observed in the S-1 withdrawal period and during the S-1-cessation cycle. Since dietary intake was poorer during the S-1 administration period, it is considered that S-1 might have disturbed lipid metabolism. Further, we know that capecitabine, which is a prodrug of fluorouracil, also induces hypertriglyceridemia. As the end product of these medicines is fluorouracil, the presence of fluorouracil or its metabolizing enzymes, the genetic background of the patient might have affected the results. We have to be aware of the risk of asymptomatic and temporal occurrence of hypertriglyceridemia by S-1 administration for the early detection with appropriate pre-emptive treatment.

Colon Cancer in Patients with Crohn’s Disease and Diabetes Mellitus

Abstract Introduction: Diabetes mellitus and colorectal cancer are diseases with an increasing impact on the population. Colorectal cancer is a well-recognized complication of inflammatory bowel diseases, such as ulcerative colitis and Crohn’s colitis. Here we describe an unusual case of diabetes mellitus, Crohn`s colitis-associated cancer. Case report: We report the case of a 49-year-old woman, known with Crohn's disease and diabetes, who developed a transverse colon adenocarcinoma associated with multiple outbreaks of high-grade or low-grade intraepithelial dysplasia/neoplasia, for which a subtotal proctocolectomy with ileorecto-anastomosis with “J” pouch it was made. Conclusions: The risk of colonic carcinoma in Crohn's disease is increasing. An association of colorectal cancer with diabet mellitus and inflammatory bowel disease has been established. From diagnosis to treatment the management of these cases can be difficult and challenging.

Surgical management of adenocarcinoma of the transverse colon: What should be the extent of resection?

Transverse colon, owing its origin to midgut and hindgut and harbouring a flexure at both ends, continues to pose a surgical challenge. When compared to the rest of the colon, transverse colon adenocarcinoma is relatively uncommon. These cancers usually present late and lie in close proximity to the stomach, omentum, and pancreas. Adequate lymphadenectomy entails dissection around and ligation of the middle colic vessels. Hence, resectional surgery for transverse colon carcinoma is considered difficult. This is more so because of the variation of arterial and venous anatomy. From this perspective, the surgeon is tempted to perform a more radical operation like extended right or left hemicolectomy to secure an adequate lymphadenectomy. Such a cancer has also been dealt with a more limited transverse colectomy with colo‐colic anastomosis. For all these reasons, patients with transverse colon adenocarcinoma were excluded from randomised trials which compared laparoscopic resection with traditional open operation. Surgical literature is yet to establish a definite operation for transverse colon cancer and the exact procedure is often dictated by surgeon's preference. This is primarily because this is an uncommon cancer. The rapid adoption of laparoscopic operation favoured extended colectomy as transverse colectomy can be difficult by minimally invasive technique. However, in the recent past, cohort studies and meta‐analyses have shown equivalent oncological outcome between transverse colectomy and extended colectomy. It is time to resurrect transverse colectomy and consider it equivalent to its radical counterpart for cancers around the mid‐transverse colon.

A Two Generation of Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is a part of genetic polyposis syndrome which is caused by germline mutation in the adenomatous polyposis coli (APC) gene located in chromosome 5q21. The pathognomonic features is formation of hundreds to thousands of colorectal adenoma in late childhood and increase in size and number during adolescence. If left untreated, almost 100% patients will develop colorectal cancer by the age 50 years. We present a case of 26 year old male who complain of rectal bleeding, diarrhea, abdominal bloating, and has multiple polyps on colonoscopic finding. Two years ago, his father was diagnosed with polyposis coli and transverse colon adenocarcinoma. The patient was planned for preventive total colectomy. In conclussion, surgery remains the cornerstone treatment of FAP and surveillance program for early detection of cancer for all family member is very important to reduce colorectal cancer-related mortality.

