Diagnosis Of Colorectal Malignancy Research Articles

FTP3.10 Does Anti-Thrombotic Medication affect the PPV of the Feacal Immunochemical Test: A Single Centre Retrospective Study

Abstract Aims Our aim of this study was to determine whether anti-thrombotic medication (i.e. anit-coagulative's such as DOACS and anti-platelets) had a causal relationship to the outcome of the FIT score by looking at the PPV in its detection for malignancy and significant neoplasm. Methods We analysed records of 500 patients over 2 years (June 2020 - June 2022) from a single centre database of patients who are FIT positive and we reviewed all their endoscopy and CT images to determine the proportion of patients with a diagnosis of Colorectal Malignancy and advanced colorectal neoplasm. Results The key finding from our data we discovered that the PPV of having a Colorectal Malignancy/Advanced Neoplasm was significantly lower for patients who were on anti-thrombotic medication (33.1%) when compared to patients who were not on any anti-thrombotic medication (48.8%). Conclusion Our findings display that the use of anti-thrombotic medication lowered the incidence of significant colorectal neoplasms and malignancies detected on colonoscopy or CT imaging for patients who are FIT positive in our local population. It is the first out of the United Kingdom to demonstrate data that is consistent with current literature, thus we can suggest that these medications increase the number of False Positives from the FIT (with a FIT cut-off score of >10ugHb/g). From further analysis we will look to answer to the question. ‘Whether having anti-thrombotic medication can increase the likelihood of smaller cancers bleeding?'

A unique case report of three morphologically distinct malignancies in an appendix specimen

Introduction and importanceAppendiceal neoplasms have a diverse histological classification, the commonest type being neuro-endocrine neoplasm and accounting for 60% of all primary appendiceal malignancies. Others include colonic-type adenocarcinoma; mucinous neoplasm, and goblet cell carcinoma. This report describes a unique case of three different histological subtypes of appendiceal malignancy within a single specimen.Case presentationA 65-year-old female presented with symptoms concerning of GI malignancy and underwent computerised tomography pneumocolon showing an abnormally enhancing appendix concerning for an appendiceal tumour.After multidisciplinary team discussion the patient underwent an open right hemicolectomy. Post-operative histological analysis showed complete resection of three distinct tumour subgroups within the specimen: a neuroendocrine tumour; a well-differentiated adenocarcinoma, and a low-grade appendiceal mucinous neoplasm.Clinical discussionThis report describes, to our knowledge, the first documented case of three separate histological malignancies in a single appendix. Appendiceal malignancy is rare and there are less than 10 cases pertaining to the appendix in the literature: all describing dual neuroendocrine tumours and appendiceal mucinous neoplasms.The case also highlights a limitation of colonoscopy in the diagnosis of colorectal malignancy, specifically for appendiceal tumours, and caution must be taken in discharging patients after a negative colonoscopy. A multi-disciplinary approach is of utmost importance in managing these patients.ConclusionThis is a rare case of 3 morphologically different neoplasms contained within one appendix and demonstrates the importance of an MDT approach to management of such cases. It also highlights the limitation of colonoscopy in diagnosis of appendiceal malignancy.

Relationship between 25(OH)D and Colorectal Cancer Prevalence at Dr. Moewardi Hospital Surakarta-Indonesia: A Cross-Sectional Study

