Multiple Primary Colorectal Carcinoma Research Articles

Clinical characteristics and prognosis of multiple primary colorectal carcinoma

Objective To explore the clinical characteristics and prognosis of multiple primary colorectal carcinoma. Methods The clinical data of 42 cases of colorectal cancer admitted to the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2018 were retrospectively analyzed. The clinicopathological features, diagnosis, treatment and prognosis were summarized. Results There were 42 patients with multiple primary colorectal carcinoma, accounting for 1.20% (42/3 499) of all colorectal carcinoma patients in the same period. The main pathological type was adenocarcinoma. Among them, 32 cases were synchronous multiple primary carcinoma. And the age ranged 38-86 years old, and the median age was 66 years old. A total of 73 colorectal cancer lesions were detected, mostly located in the proximal colon, sigmoid colon and rectum. A total of 527 lymph nodes were detected, and the positive rate was 1.9% (10). Patients with positive lymph nodes accounted for 37.5% (12/32), including 27 cases of multiple primary carcinoma, 3 cases of triple primary carcinoma, 2 cases of five primary carcinoma. The 1-year and 3-year overall survival rates were 83.75% and 74.38%, respectively. There were 10 cases of metachronous multiple primary carcinoma. Patients were aged 33-86 years old. The first cancer was mostly located in the rectum and sigmoid colon, and the second cancer was mostly located in the ascending colon area. A total of 276 lymph nodes were detected, and the positive rate was 12.3% (34). The 1-year and 3-year overall survival rates were 100.00% and 66.67%, respectively. Conclusions Multiple primary colorectal cancer is not rare clinically and its distribution shows a certain regularity. More attention should be paid to improve the early diagnosis rate. Early operation is needed to improve the survival rate of patients. Key words: Colorectal neoplasms; Neoplasms, multiple primary; Clinical characteristics; Prognosis

Clinicopathological characteristics and treatment of multiple primary colorectal carcinoma

Objective To investigate clinicopathological characteristics, diagnosis and treatment of multiple primary colorectal carcinoma (MPCC). Methods From January 2008 to March 2017, 42 patients diagnosed with MPCC underwent surgery at Beijing Shijitan Hospital, Capital Medical University. Their clinicopathological features, diagnosis and treatment were analyzed. Results These 42 MPCC patients accounted for 7.1% (42/592) colorectal cancer patients in the same period. There were 64 intestinal cancer lesions in 32 patients (76.2%) with synchronous carcinoma (SC), and 20 intestinal cancer lesions in 10 patients (23.8%) with metachronous carcinoma(MC), where the interval between the first and the recurrent was 18-105 months. The proportion of patients in the SC group with highly to moderately differentiated adenocarcinoma was significantly higher compared with that of the MC group (P 0.05). Among 42 patients undergoing radical operation, 6 received colonic metallic stent implantation as a bridge to elective resection in 10 patients with colonic obstruction. Conclusion MPCC, mainly two-lesion cancer, is most commonly found in sigmoid colon and rectum. Those with poorly differentiated cancer, mucinous carcinoma and those complicated with adenoma should be closely followed up with colonoscopy. Colonic metallic stent implantation as a bridge to elective resection may improve the detection rate of SC. Key words: Colorectal neoplasms; Neoplasms, multiple primary; DNA mismatch repair; Synchronous carcinoma; Metachronous carcinoma

Multiple primary colorectal cancer: Individual or familial predisposition?