Identification of the HT-29 cell line as a model for investigating MCT1 transporters in sigmoid colon adenocarcinoma

MCT1 transporters play a crucial role in the symbiotic relationship between humans and their colonic microbiome by facilitating the transport of bacteria-derived short chain fatty acids. Expression of colonic MCT1 transporters, localized in surface epithelial cells, is regulated by luminal butyrate levels. However, MCT1 also transports lactate and can be used by cancer cells to facilitate anaerobic glycolysis. Using immunolocalization techniques, this study investigated whether changes in MCT1 during cancer varied between different colonic regions. Whilst MCT1 abundance did not significantly change in transverse colon adenocarcinoma (P = 0.363, N = 6, paired T-Test), there was an increase in MCT1 in sigmoid colon adenocarcinoma (P = 0.010, N = 21, paired T-test). Using RT-PCR and western blotting, three human intestinal cell lines were tested for their suitability as a MCT1 cancer cell model. Experiments with Caco-2 cells confirmed that they modelled normal cells, with MCT1 only expressed after exposure to butyrate. In contrast, MCT1 was expressed in the absence of butyrate in both HCT-8 and HT-29 cell lines, with consistently high levels of MCT1 protein being present in HT-29 cells. Furthermore, butyrate treatment of HT-29 cells significantly decreased both MCT1 protein abundance (P < 0.001, N = 4, unpaired T-test) and glycosylation of its’ chaperone protein, CD147 (P < 0.001, N = 4, unpaired T-test). These data suggest that (i) MCT1 transporter abundance increases in sigmoid colon adenocarcinoma, and (ii) HT-29 cells are an appropriate cell model with which to investigate MCT1 function in this disease.

Is Robotic Complete Mesocolic Excision Feasible for Transverse Colon Cancer?

Introduction: Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is technically challenging. Robotic technology has been developed to reduce technical limitations of laparoscopy. Yet, no data are available on the role of robotic approach for CME of transverse colon cancer. The aim of this study is to evaluate the feasibility and short-term outcomes of robotic CME in this subset of colon cancer. Methods: A retrospective review of a prospectively maintained database of 29 consecutive patients undergoing robotic CME for transverse colon adenocarcinoma between December 2014 and December 2017 was performed. Data on demographics, tumor characteristics, postoperative 30-day complications, and oncologic outcomes were analyzed. Results: There were 21 (72%) men and 8 women with a mean age of 62.9 ± 15.6 years and a body mass index of 26.4 ± 4.8 kg/m2. Of the 29 robotic CME procedures, 12 patients underwent extended right colectomy, 10 extended left colectomy, 6 subtotal colectomy, and 1 total colectomy. The mean operative time was 321.7 ± 111.3 minutes and estimated blood loss was 106.9 ± 110.9 mL (median, 50; range, 10-400 mL). The intra- and postoperative complication rates were 7% and 24%, respectively. There were no conversions. The mean time to first bowel movement was 3.5 ± 1.3 and length of hospital stay was 7.1 ± 3.0 days. All the resections were R0. The mean number of harvested lymph nodes in extended and subtotal/total colectomy procedures was 36.6 ± 13.1 and 71.0 ± 30.3, respectively. The rate of mesocolic plane surgery was 79%. There were no statistically significant differences between the mesocolic and the intramesocolic/muscularis propria plane resections with respect to clinical characteristics, operative outcomes, and pathology results (P > .05). Conclusions: Robotic CME for transverse colon cancer is feasible and can be a procedure of choice to achieve a good surgical quality.

Initial experience of robotic versus laparoscopic colectomy for transverse colon cancer: a matched case-control study.

BackgroundRobotic surgery for transverse colon cancer has rarely been described. This study reports our initial experience in robotic resection for transverse colon cancer, by comparing robotic transverse colectomy (RC) to laparoscopic transverse colectomy (LC) in terms of safety, feasibility, short-term outcomes, and the surgeon’s psychological stress and physical pain.MethodsThe study population included the first 22 consecutive patients who underwent RC between March 2013 and December 2014 for histologically confirmed transverse colon adenocarcinoma. These patients were compared with 22 matched patients undergoing LC between December 2010 and February 2013. Patients were matched based on age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) score, American Joint Committee on Cancer (AJCC) tumor stage, and tumor location (ratio 1:1). Mortality, morbidity, operative, and short-term oncologic outcomes were compared between groups. The operating surgeon’s stress and pain were assessed before and after surgery on a 0–100-mm visual analog scale.ResultsThe demographic and preoperative characteristics were comparable between RC and LC patients. No group difference was observed for intraoperative complications, blood loss, postoperative pain, time to flatus, time to regular diet, and hospital stay. RC was associated with longer operative time than LC (260 min vs. 225 min; p = 0.014), but the overall operative and robotic time in the RC group decreased over time reflecting the increasing experience in performing this procedure. No conversion to laparotomy was observed in the RC group, while two LC patients were converted due to uncontrolled bleeding and technically difficult middle colic pedicle dissection. Postoperative complications (Dindo-Clavien grade I or II) occurred in 11.3 % of patients with no group difference. Mortality was nil. All resections were R0, with >12 lymph nodes harvested in 90.9 % of RC and 95.5 % of LC patients. The surgeon’s stress was not different between RC and LC, whereas the surgeon’s hand and neck/shoulder pain were significantly lower after RC.ConclusionsRC for transverse colon cancer appears to be safe and feasible with short-term outcomes comparable to LC.

