Management Of Colon Cancer Research Articles

Practice parameters for the management of colonic cancer II: other issues. Recommendations of the Colorectal Surgical Society of Australia.

Practice parameters for the management of colonic cancer II: other issues. Recommendations of the Colorectal Surgical Society of Australia.

Impact of a Clinical Guidelines Program for Breast and Colon Cancer in a French Cancer Center

Between 1993 and 1994, the 80 physicians in the French comprehensive cancer center, Léon Bérard, developed and implemented a Clinical Practice Guidelines (CPGs) project based on an analysis of the literature and a consensus of intrainstitutional experts. The aims of this project are to assist community-based oncologists in their decision making and to minimize inappropriate variation in practices. A study was designed to assess the impact of CPGs on management of breast and colon cancer. A "before-after" study, using institutional computerized records of patients with breast or colon cancer. Records for 100 women with localized breast cancer were randomly selected from those available in 1993 and 1995, and those for all patients newly referred with colon cancer in 1993 and 1995 (77 and 81 patients, respectively). Medical decisions on these records were analyzed to assess their compliance with the CPGs. (A systematic search of the literature was performed to determine the scientific evidence for noncompliant decisions.) Of 375 available medical decisions, 350 were assessable. The compliance rate with CPGs for breast cancer was significantly higher in 1995 compared with 1993, 54% (54/99; 95% confidence interval [CI], 44%-64%) vs 19% (18/95; 95% CI, 11%-27%) (P<.001). The compliance rate for colon cancer was also significantly higher in 1995 than in 1993, 70% (62/88; 95% CI, 60%-80%) vs 50% (34/ 68; 95% CI, 38%-62%) (P=.009). In 1993, 42% (40/95; 95% CI, 32%-52%) of medical decisions for breast cancer and in 1995, 68% (67/99; 95% CI, 59%-77%) conformed with the CPGs or were judged to be based on "scientific evidence." In 1993, 71% (48/68; 95% CI, 60%-81%) of medical decisions for colon cancer, and in 1995 81% (71/88; 95% CI, 73%-89%) conformed with the CPGs or were judged to be based on scientific evidence. Compliance rates were significantly higher in 1995 for both cancers. The development and implementation of CPGs for cancer management seem to result in significant changes in medical practice, although a causal relationship between changes and CPGs is not demonstrated in this study.

Perioperative management of colon cancer under Medicare risk programs

Perioperative management of colon cancer under Medicare risk programs

Perioperative Management of Colon Cancer Under Medicare Risk Programs

To determine differences in perioperative care and outcomes for patients with colon cancer enrolled in Medicare health maintenance organizations compared with similar fee-for-service nonenrollees. Cross-sectional evaluation of hospital care and posthospital outcomes with data obtained from medical records. Nineteen health maintenance organizations representing all model types were selected from 12 states. The nonenrollee sample was drawn from the same areas. The sample included 412 enrollees and 401 nonenrollees, representing 65 hospitals for health maintenance organizations and 61 hospitals for fee-for-service. Nonenrollees were slightly older and had higher preoperative risk. Enrollees had shorter intervals between admission and surgery (enrollees, 1.55 days vs nonenrollees, 2.85 days). Differences in length of stay (enrollees, 10.9 days vs nonenrollees, 14.2 days) persisted even after controlling for preoperative health status. Differences in admissions to intensive care units (enrollees, 36.4% vs nonenrollees, 44.4%) were highly influenced by preoperative health status. Nonenrollees were more significantly likely to receive preoperative antibiotics, postoperative testing (eg, postoperative chest radiographs and electrocardiograms), and postoperative patient-controlled analgesia. Tumor staging was similar for both groups. Enrollees were more likely to be discharged home, while nonenrollees were more likely to be discharged to a nursing home. There were no significant differences in hospital deaths or postdischarge readmissions. Health maintenance organization enrollees with colon cancer received less clinical services of several types than similar patients in fee-for-service settings, had shorter hospital stays, and were less likely to be discharged to nursing homes. However, there was no evidence that they experienced different outcomes.

Colon cancer.

The primary treatment of localized colon adenocarcinoma is surgical resection, and the operative procedures have been designed to maximize the chance of cure. Miles’ theory was that wide excision and regional lymphadenectomy would result in the highest cure rate from the locally invasive and regional metastatic aspects of colon carcinoma [1]. Therefore, the operative techniques have focused on the regional arterial blood supply of the colon. The regional artery has defined the extent of mesenteric, lymphatic, and colonic resection. Other intraoperative considerations that may influence survival include the no-touch technique and intraluminal spread of exfoliated tumor cells, and have been reviewed [1]. There are two recent advances in colon cancer management that influence the surgeon’s approach to this disease. First, effective postoperative adjuvant chemotherapy is available for patients who are at high risk for developing recurrent disease. Second is the development of new laparoscopic instruments and techniques that permit colonic resections through small incisions, reducing postoperative pain, stress, and recovery time. These new aspects of colon carcinoma management re-emphasize the significance and rationale of adequate excision and lymphadenectomy, and warrant this review.KeywordsLaparoscopic CholecystectomyColonic ResectionLaparoscopic AppendectomyLaparoscopic ColectomyOpen ColectomyThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Topoisomerase-I inhibitors in the management of colon cancer.

