Occult Colon Cancer Research Articles

Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report

Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report

A Case of Unprovoked Venous Thromboembolism and Occult Colon Cancer

A Case of Unprovoked Venous Thromboembolism and Occult Colon Cancer

Nontraumatic Clostridium septicum Myonecrosis in Adults

Abstract Clostridium septicum is a spore-forming anaerobic gram-positive rod capable of causing rapidly progressive nontraumatic myonecrosis. A case of nontraumatic C. septicum myonecrosis (ntCSM) is described. A systematic review of all published cases of ntCSM from 2000–2015 was performed. Twenty-three cases of ntCSM were identified. The median age was 67 years (range, 26–84 years) and 15 (68%) were men. Only 5 (21%) patients had multifocal disease. Diabetes mellitus was the most common preexisting medical condition present in 9 (39%) patients. Occult colon cancer was frequently associated with ntCSM and most commonly right-sided colon cancer (69%). Only 10 (42%) patients survived. Clostridium septicum myonecrosis is a surgical emergency associated with morbidity and mortality. Rapid and aggressive debridement remains the cornerstone of care, although mortality has changed little in the last 30 years, suggesting an opportunity for improving diagnosis, treatment, or both.

Clostridium septicum Aortitis with Synchronous Ascending Colon and Rectal Adenocarcinoma

Introduction: Sepsis secondary to C. septicum is associated with underlying occult colorectal malignancy and has a high mortality. Case Report: A 66-year-old Puerto Rican male with no significant PMH presented with three days of generalized abdominal pain and one episode of bright red blood mixed with stool. He reported subjective fevers with chills and constipation for one month. He denied nausea, vomiting, diarrhea, pruritus, weight loss, fatigue or jaundice. There was no family history of colon cancer. The patient had normal vital signs except for a temperature 101 F. Lab results were significant for leukocytosis and microcytic anemia. An abdominal ultrasound was suggestive of right colon mass and infrarenal aortitis, confirmed on the CT scan. (Image-1 and 2). Colonoscopy revealed a 2 cm mass in the proximal ascending colon and a 5 cm rectal mass (Image-3), both suspicious for malignancy. As resection of both masses at the time of aortic surgery seemed too high risk and the right colon mass was the more likely infectious culprit based on review of literature, resection of the rectal mass was thus deferred. The patient underwent transabdominal excision of infected infra-renal abdominal aorta, proximal bilateral common iliac arteries and proximal inferior mesenteric artery, followed by reconstruction with aorto-iliac cryopreserved homograft. An extended right hemi-colectomy and end ileostomy were performed as well. Cultures from blood and aorta grew C. septicum, sensitive to ampicillin-sulbactam. The right colon mass was adenocarcinoma on pathology. The patient improved clinically and completed six weeks of antibiotics. Follow up PET CT scan revealed non-specific findings. Three months later, patient underwent transanal intramural excision of rectal mass. It was adenocarcinoma on histology but was negative for C. septicum. Patient had a low oncotype DX recurrence score and was offered but declined adjuvant chemotherapy.Figure 1Figure 2Figure 3Conclusion: This is the first case of C septicum aortitis in the setting of synchronous colon and rectal adenocarcinomas. Antibiotics, aortic reconstruction and curative resection of underlying occult colon cancer (source of infection) are the cornerstone in the treatment of C. septicum aortitis. Right-sided colon cancer is the more common location of the source of infection in the setting of C. septicum aortitis.

Impact de la tomographie par émission de positons au 18-FDG dans la prise en charge des patients porteurs d’un cancer bronchique non à petites cellules a priori opérable. Étude prospective multicentrique française

Whole-body (18)F-deoxyglucose positron emission tomography (FDG-PET) has the potential to improve the management of non-small-cell lung cancer (NSCLC). We prospectively evaluated the impact of combining FDG-PET with conventional staging methods, including computed tomography (CT), on the staging and management of patients with potentially resectable NSCLC.Ninety-four consecutive patients with newly diagnosed/suspected NSCLC were enrolled. Each patient was first staged by using conventional methods, and then by FDG-PET. FDG-PET results were forwarded in a sealed envelope and divulged at the weekly staff meeting on staging and treatment, only after "Decision 1", based on conventional staging, had been reached by consensus; reevaluation taking FDG-PET into account yielded "Decision 2". The validity of these latter decisions was analyzed retrospectively.Eighty-nine patients were eligible. Relative to standard imaging, FDG-PET led to clinical staging changes in 26 (29.2%) patients. The stage was lowered in eight cases (9%) and raised in 18 cases (20.2%). "Decision 2" differed from "Decision 1" in 19 patients, modifying the surgical procedure in four cases, indicating other investigations to confirm FDG-PET evidence of metastases in 12 cases, or modifying the medical treatment in three cases. These modifications were retrospectively justified in 9/19 cases, and consisted of 2/4 modifications of the surgical procedure (one hilar and one adrenal metastasis not confirmed histologically), 4/12 further investigations (axillary and liver biopsies, mediastinoscopy, occult colon cancer) and three indications for palliative treatment, in patients who all died within 3 months after FDG-PET.Based on FDG-PET, management was modified in 19/89 (21.3%) patients, but these changes were justified in only 9/89 patients (10.1%). FDG-PET can detect asymptomatic local and distant metastases and improves the preoperative assessment of NSCLC, thereby avoiding unnecessary surgery. However, histological verification is required because of the risk of false-positive results.