Skeletal Muscle Metastasis Secondary to Adenocarcinoma of Colon: A Case Report and Review of Literature

Introduction: Colon adenocarcinoma frequently metastasizes to the liver, regional lymph nodes, lungs and peritoneum. However, metastasis to the skeletal muscles is extremely rare manifestation of colon adenocarcinoma. To date, only few cases have been reported in the literature. Skeletal muscle metastasis from colon adenocarcinoma usually remains asymptomatic or manifest as swelling and are associated with dismal prognosis. Case presentation: A 28 years old Saudi man known case of adenocarcinoma of transverse colon treated with extended hemi-colectomy and chemotherapy one year back, presented with abdominal wall swelling and right buttock swelling since 8 months. Physical examination revealed right gluteal mass of size 3×2 cm and abdominal wall mass of size 2×2cm. Rest of examination was unremarkable. Computed tomography-Positron emission tomography (CT-PET) showed 3×2 cm lobulated mass arising from gluteus maximus muscle and another mass in rectus abdominis muscle. Incisional biopsy confirmed the metastatic adenocarcinoma of colon. Patient subsequently underwent palliative radiotherapy followed by systemic chemotherapy. At time of publication, patient was alive with progressive disease. Conclusion: Skeletal muscles metastases are rare manifestation of adenocarcinoma of colon and searching for the primary focus in a patient with skeletal muscle metastasis, colon cancer should be considered as differential diagnosis.

Sister mary joseph′s nodule: What lies beneath?

Dear Editor, We recently had a 79-year-old male with no significant medical history who was referred to our hospital for a pulmonary embolism. During examination a 5 cm × 5 cm fungating mass was discovered on his belly [Figure 1]. Patient reported that the mass has been present for months and gradually increasing in size. A computed tomography scan of chest, abdomen and pelvis revealed no other abnormality. The biopsy of mass revealed moderately differentiated adenocarcinoma with stain consistent with tumor of lower gastrointestinal tract. A colonoscopy confirmed adenocarcinoma of transverse colon. Figure 1 A 5 cm ×5 cm fungating mass on patient's periumbilical area This rare manifestation of metastatic disease was recognized by a surgical assistant of Dr. William Mayo, Sister Mary Joseph, whose name has since been used to explain these umbilical nodules.[1] These metastatic lesions are mostly from gastrointestinal (52%) and gynecological neoplasms (28%), most commonly from the stomach (23%), colon (15%), pancreas (10%), and ovary (16%), and less frequently from the uterus, cervix, gallbladder, and small intestine.[2] Metastatic lesions can reach the umbilicus via spread through lymphatic ducts, the venous network, arterial spread, contiguous extension, or even through iatrogenic seeding with laparoscopy. These different pathways may help explain why there is such a wide group of malignant tumors that can produce these nodules.[3] The presence of these lesions is often a poor prognostic factor, as these patients have advanced metastatic disease at the time of initial diagnosis. In several studies, the average survival after the appearance of these nodules was approximately 10-11 months.[4] Sister Mary Joseph nodule is a rare first manifestation of colon cancer. Physicians should be aware of this unusual presentation of colon cancer.

