High Prevalence Of Colorectal Cancer Research Articles

Integration of big data analytics in the investigation of the relationship between acromegaly and cancer

ObjectiveTo evaluate the association between acromegaly and cancer and different types of cancer by using natural language processing systems and big data analytics. Material and methodsWe conducted an observational, retrospective study utilizing data from the electronic health records (EHRs) of Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain. Information from the EHRs was extracted using artificial intelligence techniques and analyzed using Savana Manager 4.0 software. ResultsOut of a total of 708,047 registered patients (54.7% females), 544 patients (0.08%; 330 women, 60.7%; mean age at diagnosis 53.0±15.8 yr) were diagnosed with acromegaly. The incidence of cancer was higher in patients with acromegaly vs those without this condition (7.7% vs 3.9%, p<0.001; OR, 2.047, 95%CI, 1.493–2.804). Male acromegalic patients had a higher prevalence of cancer vs females (57.1% vs 42.9%, p=0.012). A significantly higher prevalence of colorectal cancer (2.9% vs 1.4%, p=0.006), bladder cancer (1.1% vs 0.3%, p=0.005), and lymphoma (1.1% vs 0.3%, p=0.009) was observed in patients with acromegaly vs those without the condition. Acromegalic men had significantly higher prevalence rates of colorectal cancer (4.7% vs 1.3%, p=0.001), bladder cancer (2.8% vs 0.4%, p<0.001), breast cancer (0.9% vs 0.2%, p=0.042), gastric cancer (0.9% vs 0.1%, p=0.011), lymphoma (1.4% vs 0.3%, p=0.037), and liver cancer (0.9% vs 0.1%, p=0.012) vs non-acromegalic men. On the other hand, acromegalic women showed a higher prevalence of thyroid cancer (1.2% vs 0.4%, p=0.043) vs non-acromegalic women. ConclusionOur study, based on artificial intelligence techniques and analysis of real-world data and information, revealed a significant association between acromegaly and cancer in our hospital population, mainly acromegalic men, with a higher frequency of colorectal cancer, bladder cancer and lymphoma in particular.

Rural-Urban Disparities in Colorectal Cancer Screening, Diagnosis, Treatment, and Survivorship Care: A Systematic Review and Meta-Analysis.

Rural residents have a higher prevalence of colorectal cancer (CRC) mortality compared to urban individuals. Policies have been aimed at improving access to CRC screening to reduce these outcomes. However, little attention has been paid to other determinants of CRC-related outcomes, such as stage at diagnosis, treatment, or survivorship care. The main objective of this analysis was to evaluate literature describing differences in CRC screening, stage at diagnosis, treatment, and survivorship care between rural and urban individuals. We conducted a systematic review of electronic databases using a combination of MeSH and free-text search terms related to CRC screening, stage at diagnosis, treatment, survivorship care, and rurality. We identified 921 studies, of which 39 were included. We assessed methodological quality using the ROBINS-E tool and summarized findings descriptively. A meta-analysis was performed of studies evaluating CRC screening using a random-effects model. Seventeen studies reported disparities between urban and rural populations in CRC screening, 12 on treatment disparities, and 8 on staging disparities. We found that rural individuals were significantly less likely to report any type of screening at any time period (pooled odds ratio = 0.81, 95% CI, 0.76-0.86). Results were inconclusive for disparities in staging at diagnosis and treatment. One study reported a lower likelihood of use of CRC survivorship care for rural individuals compared to urban individuals. There remains an urgent need to evaluate and address CRC disparities in rural areas. Investigators should focus future work on assessing the quality of staging at diagnosis, treatment, and survivorship care in rural areas.