Topoisomerase-I inhibitors in the management of colon cancer.

Contributions of molecular genetics to the clinical management of colorectal cancer

Molecular genetics is a tool that can be learned as a language to assist clinicians in the management of colorectal cancer patients. Following a brief review of the genetic controls of colorectal cancer, the author focuses on the models of the Registry for Familial Adenomatous Polyposis and the Registry for Hereditary Nonpolyposis Colon Cancer to demonstrate most vividly the impact molecular genetics is currently having on the practical management of colon cancer. Recent discoveries of K-ras oncogene mutations in stool cultures and the prognostic implications of mutations of the TP53 and DCC genes are discussed in the context of future applications to the management of patients.

Laparoscopic Bowel Surgery Registry. Preliminary results.

Laparoscopic surgery has evolved rapidly since 1989. The American Society of Colon and Rectal Surgeons, the Society of American Gastrointestinal Endoscopic Surgeons, and the American College of Surgeons Commission on Cancer jointly sponsored a registry to identify as early as possible the patterns of practice and acute complications of laparoscopic colectomy. Cases were voluntarily registered by community and academic surgeons. Information was entered in the EPI-5 database. One thousand fifty-six cases were contributed by 118 surgeons; 763 patients were completed laparoscopically. The most common indication for surgery was cancer in 453 patients. The right colon (n = 364) and sigmoid (n = 294) were most frequently resected. Respondents felt adequate cancer resections were performed. Although several unique complications were noted, intraoperative complications were similar in type and frequency to open cases. Laparoscopic colorectal surgery can be performed with acceptable complications. It remains unclear if this approach is adequate for long-term management of colon and rectal cancer.

The current status of human cancer vaccines

First generation cancer vaccines are being tested for clinical efficacy in the management of metastatic melanoma, colon cancer and non-Hodgkin's lymphoma. Expectations are that more patients will respond to this mode of therapy, and that responders will show longer periods of clinical remission if the potency of these various vaccines can be enhanced. This is being achieved by reformulating these vaccines to immunise the patient optimally for a cytotoxic T-cell and/or antibody response to the tumour-associated antigens. The prevailing strategy for improving the T-cell based vaccines has been to optimise tumour antigen presentation by the HLA molecules. Many of the vaccines designed primarily to elicit an antibody response are immunising against poorly immunogenic carbohydrate antigens. Therefore, increasing their potency through the use of various adjuvants and carrier molecules is being explored. This paper will report on nine therapeutic cancer vaccines currently in clinical trial for melanoma, colon ca...

Evaluation and treatment of patients receiving radiation for cancer of the rectum or sigmoid colon in the United States: results of the 1988-1989 Patterns of Care Study process survey.

For the first time, a Patterns of Care Study (PCS) was conducted in 1989 to determine the national practice standards of radiation oncologists in evaluating and treating adenocarcinoma of the rectum and sigmoid colon. A national survey of 73 institutions using two-stage cluster sampling was conducted, and specific information on 408 patients from 69 facilities with adenocarcinoma of the rectum and sigmoid colon who received radiation as part of definitive or adjuvant management was collected. Using the modified Astler-Coller (MAC) pathologic staging system, the stage distribution was as follows: A, 0.5%; B1, 4.4%; B2, 23.5%; B3, 5.1%; C1, 8.9%; C2, 30.2%; and C3, 6.6%. Preoperative radiation was used in 29% of patients, but the total dose was greater than 40 Gy in only 20%. Seventy-three percent of patients received postoperative radiation, with approximately 4% receiving combined preoperative and postoperative radiation. Chemotherapy was administered to 44% of patients overall, representing 55% of patients with disease through the bowel wall and/or involving lymph nodes. Only 37% of all patients received chemotherapy concurrent with radiation. An abdominoperineal resection was used in 43%; a low anterior resection was used in 43% as well, while 5% underwent other types of bowel resection. Approximately 8% of patients were treated with a local curative procedure less than bowel resection (eg, local excision, endoscopic resection, fulguration, or contact radiation). At least one third of patients had interruption in their pelvic irradiation of greater than 3 days. There was no statistically significant difference in the frequency of treatment interruptions by dose per fraction or whether chemotherapy was given concurrent with radiation. There was no significant difference in total dose delivered to patients staged B2 and higher treated without chemotherapy compared with concurrent chemotherapy and radiation. Also, there was no significant difference in total dose delivered to patients with B1 and B2, or C1 and C2 versus B3 or C3 cancer. This study was conducted on patients treated just before the 1990 National Institutes of Health consensus guidelines issued on the management of colon and rectal cancer. This study indicates that the minority of patients treated with radiation in 1988 and 1989 received concurrent chemoradiation, as currently recommended. Additionally, insofar as present studies are investigating important issues such as the use of sphincter-sparing procedures, preoperative radiation and chemotherapy, and the importance of radiation dose and scheduling with chemotherapy, the information provided by this study will serve as a useful baseline to track future changes in rectal cancer evaluation and management.