Colorectal carcinoma (CRC) is one of the most frequent cancers. Along the surface of the large bowel, several foci of CRC may appear simultaneously or over the time. The development of at least two different tumours has been defined as multiple primary CRC (MPCRC): When more than one tumour is diagnosed at the same time, it is known as synchronous CRC (SCRC), while when a second neoplasm is diagnosed some time after the resection and/or diagnosis of the first lesion, it is called metachronous CRC (MCRC). Multiple issues can promote the development of MPCRC, ranging from different personal factors, such as environmental exposure, to familial predisposition due to hereditary factors. However, most studies do not distinguish this dichotomy. High- and low-pentrance genetic variants are involved in MPCRC. An increased risk for MPCRC has been described in Lynch syndrome, familial adenomatous polyposis, and serrated polyposis. Non-syndromic familial CRCs should also be considered as risk factors for MPCRC. Environmental factors can promote damage to colon mucosae that enable the concurrence of MPCRC. Epigenetics are thought to play a major role in the carcinogenesis of sporadic MPCRC. The methylation state of the DNA depends on multiple environmental factors (e.g., smoking and eating foods cooked at high temperatures), and this can contribute to increasing the MPCRC rate. Certain clinical features may also suggest individual predisposition for MPCRC. Different etiopathogenic factors are suspected to be involved in SCRC and MCRC, and different familial vs individual factors may be implicated. MCRC seems to follow a familial pattern, whereas individual factors are more important in SCRC. Further studies must be carried out to know the molecular basis of risks for MPCRC in order to modify, if necessary, its clinical management, especially from a preventive point of view.

Retreatment of a patient who presented with synchronous multiple primary colorectal carcinoma: report of a case.

It is well known that one-stage resection of synchronous multiple primary colorectal carcinoma is an ideal choice if the patient's physical condition is not bad. Detailed examination of the whole intestinal tract is very important for patients with colorectal cancer, which could prevent patients from receiving repeat treatment to a great extent. We present a case report of a patient with synchronous primary colorectal cancer. Because pre- or intra-operative examination is not sufficient at his first consultation, the patient had undergone multiple operations after receiving chemotherapy, radiotherapy and intestinal stent insertion, which results in peritoneal adhesions formation. The preoperative placement of prophylactic ureteral catheters facilitated recognition of ureters in operation that assure the prevention of ureteral injuries. If not aware of the importance of detailed preoperative examination and standardized treatment can lead to wrong treatment as in this case. Prophylactic ureteral catheters might assist in their immediate recognition.

Laparoscopic colectomy for synchronous multiple primary colorectal carcinoma

Synchronous multiple primary colorectal carcinoma (SCC) is rarely seen in the clinical practice,while it has a increasing tendency of incidence.The surgical treatment of SCC has not been normalized.The extent of resection should be individually determined according to the lesion location,range,the distance of lesions and the general condition of the patients.Total mesorectal excision (TME) and complete mesocolic excision (CME) were recognized as the standardized surgical treatment for SCC.From August 2010 to May 2013,3 patients with SCC received laparoscopic radical resection for SCC at the Huizhou First People's Hospital.Based on the clinical practice,we concluded that having a tacit teamwork,grasping the precise surgical plane,using skilled technology of dissecting blood vessel and excising the total mesentery of colorectum are guarantees for successful operation.Laparoscopic colectomy for SCC is feasible and safe. Key words: Colorectal neoplasms, synchronous ; Multiple neoplasms ; Laparoscopy