Project Approach to Organizing Colorectal Cancer Screening as a Basis for Improving Public Health

Introduction: Colorectal cancer occupies leading positions in terms of morbidity and mortality rates among malignant neoplasms and, according to recent research findings, no trend towards a decrease in its prevalence is predicted. Colorectal cancer is one of the tumors for which the effectiveness of population-based screening has been demonstrated. In 2023, the population screening model is used in 10 constituent entities of the Russian Federation. Objective: To develop a regional model of a system for early diagnosis of colorectal cancer as part of the clinical examination of certain groups of the adult population based on the analysis of colorectal cancer screening organizational patterns. Materials and methods: We examined the system for early diagnosis of colorectal cancer in primary health care, analyzed statistical reporting data and the contents of fifteen regulations guiding screening within the clinical examination of certain groups of the adult population. Results: Given the high prevalence of colorectal cancer in the Sverdlovsk Region, a pilot project for colorectal cancer screening to be conducted as part of the clinical examination of certain groups of the regional adult population has been developed. It included creation of the regulatory framework, choice of participating health facilities, approval of an algorithm for examining certain groups of adults aged 40 to 75 years, selection of effectiveness criteria for the screening tests, as well as the planned number of tests, groups of the adult population subject to screening, and the frequency of the latter. Coordination functions were assigned to the intermunicipal medical center entrusted to centralize laboratory testing, provide methodological support for the pilot project implementation, collect and analyze statistics from all project participants. Conclusion: Introduction of screening programs aimed at early diagnosis of malignancies allows elaboration of new techniques and mechanisms for their implementation by means of pilot studies, enabling replication of successful projects in regional health facilities and, in the long term, obtaining an overall cumulative effect of sustainable positive changes.

Zearalenone attenuates colitis associated colorectal tumorigenesis through Ras/Raf/ERK pathway suppression and SCFA-producing bacteria promotion

The high prevalence of colorectal cancer (CRC) and its leading death causing rate have placed a considerable burden on patients and healthcare providers. There is a need for a therapy that has fewer adverse effects and greater efficiency. Zearalenone (ZEA), an estrogenic mycotoxin, has been demonstrated to exert apoptotic properties when administrated in higher doses. However, it is unclear whether such apoptotic effect remains valid in an in vivo setting. The current study aimed to investigate the effect of ZEA on CRC and its underlying mechanisms in the azoxymethane/ dextran sodium sulfate (AOM/DSS) model. Our results revealed that ZEA significantly lowered the total number of tumours, colon weight, colonic crypt depth, collagen fibrosis and spleen weight. ZEA suppressed Ras/Raf/ERK/cyclin D1 pathway, increasing the expression of apoptosis parker, cleaved caspase 3, while decreasing the expression of proliferative marker, Ki67 and cyclin D1. The gut microbiota composition in ZEA group showed higher stability and lower vulnerability in the microbial community when compared to AOM/DSS group. ZEA increased the abundance of short chain fatty acids (SCFAs) producing bacteria unidentified Ruminococcaceae, Parabacteroidies and Blautia, as well as the faecal acetate content. Notably, unidentified Ruminococcaceae and Parabacteroidies were substantially correlated with the decrease in tumour count. Overall, ZEA demonstrated a promising inhibitory effect on colorectal tumorigenesis and exhibited the potential for further development as a CRC treatment.

Challanges of Meeting the Palliative Care Needs of Colorectal Cancer patients in Iran: A Qualitative Research.

Background:Despite the high prevalence of Colorectal Cancer (CRC) in Iran and the need to pay more attention to the Palliative Care (PC) needs of patients with this disease, a few studies have previously examined the PC needs of them by gaining the patients', family members', and treatment team's views. This study aimed to investigate the challenges in the way of meeting the PC needs of CRC patients.Materials and Methods:This study was a qualitative content analysis study conducted on 43 participants (including 15 patients, 20 health care providers, and eight family members) through purposive sampling and semi-structured individual interviews in Omid Educational and Medical Center and Iranian Cancer “Control Center (MACSA) in Isfahan from May 2020 to December 2021. Data analysis was performed simultaneously with data collection using conventional qualitative content analysis with the Graneheim and Lundman approach. In order to assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used.Results:Data analysis led to the production of 615 primary codes, 16 sub-categories, and five main categories. These five main categories included “Lack of facilities and equipment”, “Lack of quality of services provided by the treatment team”, “Insufficient financial support to the patient and family”, “Insufficient psychological and emotional support from the patient and family”, and “Inefficiency of the patient and community awareness process”.Conclusions:To improve the quality of care and increase patients’ satisfaction with the provided services, it is recommended that policymakers should meet the challenges of the PC.

