Presence Of Colon Cancer Research Articles

Impact of colon cancer on outcomes in hospitalized patients with Clostridioides difficile infection: a national inpatient analysis

Background and aim Clostridioides difficile infection (CDI) burdens hospitalized patients, particularly those with comorbidities. Colon cancer may worsen CDI severity and outcomes. We aimed to assess CDI outcomes in hospitalized colon cancer patients. Methods A retrospective analysis of 2016 to 2020 National Inpatient Survey data identified adults with CDI, categorized by the presence of colon cancer. Hospitalization characteristics, comorbidities, and outcomes were compared between groups. Primary outcomes included in-hospital mortality, length of stay, and total hospital charges. The secondary outcomes were CDI complications. Multivariate logistic regression analysis was performed, with P values ≤0.05 indicating statistical significance. Results Among 1,436,860 CDI patients, 14,085 had colon cancer. Patients with colon cancer had a longer length of stay (10.77 vs 9.98 days; P < 0.001). After adjustment for confounders, colon cancer patients exhibited higher odds of acute peritonitis (adjusted odds ratio [aOR] 2.37; P = 0.009), bowel perforation (aOR 5.49; P < 0.001), paralytic ileus (aOR 2.12; P = 0.003), and colectomy (aOR 36.99; P < 0.001), but lower risks of mortality, sepsis, septic shock, acute kidney injury, cardiac arrest, and mechanical ventilation (all P < 0.001). Conclusion Colon cancer significantly impacts CDI outcomes in hospitalized patients, highlighting the need for improved management strategies to reduce morbidity and mortality.

Predictors of in-hospital outcomes for diverticular bleeding patients: a retrospective analysis of National Inpatient Sample data (2016-2020).

Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management.

S2155 Utilizing the Pure-Vu EVS for Inpatient Colonoscopy for Patients With an LVAD: A Case Report

Introduction: Colonoscopy is considered the standard for colon cancer screening. A key factor in ensuring high quality colonoscopy is adequate colon cleansing. In hospitalized patients, bowel preparation is often challenging and inadequate cleansing is often due to patient’s inability to tolerate the preparation, slow bowel transit in the setting of immobilization and acute illnesses, and the use of motility-altering medications. Poor bowel preparation limits visualization of the colonic mucosa and can lead to incomplete colonoscopies, missed pathology, adverse events, prolonged hospital stays and increased costs. New technologies have been developed to improve bowel preparations intra-procedurally. The Pure-Vu EVS system, which is an over-the-scope irrigation and cleansing device. This case report describes a novel use of the Pure-Vu EVS system to improve inpatient colonoscopy prep. Case Description/Methods: A 58-year-old female with past medical history significant for chronic systolic heart failure, ischemic cardiomyopathy status post Left Ventricular Assist Device (LVAD) one year prior. End stage heart failure patients requiring LVAD placement routinely undergo screening colonoscopy as part of their pre-transplant evaluation, as the presence of colon cancer or advanced neoplasia could preclude heart transplantation. As part of orthotopic heart transplant evaluation she was admitted to the hospital for IV heparin bridging for screening colonoscopy. After admission, the patient was started on standard bowel prep consisting of 4L of Golytely and Dulcolax suppository. Despite completion of prep, she continued to pass sediments and prep was deemed inadequate. The patients LVAD anticoagulation had been held for the procedure and the decision was made to proceed with colonoscopy utilizing the Pure-Vu EVS device. During the procedure the clinical team utilized the Pure-Vu EVS device and performed the procedure with cardiovascular anesthesia. The Pure-Vu EVS system effectively irrigated and suctioned areas of inadequate bowel prep with sediment larger than 3.8 mm, allowing for improved visualization of the colonic mucosa. Discussion: Pure-Vu EVS allowed for us to perform a screening colonoscopy as part of orthotopic heart transplant evaluation in a patient with LVAD admitted a hospital inpatient service for heparin bridge. This case report describes one of the first cases of the utilization of this unique technology in a patient requiring inpatient screening colonoscopy with advanced heart failure.

Evaluation of Patients Diagnosed with Ileus in the Emergency Department

In emergency department, a delayed diagnosis and treatment of ileus causes a substantial increase in morbidity and mortality. : In this study we aimed to determine the major risk factors of mortality and hospital stay length in patients with ileus. It was determined that blood transfusion requirement; lactate, total bilirubin, and C-reactive protein levels; presence of colon cancer; and mean arterial pressure were among the parameters that can be used for predicting mortality in patients with ileus. In addition, qSOFA value and potassium, sodium, and total protein levels were determined to be among the parameters that are effective for determining the need for surgery in patients with ileus.