Clinicopathological features of multiple primary colorectal carcinoma

Objective To investigate the clinicopathological features of multiple primary colorectal carcinoma. Methods The clinical data of 30 patients with multiple primary colorectal carcinoma and 580 patients with single colorectal carcinoma who were admitted to the Peking University People's Hospital from January 2001 to March 2008 were retrospectively analyzed. There were 16 patients with multiple synchronous carcinoma and 14with multiple metachronous carcinoma. The survival of the patients was analyzed using Kaplan-Meier method and the survival rates were compared using Log-rank test. All data were analyzed using the chi-square test. Results The onset age of multiple metachronous primary carcinoma was younger than that of multiple synchronous carcinoma and single colorectal carcinoma, while the onset age of multiple metachronous secondary carcinoma was close to that of multiple synchronous carcinoma and single colorectal carcinoma. Most of the synchronous carcinoma located at the left colon; while most of the metachronous primary carcinoma located at the rectum and sigmoid colon, and most of the metachronous secondary carcinoma located at the ascending colon. Patients with multiple synchronous carcinoma or multiple metachronous primary carcinoma received radical resection. Of the 14 patients with multiple metachronous carcinoma, 9 received radical resection for secondary focus. Except for three patients with multiple synchronous carcinoma and two patients with multiple metachronous carcinoma, all patients received postoperative chemotherapy with FCF, FOLFOX or XELOX regimen. Of the 580 patients with single colorectal carcinoma, 512 received radical resection, 68 received palliative operation, and 519 received postoperative chemotherapy. The cumulative survival rate of patients with multiple metachronous primary carcinoma was significantly higher than that of single colorectal carcinoma (x2 = 17. 289, P ＜ 0. 05). There was no significant difference in the cumulative survival rate between patients with single colorectal carcinoma and those with multiple metachronous secondary carcinoma or multiple synchronous carcinoma (x2 = 1.731, 0. 800, P ＞ 0. 05). Conclusion The prognosis of patients with colorectal multiple metachronous carcinoma is better than those with single colorectal carcinoma, and the prognosis of colorectal synchronous carcinoma is similar to those with single colorectal carcinoma. Key words: Colorectal neoplasms; Multiple primary carcinoma; Clinicopathological features

Clinical analysis of 36 cases with synchronous multiple primary colorectal carcinoma

Objective To explore the diagnosis and surgical treatment of synchronous multiple primary coloreetal carcinoma(SCC).Methods The clinical data of 36 patients with SCC were analyzed retrospectively.Results The 36 patients with SCC were resected simultaneously.Thirty-five patients were reseeted radically and one patient was reseeted palliatively.The 5-,10-year survival rate were 58.3%,41.7%,respectively.There was no significant difference in 5-year and 10-year survival rate between SCC and mono-primary colorectal carcinoma at the same time.Conclusion The preoperative or intraoperative full-course colonoseopy should be emphasized to be a routine method in the patient with colorectal carcinoma.The resection specimen should be examined routinely.Surgical radical resection is the principal in the treatment of SCC. Key words: Cdoreetal neoplasms; Neoplasms,multiple primary

Clinicopathological analysis of 39 patients with multiple primary synchronous colorectal carcinoma

To investigate the clinicopathologic characteristics and prognosis of multiple primary synchronous colorectal carcinoma (synchronous CRC) and single colorectal carcinoma (single CRC). Clinicopathological data of 39 patients with synchronous CRC and 528 patients with single CRC from May 1996 to June 2001 were reviewed retrospectively. The patients with synchronous CRC accounted for 6.9% of all the patients with colorectal carcinoma treated in our hospital during the same period. Compared with concurrent lesions, Dukes stage of the index lesions of synchronous CRC was more developed and the lymph node metastasis and vessel invasion occurred more frequently. In addition, it also had poorer differentiation. There were significant differences of Dukes stages and lymph node metastasis between the index lesions and single CRC. The incidence of adenomatous polyp in synchronous CRC was higher than that in single CRC(59.0% vs 25.0%,P<0.01). The sensitivity of preoperative colonoscopy examination was 76.9%, which was significantly higher than that of barium examination and exploration during operation. The total 5-year survival rate of synchronous CRC was significantly lower than that of single CRC (5.1% vs 28.2%,P=0.042), and no significant difference of total 5-year survival rate was found between single CRC patients and synchronous CRC patients undergone radical operation. Synchronous CRC patients undergone radical operation had longer survival as compared to those undergone palliative operation(P<0.01). Multivariate analysis indicated that Dukes stages, lymph node metastasis, vessel invasion and the type of operation were independent prognostic factors of synchronous CRC. Synchronous CRC and single CRC are not always similar in clinicopathologic characteristics and prognosis. Early finding, early diagnosis and radical operation are the keys to improve the survival rate of synchronous CRC.