Molecular characteristics of advanced colorectal cancer and multi-hit PIK3CA mutations.

3535 Background: Approximately 20% of colorectal cancer (CRC) has an activating mutation in the PIK3CA oncogene. PIK3CA codes for the catalytic subunit of phosphoinositide 3-kinase alpha (PI3Kα), which ultimately activates the AKT and mammalian target of rapamycin (mTOR) pathway. The PI3Kα inhibitor alpelisib has been approved for breast cancer where a single PIK3CA activating mutation is sufficient for response. However, two activating mutations (multi-hit) in the PIK3CA allele substantially increases PI3Kα signaling compared to single hot spot mutations and results in exceptional response to PI3Kα inhibition. We aimed to identify the prevalence of PIK3CA multi-hit mutations in CRC to identify patients potentially susceptible to PI3K inhibitors. Methods: Tissue-based comprehensive genomic profiling (CGP) was performed in a Clinical Laboratory Improvement Amendments (CLIA)-certified, CAP (College of American Pathologists)-accredited laboratory (Foundation Medicine Inc., Cambridge, MA, USA) on all-comers during the course of routine clinical care from 2013-2021. Approval was obtained from the Western Institutional Review Board (Protocol No. 20152817). Hybrid capture was carried out for at least 324 cancer-related genes, including PIK3CA. Results: We identified 48,836 patients with advanced CRC who underwent Foundation Medicine testing and 846 (1.7%) patients with multi-hit PIK3CA mutations. Additional clinical and molecular data was available for 41,154 of these patients of which 710 (1.7%) had multi-hit PIK3CA and 7627 (19%) had any deleterious PIK3CA mutation . The local colon tumor was used for sequencing in 70% of cases and a separate site in 30% of cases. Patients with PIK3CA multi-hit mutations were 53% male with a median age of 60 (interquartile range 50-70). The microsatellite status was available for 697 of 710 patients with multi-hit PIK3CA and 123/697 (18%) were microsatellite instability-high. The Table outlines the genes with cooccurring mutations of &gt;10% prevalence for multi-hit PIK3CA CRC, including the clinically relevant mutations in KRAS (65%) and BRAF (13%). The four most common PIK3CA variants were H1047R (9.8%), E545K (9.2%), E542K (9.0%) and R88Q (7.1%). The most common variant pair was E542K with E545K in 4.7% of multi-hit cases. Conclusions: Double-hit mutations in PIK3CA are seen in 1.7% of advanced CRC patients and may represent a subset of patients that may have enhanced sensitivity to PI3K inhibitors. Given the high prevalence of CRC in the United States and worldwide this represents a clinically meaningful prevalence of multi-hit PIK3CA. Future investigation on the clinical utility of PI3K inhibitors may be warranted in multi-hit PIK3CA CRC.[Table: see text]

Abstract PO-184: Investigating factors associated with colorectal cancer incidence among long-haul truck drivers in the United States