Gas gangrene of the thigh in a morbidly obese patient with occult colon cancer

We report a case of atraumatic gas gangrene and myonecrosis of the leg secondary to infection with Clostridium septicum in a severely obese patient with an occult cancer. She was treated successfully for both conditions. A review of the current literature describes this constellation of findings and the appropriate treatment.:

Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report

BackgroundEven though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet.Case presentationWe describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain. Preoperative colonoscopy, staging exams and subsequent surgery demonstrated a stenotic adenocarcinoma of the sigmoid colon, invading the left urinary tract and the homolateral bladder wall, with regional lymph nodes involvement and massive bilobar liver metastases (T4N1M1). After Hartmann's rectosigmoidectomy and despite systemic chemotherapy, a rapid progression occurred and the patient survived for only 5 months after diagnosis. Five years before detecting this advanced colonic cancer, the patient underwent aortic valve replacement due to a severe Streptococcus bovis endocarditis. Subsequent to this infection he never underwent a colonoscopy until overt intestinal symptoms appeared.ConclusionAs this case illustrates, in the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up. Rigorous application of these recommendations in the case described would have likely led to an earlier diagnosis of cancer and maybe saved the patient's life.

Pyogenic Liver Abscess Presenting after Malignant Polypectomy

Streptococcus bovis bacteremia has been linked to the presence of occult colon cancer since 1977. We present a case of pyogenic liver abscess and bacteremia with a different Streptococcus viridans 1 week after colonic adenocarcinoma was removed via polypectomy, discuss the likely etiology and review whether there is evidence to support looking for colon cancer in patients who present similarly but have not already undergone screening.

Pyogenic Liver Abscess and Occult Colon Cancer

TO THE EDITOR: We read with interest the article by Lederman and Crum (1) on pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen. Because a shift from Escherichia coli to K. pneumoniae has been present in the most common pathogen isolated from liver abscess patients in Asia (2), they examined the microbiologic trends of pyogenic liver abscess at a single U.S. hospital for the past 5 yr. They identified 20 cases of liver abscesses from their hospital records, and 6 of the 20 cases were K. pneumoniae liver abscess (KLA). K. pneumoniae was the most common organism isolated from pyogenic liver abscesses, surpassing the incidence of E. coli as a liver abscess pathogen. Although most patients with KLA have poorly controlled diabetes (3), only 2 of the 6 patients were diabetic in their series. Blood cultures grew K. pneumoniae in 5 of the 6 cases. We suspect that this low frequency of diabetic patients but high frequency of bacteremia can indicate the presence of other risk factors.

Incidental detection of colon cancer by FDG positron emission tomography in patients examined for pulmonary nodules.

Fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging has been used extensively to diagnose cancer with high rates of sensitivity and specificity. One of its applications is to distinguish benign from malignant pulmonary nodules. It is common to observe colonic uptake on whole-body FDG-PET images. Because patients with lung cancer also tend to be in the age group with the highest incidence of colon cancer, the authors tried to assess the efficacy of FDG-PET for detecting occult colon cancer in patients referred for the evaluation of lung nodules. The records of 500 consecutive patients referred for the evaluation of pulmonary nodules were reviewed retrospectively. Among the patients, 197 had no previous clinical or radiographic evidence of abnormalities in the gastrointestinal tract, and none had been found to have any cancer before undergoing an FDG-PET study. All colon lesions were verified either by histologic analysis or by clinical course. Among the 197 patients analyzed, 59 had diffuse colonic uptake in various segments of the colon. Seventeen of the patients had focal colonic uptake, five of which were proved to be colon cancer. The routine use of FDG PET to characterize lung lesions significantly increases the probability of detecting unexpected extrathoracic disease. In these patients, the incidental finding of colon cancer had an important effect on their treatment and may prove to be very cost-effective.

Infections associated with occult colon cancer

Infections associated with occult colon cancer

Familial colon cancer.

Study was made of a kindred with a strong history of carcinoma of the colon. Twenty-three family members were screened for the tumor with carcinoembryonic antigen (CEA) assay, barium enema, and proctoscopy; one occult colon cancer was diagnosed. Identification and surveillance of families at high colon cancer was diagnosed. Identification and surveillance of families at high risk of cancer can provide unusual opportunities for early tumor detection.