Current Management of Colon and Rectal Cancer

Current Management of Colon and Rectal Cancer

Surgical management of nonhepatic intra-abdominal recurrence of carcinoma of the colon.

The role of surgery in the management of intra-abdominal recurrence of colon cancer has not been clearly determined. We reviewed the charts of 28 patients operated upon at our institution for nonhepatic intra-abdominal recurrence of carcinoma of the colon and followed for a median of 10.5 months after reoperation. Total resection of gross disease was possible in 15 patients, who had a median overall actuarial survival of 25.5 months and a disease-free survival of 13 months. Within this group, disease-free survival was significantly prolonged when time to first recurrence was greater than 16 months and when patients had not had a prior operation for recurrent disease (P < 0.05). Six patients having a partial resection and seven patients having only a bypass or ostomy had significantly shorter survivals than those in the totally resected group, with median survivals of 8 and 3.5 months, respectively (P < 0.05). Operative management of recurrent colon cancer may prolong survival when disease can be eradicated, and palliative operations appear more successful when tumor is resected rather than bypassed.

Use of the radiolabeled murine monoclonal antibody, 111In-CYT-103, in the management of colon cancer

Monoclonal antibodies directed at tumor-associated antigens may be useful adjuncts for the management of patients with colorectal cancer. The murine monoclonal antibody, B72.3, binds Tag-72, a cell-surface antigen, which is expressed by colorectal carcinoma cells. We investigated the benefit of indium-111-labeled B72.3, 111In-CYT-103, in localizing the presence and extent of disease in patients with suspected or biopsy-proven primary colorectal cancer and in patients with apparently localized recurrent colorectal adenocarcinoma. Twenty patients were enrolled in this study. Each patient received 1 mg of B72.3 labeled with 4 to 5 mCi of 111In. Patients then underwent planar and single-photon emission computed tomographic imaging 2 to 5 days after infusion. Fifteen patients underwent surgery 1 to 14 days after scanning. There were 11 true positives, 1 false positive, 2 true negatives, and 1 false negative. The 111In-CYT-103 scan correctly identified the presence or absence of tumor in the 15 patients in whom biopsies were obtained, for an accuracy rate of 87%. Overall, 111In-CYT-103 supplied clinically useful information regarding the extent of disease that was not previously reported by standard techniques in 33% (5 of 15) of patients who underwent surgical exploration. We conclude that 111In-CYT-103 is a promising imaging agent for patients with potentially resectable recurrences and for those patients with a presumed isolated primary tumor requiring preoperative staging.

Colonic Cancer During Pregnancy: Case Report and Review of the Literature

Colonic cancer during pregnancy is rare. Herein we describe a case of adenocarcinoma of the transverse colon in a 29-year-old pregnant patient. Early diagnosis is difficult because the initial symptoms of colorectal cancer, such as abdominal pain, nausea and vomiting, constipation, and abdominal distention, are often attributed to a normal pregnancy. Management of colonic cancer during pregnancy depends on gestational age and operability of the tumor. Medical and surgical management considerations are discussed.

Cost‐effective management of colon and rectal cancer

Health care costs in the United States of America continue to rise. Legislators, economists and third party payers are becoming increasingly concerned with intervention outcomes and the distribution of resources. It is the responsibility of the medical profession to assume a leading role in assessing the cost-effectiveness of health care interventions. Although many physicians perform informal cost-effectiveness analyses on a daily basis, health economists employ a variety of more complex methodologies. This article will attempt to provide physicians with an understanding of the value and limitations of the tools used in formal cost-effectiveness analyses and demonstrate how these tools may be applied to the management of colon and rectal cancer.

Principles of surgical technique in the treatment of carcinoma of the large bowel

The principles of surgical technique for the operative management of colon cancer are described. With the background of the evolution of anastomotic alternatives, the methods for reestablishing intestinal continuity and the approach to the treatment of complicated presentations of colonic cancer are reviewed. While one may construe this paper to have a certain author bias, I have tried to present diverse options where pertinent, but there should be little question as to where my opinion lies.

Clinical Data Release: How Soon?