Abstract A retrospective cross-sectional analysis using Commercial Driver Medical Exam (CDME) data was performed to determine the association between colorectal cancer (CRC) risk factors and CRC incidence among long-haul truck drivers (ages 21-85), after adjustment for age. Our hypothesis was that long-haul truck drivers with poor health have a higher prevalence of CRC due to the confluence of CRC risk factors experienced by this population after adjusting for age. CRC is a common and deadly malignancy with several known risk factors, including heavy alcohol use, obesity, high consumption of processed and red meat, sedentary lifestyle, and tobacco use. Long-haul truck drivers have a high prevalence of the abovementioned risk factors, yet CRC risk has not been studied in this group. Given the reported risk factors associated with the truck driving occupation married to the lack of health literature and, a need remains to extensively examine the health of long-haul truck drivers. National survey data from January 1, 2005, to October 31, 2012, among commercial motor vehicle drivers in 48 states were examined. The CDME does not have a specific question about CRC diagnosis, text recognition was used to identify specific terms in the CDME notes and comments. Next, the entire CDME was reviewed by two researchers to determine definite versus probable CRC diagnosis, blinded to all other data. Our team also identified 311 records by searching for the following terms: colon, rectum, cancer, colorectal, CRC, and polyp. To achieve the study purpose, Kruskal-Wallis tests were employed to analyze continuous variables and Fischer's exact tests to analyze categorical variables. CRC incidence was the primary outcome, while our independent variables included demographics, body mass index, along with concomitant medication conditions verified by a medical examiner. Univariate and multivariable logistic regression was utilized to quantify the magnitude and direction of the association between our independent variables of interest and CRC incidence. Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, gender, years of employment with the company, and Body Mass Index in a multivariate logistic regression. Obesity (OR=4.28; 95% CI=1.28-14.29) and increasing age (OR=1.09; 95% CI=1.06-1.12) were significantly associated with CRC incidence. Additionally, truckers with 4+ concomitant medical conditions were more likely to have CRC (OR=5.58; 95% CI=1.26 – 24.75). Despite a growing body of literature ascertaining the health of truck drivers and risk factors associated with truck driving as an occupation, knowledge gaps remain, and inadequate data is available on this population for CRC. Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers—a unique population estimated to live up to 16 years less than the general male population. Citation Format: Jasmine A. Lopez, Ethan M. Petersen, Folasade P. May, Ellen Brooks, Matthew S. Thiese, Carson D. Kennedy, Charles R. Rogers. Investigating factors associated with colorectal cancer incidence among long-haul truck drivers in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-184.

TEACHING BASIC COLONOSCOPY SKILLS: QUALITY AND SAFETY STANDARDS CAN BE FULFILLED IN AN OUTPATIENT UNIVERSITY CENTER.

Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.

Association Between Pathological Complete Response and Tumor Location in Patients with Rectal Cancer After Neoadjuvant Chemoradiotherapy, a Prospective Cohort Study

Background: Colorectal cancers are the third common malignancies after lung and breast neoplasms. Some contributing factors for pathological complete response (pCR) to neoadjuvant therapy of rectal cancer have been defined. Despite various studies in this era, there are few studies on the location of tumors. Objectives: Regarding the high prevalence of colorectal cancer in Iran and the importance of neoadjuvant chemoradiation for survival and morbidity, this study was carried out to determine the association between pathologic complete response and tumor location in patients with rectal cancer after neoadjuvant chemoradiotherapy. Methods: In this prospective cohort, 100 cases with rectal adenocarcinoma from 2017 to 2019 were enrolled. Distance between anal verge and tumor was measured by clinical examination, colonoscopy, endo-sonography, and MRI. Tumors were defined as distal (less than 5 cm from the anal verge) and none distal (more than 5 cm from the anal verge). Another subdivision was inferior (0 - 4.99 cm), middle (5 - 9.99 cm), and superior (10 - 15 cm). The pathological response was compared across the groups. Results: In this study, the pCR was seen in 30%. In univariate analysis body mass index (BMI), grade, N-stage, and distance from anal verge were related to pCR. In cases with BMI over 25 kg/m2 and in tumors with low to medium grade N0/N1, and distance less than 5 cm from the anal verge (low lying tumors) the pCR to neoadjuvant treatment was higher. In multivariate analysis tumor grade, N stage, and distance from anal verge were still related to pCR. Conclusions: According to the obtained results in this study, there may be some association between rectal tumor location and pathologic complete response.