Background: Colorectal cancer is a malignancy of the colon and / or rectum. Vitamin D has a role as an inhibitor of tumor progression, namely through the process of influencing cellular differentiation and proliferation. (VDR) Vitamin D Receptor affects cell differentiation by upregulating brush boundary enzymes and improving morphological microvilli. This study seeks to determine the relationship between 25(OH)D levels and colorectal cancer in dr. Moewardi Hospital, Surakarta, Indonesia. Methods: A cross-sectional design study with quantitative-analytical observation was conducted. All patients had symptoms of colorectal cancer, either undiagnosed or previously diagnosed. 25(OH)D samples were taken from a total of 50 patients at dr. Moewardi Surakarta and subsequent diagnostic measures from the results of histopathology were assessed. The parameters assessed were 25(OH)D level and a diagnosis of colorectal malignancy. Statistical analysis of 25(OH)D levels and colorectal diagnosis using the Chi Square test. Results: The prevalence of colorectal cancer is higher in respondents with 25(OH)D deficiency and insufficiency compared to respondents with normal 25(OH)D concentrations who tend to have non-colorectal cancer. Based on the Chi-Square test result, the significance value was 0.004, marking a statistically significant association. Conclusion: This study shows a significant relationship between deficiency and insufficiency of 25(OH)D concentrations with the occurrence of colorectal malignancy

EP.WE.231Emergency Presentations of Colorectal Cancer during the COVID-19 Era

AimsCOVID-19 has reduced the ability to provide red flag investigations for colorectal patients. The aim of this study is to assess the number of emergency presentations of new colorectal malignancy during the COVID-19 era and if there is an increase in palliative cases.MethodsA retrospective review of all patients presenting to unscheduled care with a new diagnosis of colorectal malignancy from 31st March 2020 - 25th January 2021 in a single UK Trust. An institutional data base and electronic care records were used to review patient demographics, management and curative intent. Data points for the same period in 2019-2020 were recorded for comparison.Results45 patients diagnosed with new colorectal malignancy during an unscheduled admission to hospital within the study timeframe. 22% (10/45) presented in January 2021. 29 diagnosed during the same time interval 2019-2020. Median age at presentation was 77.5 and 79 respectively.40% (18/45) of patients in 2020-2021 proceeded to emergency surgery, compared to 58% (17/29) in 2019-2020 (p = 0.12).10.3% (3/29) of 2019-2020 patients were managed with colonic stenting. This increased in 2020-2021 to 17.8% (8/45) (p = 0.38).77.8% (35/45) patients in 2020/2021 presented at a palliative stage of disease compared to 62.1% (18/29) in 2019-2020 (p = 0.15).ConclusionsOverall the data has not shown a statistically significant difference in patients presenting as an emergency with new colorectal malignancy. However, there was a rise in admissions noted in January 2021; should this trend continue, alongside the persistent pressures of COVID-19 ongoing research is needed to assess the true impact.

The value of brush cytology and biopsy for the diagnosis of colorectal cancer

Background/Aim. Although it is well-known the high sensitivity of brush cytology for the diagnosis of colorectal adenocarcinoma, this kind of diagnostics is not routinely used, and for the past years it has even been declining. The purpose of this study was to evaluate the value of brush cytology for the diagnosis of colorectal carcinoma, by comparison the results of brush cytology and biopsy, and then the results of both diagnostic methods with the final patohistological diagnosis of colorectal resection. Methods. This retrospective study included 173 patients with brush cytology of colorectal region during colonoscopy. In 166 patients concomitant biopsy specimens were obtained, and in 116 of them resection of the intestine as well. A total of the 106 patients underwent to all three diagnostic procedures. Results. Out of 166 patients who went through both brush cytology and biopsy, the congruent diagnosis was made in 129 (77.7%) patients: in 109 (65.7%) adenocarcinoma was diagnosed, which was confirmed after the resection of the intestine in 75 of the patients, and in 14 (8.4%) benign lesion, so there was no need for resection of the intestine. In 6 (3.6%) of the patients, both cytology and biopsy were negative, but the resected specimen was malignant. In 10 of the patients with malignant cytology in whom biopsy was not done, resection of the intestine confirmed malignancy. The sensitivity of detecting malignancy by brush cytology and biopsy were 87.9% and 78.3%, respectively (but this difference was not statistically significant, p = 0.083). Both methods had specificity and positive predictive values 100%. Negative predictive values for cytology and biopsy were 50% and 37.8%, respectively. The accuracy of cytology and biopsy was 89.2% and 80.8%, respectively. The combination of the results of brush cytology and biopsy increased the sensitivity of preoperative diagnostics to 94.8% which was significantly higher than sensitivity of biopsy (p < 0.001), but not than sensitivity of cytology (p = 0.102). Conclusion. Brush cytology could be a routine method, along with biopsy, in the diagnosis of colorectal malignancy. Both methods have comparable both sensitivity and accuracy, and its combination increases sensitivity of preoperative diagnostics of colorectal adenocarcinoma, which gives opportunity to better estimation of further diagnostic and therapeutic approach.