WHEN publicly funded research results have immediate effect on patient care, should the funding agency announce the findings before they are published in a scientific journal? National Institutes of Health (NIH) officials in Bethesda, Md, are pondering this question and awaiting guidelines that might help with such early release clinical alerts. The NIH's National Cancer Institute was the first to grapple with the issue in May 1988, when it announced an adjuvant therapy for breast cancer. Then, in October 1989, that institute issued a clinical update on colon cancer management. This sort of decision has put the NIH at the center of discussion of whether to make early release of the information or use the traditional but usually more time-consuming route of initial publication in the scientific literature. The advice from several speakers came at a meeting called by the NIH to discuss ways in which this policy can be

Genetic diagnosis of lynch syndrome II in an extended colorectal cancer-prone family

Knowledge of colon cancer genetics, with particular attention to precision in hereditary cancer syndrome diagnosis, can often enable highly targeted surveillance and management strategies for patients at high genetic risk. Unfortunately, the patient's family history of cancer is often given minimal attention, and knowledge of hereditary cancer syndromes is frequently limited. Indeed, many physicians still consider familial adenomatous polyposis (FAP) as the only genetic risk factor for colorectal cancer. This concern with FAP was noted in a colorectal cancer-prone kindred which for decades had been thought to manifest that syndrome. However, after meticulous genetic, medical, and pathologic studies, the cardinal phenotypic characteristics of Lynch syndrome II were observed. The potential for cancer control in current and future generations of families like this one clearly mandates the need for computerized registries which could transmit current information about hereditary colon cancer syndrome diagnosis, surveillance, and management.

Effects of 1,25-dihydroxyvitamin D 3 and its analogs on butyrate-induced differentiation of HT-29 human colonic carcinoma cells and on the reversal of the differentiated phenotype

1,25-Dihydroxyvitamin D 3 (1,25-(OH) 2D 3) greatly enhances sodium butyrate (NaB)-induced enterocyte differentiation of HT-29 human colonic carcinoma cells while 1,25-(OH) 2D 3 alone induces growth restriction without associated differentiation. In the present study, the efficacies of various analogs of 1,25-(OH) 2D 3 to enhance NaB-induced HT-29 differentiation and to prolong the reversal of the differentiated phenotype under NaB-free growth conditions were subsequently examined. Extent of HT-29 differentiation was assessed by measurement of alkaline phosphatase (AP) activity, appearance of mucin-producing cells, changes in morphological characteristics, and expression of differentiation-associated cytokeratin proteins. Among active analogs of 1,25-(OH) 2D 3, 26,26,26,27,27,27-hexafluoro-1,25-(OH) 2D 3 (F 6-1,25-(OH) 2D 3), 24,24-difluoro-24-homo-1,5-(OH) 2D 3, and 26,27-dimethyl-1,25-(OH) 2D 3 were 100-, 10-, and 5-fold, respectively, more effective than 1,25-(OH) 2D 3 in enhancing NaB-induced mucin production. Combined use of NaB and F 6-1,25-(OH) 2D 3 (10 −9 m) also induced HT-29 cells to form highly differentiated goblet-like enterocytes, and increased both cellular AP enzymatic activity and tissuetype cytokeratin content. This differentiated state was qualitatively more advanced than that achieved by a combination of NaB and 10 −7 m 1,25-(OH) 2D 3. NaB-mediated HT-29 differentiation (in short-term inductions) was found to be reversible following a return to NaB-free medium. HT-29 cells differentiated by combined use of NaB and 1,25-(OH) 2D 3 or its analogs exhibited a significant prolonged reversal time relative to cells differentiated with NaB alone. The most prominent effect was achieved using cells differentiated with NaB and 10 −9 mF 6-1,25-(OH) 2D 3 which exhibited a 7-fold prolonged reversal time over colonocytes differentiated by NaB alone. Our data suggest that a combined use of NaB and 1,25-(OH) 2D 3 or its derivatives may provide a convenient in vitro model system to probe molecular events associated with steroid-target tissue interactions in a differentiating cell system as commonly occurs in vivo. Such an analysis might lend itself to design of a rational combination differentiation-based therapy for the clinical management of colon cancer.

Intraoperative antegrade colon irrigation--in the management of obstructing left-sided colon cancer.

The management of obstructing left-sided colon cancer remains controversial. The advent of intraoperative antegrade colonic irrigation (I.A.C.I.) has allowed primary anastomosis to be performed in the obstructed bowel. From July 1985 to Feb. 1989, there were eleven patients with obstructing left-sided colon cancer admitted to Changhwa Christian Hospital. Eight of these patients, five men and three women, age ranged from 31 to 80 years old, accepted the I.A.C.I. procedure and followed by the one-staged operations. The I.A.C.I. procedure was advocated by Dudley et al in 1980. Postoperatively, there was no case which suffered from clinical leakage or sepsis, except two cases with mild wound infection. Consequently, there was no operative mortality.