Опыт ксенотрансплантационного гетеротопического моделирования колоректального рака различных клеточных типов у бестимусных мышей линии BALB/c nude

Введение. Высокий уровень заболеваемости колоректальным раком стимулирует поиск методов его своевременной диагностики и эффективной терапии, что, в свою очередь, предполагает использование адекватных животных моделей на стадиях разработки и доклинических исследований. Методика. Для моделирования гетеротопических ксенографтов были использованы клеточные культуры колоректального рака человека линий DLD-1, HCT 116 и HT-29. В качестве носителей опухолевых моделей были взяты мыши линии BALB/c nude. Суспензию клеток вводили подкожно в область лопатки с помощью шприца. Результаты. Полученные из Американской коллекции типовых культур (ATCC) клетки культивировали до достижения необходимого количества для моделирования ксенографтов (20 сут). Клетки линии HCT-116 культивировались активнее и образовывали монослой в 3 раза быстрее, чем клетки линии DLD-1 и HT-29. Выживаемость мышей после проведения процедуры подкожной ксенотрансплантации составляла 100%. Образование ксенографтов объемом около 1 см3 наблюдали на 17-е - 26-е сут после прививания клеток. Приживаемость введённых клеток составила 100% для линии HCT-116. Для клеток колоректального рака человека линий DLD-1 и HT-29 приживаемость составила 75% и 60%, соответственно. Заключение. При экспериментальном моделировании подкожных гетеротопических ксенографтов колоректального рака человека на мышах линии BALB/c nude была получена высокая степень воспроизводимости при 100%-ной выживаемости животных-носителей. Introduction. The high prevalence of colorectal cancer (СС) stimulates scientists and physicians to search methods for СС diagnosis and effective therapy, which requires appropriate animal models at the stage of development and preclinical studies. Methods. CC cell cultures (DLD-1, HCT 116, and HT-29) were used for heterotopic xenograft modeling in BALB/c nude mice. The cell suspension was injected subcutaneously with a syringe. Results. CC cells from ATCC (American Type Culture Collection) were cultivated until obtaining the required number of cells for xenograft modeling (20 days). The HCT-116 cell culture developed more actively and formed a monolayer three times faster than DLD-1 and HT-29 cells. Survival of the mice after subcutaneous transplantation was 100%. Xenografts of approximately 1 cm3 volume formed at 17-26 days after grafting. Transplantability of the injected cells was 100% for HCT-116, 75% for DLD-1, and 60% for HT-29. Conclusion. The experimental modeling of subcutaneous heterotopic CC xenografts in BALB/c nude mice showed a high level of reproducibility with absolute 100% - survival of recipient mice.

Author commentary on Manuel Zorzi et al.

Manuel Zorzi et al. Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer

Comment on: Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence.

Latest evidence indicates that patients with acute diverticulitis have higher prevalence of colorectal cancer than reference patients. Therefore, colonoscopy should be offered after an episode of acute diverticulitis.

Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer.