Meta analysis of 2025 cases with multiple primary colorectal carcinoma

To summarize the clinicopathological characteristics of multiple primary colorectal carcinoma. With "multiple primary colorectal carcinoma" as search words,and with the same inclusion and exclusion criteria, related Chinese literatures published were retrieved. A meta analysis was carried out. The incidence of multiple primary colorectal carcinoma was 2.9%; and the average age was 53 years. 55.2% of the cases with synchronous multiple primary colorectal carcinoma were diagnosed by fiberoptic colonoscopy before operation,37.5% by intraoperative exploration, 15.7% by postoperative pathology. 94.8% of the cases with metachronous multiple primary colorectal carcinoma were diagnosed by fiberoptic colonoscopy before operation,and the average interval was 5.2 years. 30.9% of the lesions were located in the rectum, 19.9% in the sigmoid, 9.0% in the descending colon, 5.2% the in splenic flexure, 9.1% in the transverse colon, 6.1% in the hepatic flexure, 11.8% in the ascending colon,and 8.1% in the caecum. 37.6% of the cases were complicated with extra- intestinal lesions,and 43.7% adenoma or polyps. 34.6% of the cases had lymph node metastasis. Histological type was the same in 60.6% of the cases,and adenocarcinoma accounted for 89.2% and cancerization of adenoma 8.4%. Radical resection was performed in 85.9% and palliative resection in 10.1% of the cases. The 3, 5, 10 and 15 year survival rates were 64.3%, 44.6%, 26.3% or 9.4% in synchronous multiple primary colorectal carcinoma respectively, and 69.6%, 59.2%, 45.0%, 36.7% in metachronous multiple primary colorectal carcinoma. Multiple primary colorectal carcinoma is rare in clinic. The diagnosis mainly depends on colonoscopy and intra-operative exploration. The resection rate is high and the prognosis is better. The prognosis of metachronous multiple primary carcinoma is better than that of synchronous multiple primary colorectal carcinoma.

Multiple primary colorectal carcinomas: an analysis of 42 cases

AIM:To conclude the clinical characteristics of multiple primary colorectal carcinoma(MPCC). METHODS:The clinical data of 42 patients with MPCC out of 1354 primary colorectal cancer cas- es,who were treated in our hospital from 1980 to 2005,were retrospectively analyzed. RESULTS:The percentage of patients with MPCC was 3.10%(synchronous:0.96%;meta- chronous:2.14%).Of the 42 cases,20(1.48%) were accompanied by carcinoma of other or- gans.Adenocarcinoma was the most common cancer,locating at the right colon(46.3%)and rectum(31.3%).The tumors of other organs were mainly located at stomach,small intestine, breast,ovary and uterus.The data of 12 cases (12/42,28.6%)were in accordance with Am- sterdam criteriaⅡfor hereditary nonpolyposis colorectal cancer(HNPCC),and the data of 16 cases(16/42,37.2%)were in accordance with the Chinese criteria for HNPCC.Colon fiberscopy was helpful in the diagnosis of MPC. CONCLUSION:MPCC,with a high incidence rate,has particular epidemic,clinical and pathological characteristics.Colon fibers- copy is important in the diagnosis of MPC, and postoperative following up should be strengthened for the diagnosis of HNPCC.

The diagnosis and treatment of multiple primary colorectal carcinoma

目的 探讨结直肠多原发癌的诊断与治疗.方法通过4例病例并结合文献报道,讨论结直肠多原发癌的发病率、高危因素、诊断及治疗.结果同时性结直肠多原发癌约占大肠癌2%～6%,异时性结直肠多原发癌的发病率为0.6%～9%;其高危因素包括手术、放疗、遗传性非息肉病性结直肠癌和大肠多发腺瘤等;同时性结直肠多原发癌应避免漏诊,异时性结直肠多原发癌应避免误诊;常见手术方式有根治术、扩大根治术和全结肠切除术.结论对该病应重视高危人群的监测,根治术加术后结肠镜长期随访是处理的适当选择。

Clinical features, diagnosis, treatment and prognosis of multiple primary colorectal carcinoma.