Atypical presentation of colon adenocarcinoma: a case report

IntroductionAdenocarcinoma of the colon is the most common histopathological type of colorectal cancer. In Western Europe and the United States, it is the third most common type and accounts for 98% of cancers of the large intestine. In Uganda, as elsewhere in Africa, the majority of patients are elderly (at least 60 years old). However, more recently, it has been observed that younger patients (less than 40 years of age) are presenting with the disease. There is also an increase in its incidence and most patients present late, possibly because of the lack of a comprehensive national screening and preventive health-care program. We describe the clinicopathological features of colorectal carcinoma in the case of a young man in Kampala, Uganda.Case presentationA 27-year-old man from Kampala, Uganda, presented with gross abdominal distension, progressive loss of weight, and fever. He was initially screened for tuberculosis, hepatitis, and lymphoma, and human immunodeficiency virus/acquired immunodeficiency syndrome infection. After a battery of tests, a diagnosis of colorectal carcinoma was finally established with hematoxylin and eosin staining of a cell block made from the sediment of a liter of cytospun ascitic fluid, which showed atypical glands floating in abundant extracellular mucin, suggestive of adenocarcinoma. Ancillary tests with alcian blue/periodic acid Schiff and mucicarmine staining revealed that it was a mucinous adenocarcinoma. Immunohistochemistry showed strong positivity with CDX2, confirming that the origin of the tumor was the colon.ConclusionsColorectal carcinoma has been noted to occur with increasing frequency in young adults in Africa. Most patients have mucinous adenocarcinoma, present late, and have rapid disease progression and poor outcome. Therefore, colorectal malignancy should no longer be excluded from consideration only on the basis of a patient's age. A high index of suspicion is important in the diagnosis of colorectal malignancy in young African patients.

Do patients require outpatient follow‐up after rapid referral double contrast barium enema?

In our hospital, patients above the age of 40 years referred with a change in bowel habit without rectal bleeding undergo a double contrast barium enema (DCBE) ideally within 2 weeks. Results of benign studies are sent to a consultant colorectal surgeon and a routine clinic visit arranged. The aim of this study was to identify whether, following DCBE, patients (i) presented at a later date with colorectal cancer and (ii) needed assessment in clinic. This is a review looking at all patients who underwent DCBE prior to routine clinic visit between January 2004 and December 2005. Hospital databases were cross-referenced to identify any patients presenting with a new diagnosis of colorectal malignancy between DCBE and April 2007. Clinic letters were reviewed to identify the number of outpatient visits prior to discharge and reasons for continued follow-up. During the study period, 521 patients (age range 31-93 years, 316 female) had DCBE prior to assessment in clinic. Diagnoses: cancer 48 (9.2%), polyps 13 (2.5%), colitis 3 (0.6%), no significant pathology 457 (87.7%). Of this latter cohort, 387 (84.7%) were discharged after one clinic visit; 54 (11.9%) attended twice and 11 (2.4%) were seen more than twice. Reasons for multiple attendances were management of haemorrhoids/anal fissure or investigations of unrelated symptoms. No new cancers were identified in this cohort between January 2004 and April 2007. Double contrast barium enema is a safe screening tool following a '2-week rule' referral with CIBH. Following a report of no significant pathology, there is no need to arrange routine follow-up.