BACKGROUND : Colorectal cancer (CRC) screening programs based on fecal immunochemical testing (FIT) generate substantial pressure on colonoscopy capacity in Europe. Thus, a relevant proportion of FIT-positive patients undergo colonoscopy after the recommended 30-day interval, which may be associated with an excess CRC risk. METHODS : In a cohort of 50-69-year-old patients undergoing biennial rounds of FIT (OC-Hemodia latex agglutination test; cutoff 20 µg hemoglobin/g feces) between 2004 and 2017, we assessed the outcome at colonoscopy (low/high risk adenoma/CRC/advanced stage CRC) among FIT-positive patients, according to different time intervals. The association of each outcome with waiting time, and demographic and clinical factors, was analyzed through multivariable analysis. RESULTS : 123 138/154 213 FIT-positive patients (79.8 %) underwent post-FIT colonoscopy. Time to colonoscopy was ≤ 30 days, 31-180 days, and ≥ 181 days in 50 406 (40.9 %), 71 724 (58.3 %), and 1008 (0.8 %) patients, respectively. At colonoscopy, CRC, high risk adenoma, and low risk adenoma were diagnosed in 4813 (3.9 %), 30 500 (24.8 %), and 22 986 (18.7 %) patients, respectively. An increased CRC prevalence at colonoscopy was observed for a time to colonoscopy of ≥ 270 days (odds ratio [OR] 1.75, 95 % confidence interval [CI] 1.15-2.67), whereas it was stable for waiting times of < 180 days. The proportion of advanced CRC also increased after 270 days (OR 2.79, 95 %CI 1.03-7.57). No increase for low or high risk adenomas according to time to colonoscopy was observed. CONCLUSION : In a European FIT-based screening program, post-FIT colonoscopy after 9 months was associated with an increased risk of CRC and CRC progression.

A91 SARCOMATOID CARCINOMA OF THE COLON PRESENTING AS IRON DEFICIENCY ANEMIA

Abstract Background Gastrointestinal malignancy is a common cause of iron deficiency and occult gastrointestinal bleeding among adults in developed countries. Given the high prevalence of colorectal cancer and adenomatous polyps in our population, it is imperative that these patients undergo early colonoscopy. Sarcomatoid carcinoma (SCA) of the colon is a very rare condition, with less than 30 cases reported in the literature. Given the highly aggressive nature of this neoplasm, it is important to familiarize oneself with its presentation, histopathology and treatment options. Aims Describe a case of SCA of the colon in a cirrhotic patient, presenting initially as iron deficiency anemia of unknown etiology. Methods Case report and literature review. Results A 69-year-old female presented to the emergency department with complaints of progressive weakness and failure to thrive. Past medical history was significant for chronic kidney disease, NASH cirrhosis Child-Pugh C and recurrent hepatocellular carcinoma despite previous radiofrequency ablation. Investigations demonstrated de novo iron deficiency anemia with the following blood results: hemoglobin of 96, iron of 8.6, iron saturation of 20% and ferritin of 56. Subsequently, gastroenterology was consulted in order to assess for an occult source of bleeding. A gastroscopy was first performed in which no abnormalities were found. She then underwent a colonoscopy, which demonstrated a very large indurated nodular ulcer in the ascending colon, suggestive of invasive neoplasm (Figure A). Indeed, the biopsies demonstrated a malignant spindle cell neoplasm consistent with SCA. On immunohistochemistry, the tumor cells stained positive for keratin AE1/AE3, weakly positive for SMA and S-100, but negative for SMM, HMB45, DOG1, C-KIT and CD31. Given her severe comorbidities, no therapeutic options were available for this patient, thus further staging investigations were not pursued. Unfortunately, the patient rapidly deteriorated and died less than 8 weeks following her diagnosis. Conclusions Sarcomatoid carcinoma of the colon is an extremely rare neoplasm with very poor prognosis. Histologically, this tumor is characterized by a typical biphasic pattern, composed of both mesenchymal and epithelial cells. However, as demonstrated in this case, some SCA display a rather predominantly mesenchymal pattern, rendering the diagnosis difficult using morphology only. Immunostaining is therefore used to identify carcinoma features and to rule out similar tumors such as sarcoma, GIST, mesothelioma and melanoma. SCA of the colon is exceedingly aggressive, with remarkably rapid tumor growth and early distant metastasis. Indeed, median survival is reported to be less than 6 months. Given its rarity, no well-defined treatment guidelines exist, however most patients are managed with early radical surgery, adjuvant chemotherapy and close follow-up. Funding Agencies None

Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

Background: The high prevalence of colorectal cancer (CRC) and its increasing incidence can be a major problem in cancer management. Preoperative staging plays a significant role in the therapeutic process, especially in CRC which has high risk for lung metastases. Objectives: This study aimed to evaluate accuracy of chest X-ray (CXR) in comparison with chest CT (CCT) for diagnosing lung metastases in patients with CRC. Patients and Methods: A cross sectional study was conducted of 377 patients with newly diagnosed CRC which were evaluated with CXR and CCT. Results: CCT revealed normal/benign findings in 285 (75.6%), indeterminate nodules in 28 (17%) and suspicious nodules in 64 (17%) patients. Although CXR did not reveal any pulmonary metastatic lesions in of the 23 (7%) patients, the measure of agreement between CXR and CCT was good (0.64, P < 0.01) and CCT changed TNM staging in only eight (2%) patients. On logistic regression analysis, liver metastasis could increase the risk of pulmonary metastasis (P < 0.01). Conclusion: The study suggested CCT for preoperative staging in CRC patients, especially at stages 3 and 4 in TNM staging and for liver metastases.

Association analysis of dietary habits with gut microbiota of a native Chinese community.

Environmental exposure, including a high-fat diet (HFD), contributes to the high prevalence of colorectal cancer by changing the composition of the intestinal microbiota. However, data examining the interaction between dietary habits and intestinal microbiota of the Chinese population is sparse. We assessed dietary habits using a food frequency questionnaire (FFQ) in native Chinese community volunteers. Based on the dietary fat content determined using the FFQ, the volunteers were divided into HFD group (≥40% of dietary calories came from fat) or low-fat diet (LFD) group (<40%). Fecal and colonic mucosal microbiota composition was determined using 16S rDNA based methods. In stool matter of HFD group, Prevotella and Abiotrophia showed significantly higher abundance, whereas unclassified genus of S24-7 (family level) of Bacteroidetes, Gemmiger, Akkermansia and Rothia were less abundant. On colonic mucosal tissue testing, unclassified genus of S24-7 showed significantly higher abundance while Bacteroides, Coprobacter, Abiotrophia, and Asteroleplasma were less abundant in HFD group. A high fat and low fiber diet in a native Chinese community may partially contribute to changes of intestinal microbiota composition that may potentially favor the onset and progression of gastrointestinal disorders including inflammatory, hyperplastic and neoplastic diseases.

Leukocyte telomere length throughout the continuum of colorectal carcinogenesis.

Considering the high prevalence of colorectal cancer (CRC) and relatively high mortality there is strong interest in identification of clinically relevant biomarkers. Telomere shortening is supposed to contribute to genomic instability and crucially involved in process of carcinogenesis. Peripheral blood leukocyte (PBL) telomere length was previously investigated in several studies as potential biomarker for CRC but with controversial results. This prompted us to investigate relative PBL telomere length in association with different histological findings throughout the continuum of colorectal carcinogenesis in order to reflect the whole spectrum of putative CRC development in a large study involving 2011 individuals. The study based on the Colorectal Cancer Study of Austria (CORSA), including 384 CRC cases as well as age- and gender-matched 544 high-risk adenomas, 537 low-risk adenoma patients and 546 colonoscopy-negative controls. Relative expression of telomeric repeats and the single copy reference gene, albumin (T/S ratio) was determined using monochrome multiplex quantitative PCR (MMQPCR). Telomeres were found to be significantly longer in CRC patients compared to control subjects (P = 3.61x10-6). Yet, no significant differences in telomere length could be detected for high-risk (P = 0.05956) and low-risk colorectal adenoma patients (P = 0.05224). In addition, results presented in this manuscript highlight the impact of various epidemiological factors on PBL telomere length and its involvement in CRC. However, further large studies also including colorectal adenomas are necessary to confirm these results.

High prevalence of advanced colorectal neoplasia in the Thai population: a prospective screening colonoscopy of 1,404 cases.