To investigate the clinical features, diagnosis, treatment and prognosis of multiple primary colorectal carcinomas (MPCC). A retrospective analysis of 37 patients with MPCC from 1974 to 1998 was carried out. The incidence of MPCC was 2.74%(37/1 348) in patients with primary colorectal carcinomas, 15 cases of them were patients with synchronous carcinomas (SC) and 22 cases were diagnosed as metachronous carcinomas (MC). Most tumors were located in the right colon and rectum. Fifty-five percent (12/22) of MC were diagnosed within 3 years after tumor resection and 41%(9/22) of MC occurred after 8 years. Radical resections were performed in all patients except for 1 case. The 5-year survival rate of SC was 72.7%(8/11) and that of MC after the first cancer and second cancer was 71.4%(15/21) and 38.9%(7/18), respectively. The results indicate the importance of complete preoperative examination, careful intraoperative exploration and periodic postoperative surveillance. Early diagnosis and radical resection can increase survival rate of MPCC.

Multiple primary colorectal and gastric carcinoma in Japan.

We investigated the occurrence of multiple primary colorectal and gastric cancer (MPCGC) in 1277 colorectal cancer patients between 1972 and 1996. MPCGC was found in 65 (5.1%). In the 28 synchronous cases, gastric or colorectal cancer was accidentally detected by pre-, intra-, or postoperative examinations. In 23 of the 37 metachronous cases, colorectal cancer developed on average 83 months after the operation for gastric cancer. In the other 14 cases, gastric cancer developed on average 70 months after the operation for colorectal cancer. Therefore, careful pre-, intra-, or postoperative examinations are strongly called for in order to not overlook the presence of colorectal or gastric lesions in MPCGC cases.

Multiple colorectal carcinomas and colorectal carcinoma associated with extracolonic malignancies.

In this study, we analyzed 149 surgical cases of colorectal cancer between January 1983 and August 1989. Thirteen cases (8.7 percent) of colorectal primary cancer associated with extracolonic primary malignancy of 14 lesions and 10 cases (6.7 percent) of multiple primary colorectal cancers were included. Among the 14 lesions of extracolonic primary malignancy, there were 6 gastric carcinomas, 2 endometrial carcinomas, 2 urinary bladder carcinomas, and one each in the esophagus, liver, bile duct and jejunum. The second tumor was not detected preoperatively in 3 of 4 cases of synchronous multiple primary colorectal carcinoma. A curative resection was done in 10 (77 percent) out of 13 cases of colorectal cancer associated with extracolonic malignancy, while 7 (88 percent) out of 8 cases of multiple colorectal cancers had a curative resection. Nine patients (69 percent) with colorectal cancer associated with extracolonic malignancy were disease-free for 2 months to 14 years. Seven patients (88 percent) with multiple colorectal cancers were disease-free for one to 22 years. We recommend, therefore, that in any patient with colorectal cancer, the entire large bowel should be thoroughly searched for any other primary tumors, by taking the existence of extracolonic tumors into account. A curative resection should be performed, and the follow-up period should be life-long.

Mutiple carcinomas of the colon and rectum.

In a series of 960 cases comprising almost all cases of colorectal carcinoma diagnosed intra vitam during a 10-year period in a defined population, there were 62 (6.5%) patients with multiple primary colorectal carcinoma. The average annual incidence was 2.6/100,000 inhabitants. Males were affected more often than females, and the frequency of patients with coexisting adenomas was higher than that in the parent series. The survival rates did not differ from those in the parent series. Synchronous lesions were seen twice as often as metachronous lesions, but the frequency of the latter is regarded as provisional. The findings suggest an interrelationship between colorectal adenoma and carcinoma. It may be concluded that every case of colorectal carcinoma requires a thorough preoperative examination of the entire large intestine. It is also concluded that all patients with colorectal carcinoma operated upon for cure should be regularly followed up for the rest of their lives for metachronous carcinomas. Cancer 33:1630–1634, 1974.