A Case of Adenocarcinoma of the Transverse Colon with Humoral Hypercalcemia of Malignancy

것 이외에 과거력과 가족력에서 특이 소견은 없었다. 최근 2개월 간 5 kg의 체중 감소가 있었고, 입원 당시 체온은 36.2C, 맥박수 108 회/분, 호흡수 24회/분, 혈압 120/95 mmHg이었다. 복부 진찰에서 우상복부에 비교적 단단하게 유착되어 있는 복부 종괴가 만져졌으나, 압통이나 반발통은 없었다. 혈액검사에서 백혈구 11,100/mm, 혈색 소 13.8 g/dL, 혈소판 248,000/mm였으며, 혈청생화학검사에서 총 단백 5.4 g/dL, 알부민 3.0 g/dL, 칼슘 9.1 mg/dL, 인 2.7 mg/dL, BUN 16 mg/dL, creatinine 0.7 mg/dL, 총빌리루빈 0.5 mg/dL, AST 129 U/L, ALT 53 U/L, alkaline phosphatase 103 U/L, LDH 11,430 U/L였다. 복부 전산화단층촬영에서는 횡행 결장에 주변 조직 으로 침윤하고 있는 종괴가 보였으며 주변 림프절 비대와 간의 전이성 종괴가 보였다(Fig. 1). 대장내시경검사에서 횡행결장 근위부에 관내 강을 완전히 둘러싸고 있는 궤양성 종괴가 있어 조직생검을 시행하였 다(Fig. 2). 생검 결과에서 미분화 대장 선암종으로 진단되었다(Fig. 3). 환자는 입원 후 전신 상태가 급속히 악화되어 고식적 항암치료는 시행하지 못하고 통증 조절 등의 대증적 치료만 시행하였다. 입원 14 일째 환자는 오심, 구토, 식욕부진 등의 증상이 심해지고 혈청생화학 검사에서 칼슘이 11.6 mg/dL (참고범위 8.2-10.7 mg/dL)로 증가 하고 인은 2.2 mg/dL (참고범위 2.5-4.5 mg/dL)로 감소되었으며, 당시 혈청 알부민은 2.4 mg/dL, 이온화 칼슘은 1.69 mmol/L로 측 A Case of Adenocarcinoma of the Transverse Colon with Humoral Hypercalcemia of Malignancy

Transverse Colon Adenocarcinoma Presenting as a Copremesis

Transverse Colon Adenocarcinoma Presenting as a Copremesis

大腸癌が上顎および頸部リンパ節に転移した１例

大腸癌が上顎および頸部リンパ節に転移した１例

An appendix carcinoid tumor in a patient with hereditary nonpolyposis colorectal cancer

Gastrointestinal carcinoid tumors are often associated with other tumors, particularly colon adenocarcinomas; but the association between carcinoid tumors and hereditary nonpolyposis colorectal cancer (HNPCC) syndrome has not yet been explored. We report an unusual case of a 28-year-old woman with HNPCC who underwent surgery for a transverse colon adenocarcinoma in whom an appendix carcinoid tumor was incidentally found. To assess whether the carcinoid tumor displayed the characteristic molecular features of HNPCC tumors, we investigated the expression of mismatch-repair (MMR) proteins and microsatellite instability (MSI) status in both tumors. Both tumors demonstrated normal expression of the MMR proteins hMLH1, hMSH2, hMSH6, and hPMS2. Interestingly, the adenocarcinoma exhibited an MSI phenotype but the carcinoid tumor did not, indicating that these 2 tumors arose through different molecular pathways.

Toxic retinopathy following sparsomycin therapy.

This paper presents the clinical and histologic ocular findings of two patients who developed toxic retinal changes while receiving sparsomycin, an antibiotic from<i>Streptomyces sparsogenes</i>used as a cancer chemotherapy agent. A preliminary report of these cases appeared recently.¹The cases are the first reported of patients showing ocular toxicity to this drug. <h3>Report of Cases</h3><h3>Patient 1.</h3> —A 44-year-old Negro man had both a local recurrence of, and lung metastases from, a previously resected transverse colon adenocarcinoma. Sparsomycin was given intravenously in an initial dose of 0.6 mg which was increased by 0.1 mg increments daily until 1.0 mg/day was attained. This level was maintained for nine days until a total dose of 12 mg over a period of 13 days had been given. On the 13th day of therapy the sparsomycin was discontinued because of the patient's complaint of blurred vision. An ophthalmic consultation was obtained the