BackgroundIncreasing morbidity and mortality from colorectal cancer is evident in recent years in the developing Asian nations. Particularly in Thailand and most neighbouring low-income countries, screening colonoscopy is not yet recommended nor implemented at the national policy level.MethodsScreening colonoscopy was offered to 1,500 healthy volunteers aged 50–65 years old who were registered into the program between July 2009 and June 2010. Biopsy and surgery was performed depending on the identified lesions. Fecal immunochemical tests (FIT) were additionally performed for comparison with colonoscopy.ResultsThere were 1,404 participants who underwent colonoscopy. The mean age of the cohort was 56.9 ± 4.2 years and 69.4 % were females. About 30 % (411 cases) of all colonoscopies had abnormal colonoscopic findings, and of these, 256 cases had adenomatous polyps. High risk adenomas (villous or tubulovillous or high grade dysplasia or size > 1 cm or > 3 adenomatous polyps) were found in 98 cases (7 %), low risk adenoma in 158 cases (11.3 %), and hyperplastic polyps in 119 cases (8.5 %). Eighteen cases (1.3 %) had colorectal cancer and 90 % of them (16 cases) were non-metastatic including five stage 0 cases, seven stage I cases, and four stage IIA cases. Only two cases had metastasis: one to regional lymph nodes (stage IIIB) and another to other organs (stage IVA). The most common cancer site was the distal intestine including rectum (7 cases, 38.9 %) and sigmoid colon (7 cases, 38.9 %). Ten colorectal cancer cases had positive FIT whereas 8 colorectal cancer cases were FIT-negative. The sensitivity and specificity of FIT was 55.6 % and 96.2 %, respectively, while the positive predictive value was 16.4 % and negative predictive value was 99.4 %. The overall survival of colorectal cancer cases at 5-year was 83.3 %.ConclusionHigh prevalence of colorectal cancer and high-risk adenoma was found in the Thai population aged 50–65 years old by screening colonoscopy. FIT was not sensitive enough to detect colorectal cancer in this asymptomatic cohort. Integration of screening colonoscopy into the national cancer screening program should be implemented to detect early cases of advanced colorectal neoplasia and improve survival of colorectal cancer patients in Thailand.

Wnt/β Catenin-Mediated Signaling Commonly Altered in Colorectal Cancer.

Colorectal cancer is the second most common cancer in females and the third most common cancer diagnosed in males (Torre et al.1). In 2012, there were about 1.4 million cases and 693,900 deaths due to colorectal cancer worldwide. It is more common in developed countries, and North America, Europe, and Australia have the highest incidence rates. In the United States, adults have a 5% chance of developing colorectal cancer (Cancer of the colon and rectum-SEER stat fact sheets2). Due to the high prevalence of colorectal cancer, understanding the mechanism underlying its initiation and progression in order to find better therapeutic agents will have a high impact in the field of oncology and may improve the treatment of other cancers with shared mechanistic properties. Aberrant Wnt/β-catenin signaling is a characteristic feature of colorectal cancer development and is the focus of this review.

The place of targeted agents in the treatment of elderly patients with metastatic colorectal cancer.

Despite the high prevalence of colorectal cancer in a continuously aging population and the substantial advances in the treatment of metastatic disease during the past decade, the treatment of elderly patients with advanced, unresectable or metastatic colorectal cancer is a clearly unmet need. Since older patients are under-represented or even excluded from randomized trials, the evidence that oncologists use as guidance is weak. However, small prospective studies, pooled analyses and observational studies show that combination approaches are safe, efficacious and feasible in the geriatric population with metastatic colorectal cancer. The use of biologic agents targeting angiogenesis and the epidermal growth factor receptor, which have been shown to clearly improve outcomes in multiple prospective trials in patients with advanced colorectal cancer, is a vital component of the aforementioned combination approaches. Herein, we review all available data concerning the management of elderly patients with these agents and underscore the differences between this age subgroup and younger patients.