Abstract 4987: Biofilm-producing sulfate-reducing bacteria suppress tumor burden in a rat model of colon cancer

Abstract Human epidemiological and animal model studies have shown that the presence of colon cancer is associated with certain microbiota. Previously, we re-derived genetically identical embryos of the Pirc (F344/NTac-Apc+/Pirc) rat model of familial adenomatous polyposis using three strains of surrogate dams (F344/NHsd, LEW/SsNHsd, and Crl:SD), each harboring distinct gut microbiota (GM) that modulated adenoma susceptibility. Bacterial relative abundances as determined by 16S rDNA sequencing showed several taxa correlating with suppression of both tumor growth and phenotype penetrance as early as 1 month of age. One taxon associated with reduced adenoma burden was a sulfate-reducing bacterium, viz. Desulfovibrio spp. To determine if Desulfovibrio was responsible for differences in tumor burden, Pirc rats harboring complex GM were gavaged at 14 and 15 days of age with two genetic isolates of Desulfovibrio (~10^8 colony forming units, CFU): biofilm-forming DvH-MT and biofilm-deficient DvH-MO. We found that the rats stably colonized with the biofilm-forming DvH-MT strain, with the bacteria present at 4 months of age. Adenoma burden at sacrifice showed that the biofilm-competent strain significantly reduced colonic adenoma size (t-test, p&amp;lt;0.05), compared to the biofilm-deficient, DvH-MO-treated rats. To understand how the biofilm-forming capacity of the DvH-MT strain modulated adenoma burden, the genomes of the DvH-MT and DvH-MO strains were sequenced and 12 variants were identified between the two strains. In the DvH-MO strain one variant in the DVU1017 type-1 secretion system ABC transporter binding protein gene was shown to be required for biofilm-formation by Desulfovibrio in vitro. This gene was inactivated in the parent DvH-MT strain and the new construct was designated JWT716. To determine the presence and proximity of Desulfovibrio to adenomas in the colon, we modified the parental DvH-MT to express the fluorescent protein, dTomato and designated the fluorescent strain as JWT733. Pirc rats were treated with the biofilm-forming, JWT733 and the biofilm-deficient, JWT716. 3-months post-treatment we confirmed via qRT-PCR the presence of the biofilm-forming, JWT733 in fecal samples. JWT716 was undetectable in the fecal samples from most rats. Using a narrow-band filter to detect dTomato, we confirmed JWT733 colonization in the treated rats by colonoscopy. At 4 months of age, the rats were sacrificed and adenoma burden was estimated. We found that the biofilm-forming Desulfovibrio suppressed tumor burden in the colon compared to rats treated with the biofilm-deficient strain (t-test, p&amp;lt;0.05). This implicates the role of biofilm formation and potentially sulfate-reduction by this bacterium in the suppression of tumor multiplicity. In this model of colon cancer, Desulfovibrio alone or in concert may be residing in a niche in the intestinal mucus layer creating a beneficial or protective biofilm. Citation Format: Susheel Bhanu Busi, Kara B. De Leon, Judy D. Wall, James M. Amos-Landgraf. Biofilm-producing sulfate-reducing bacteria suppress tumor burden in a rat model of colon cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4987.

Autonomic dysregulation in colon cancer patients

To the best of our knowledge, only two studies analyzed the relationship between HRV and carcinoembryonic antigen (CEA) in colon cancer patients. The aim of this study was to analyze changes in the autonomic activity of colon cancer patients using heart rate variability (HRV) and blood pressure variability (BPV) measures, and to verify if HRV and BPV parameters correlate with hemodynamic indices in this group and the plasma levels of CEA. Presence of colon cancer is associated with changes in autonomic activity, namely parasympathetic-sympathetic imbalance in form of sympathetic overdrive. Cancer-related autonomic dysfunction may contribute to impairment of gastrointestinal motility.

Opium Use and Risk of Lower Gastrointestinal Cancers: Population-Based Case-Control Study in South of Iran

Background: Colorectal cancers, including colon, rectum and anus, are relatively prevalent in Iran. Use of opium and its derivatives is also considerably prevalent in some areas in Iran. Objectives: The aim of this study was to assess the association between use of opium and its derivatives, and incidence of lower gastrointestinal (LGI) cancers. Methods: This study was a matched case-control study in Shiraz (south of Iran). Cases were the new colorectal cancers from cancer registry center of Shiraz University of Medical Sciences and controls were selected from healthy volunteers of cases’ neighbors matched for age and gender (2 controls per 1 case). Data related to consumption of opium and its derivatives, smoking, alcohol use and diet status were collected through a structured questionnaire. The conditional logistic regression models were used to assess all associations. Results: 160 cases and 320 controls participated in the present study with non-response rate less than 9 %. Opium use was associated with increased risk of colorectal cancer (adjusted OR = 4.4; 95% CI: 2.2 - 8.8). Also, a dose-response association was observed between cumulative consumption of opium and the colorectal cancer incidence (OR = 3.8; 95% CI: 1.5 - 9.1), and (OR = 4.6; 95% CI: 1.7 - 12.0) for low and high use, respectively. Also, the significant dose-response association was observed for low (OR = 3.4; 95% CI: 1.2 - 9.2) and high (OR = 7.7; 95% CI: 1.5 - 38.6) opium use with presence of colon cancer. Conclusions: The results of this study showed that opium use can be an important risk factor for colorectal cancer in Iran.

Elevated mean platelet volume is associated with presence of colon cancer.

Colon cancer is the second most common cancer in developed countries. Activated platelets play a key role in inflammation and atherothrombosis, with mean platelet volume (MPV) is an early marker of platelet activation. The aim of the study was to clarify the relevance of MPV in patients with colon cancer. We measured MPV levels in 128 patients with colon cancer before and after surgery, and 128 controls matched for age, gender, body mass index (BMI) and smoking status. The odds ratios (ORs) and 95% confidence intervals (CIs) for colon cancer were calculated using multivariate logistic regression analyses across MPV quartiles. Patients with colon cancer had higher MPV compared with controls. Surgical tumor resection resulted in a significant decrease in MPV levels (11.4 fL vs 10.7 fL; p<0.001). A positive correlation between MPV and tumor-nodule-metastases (TNM) stage was found. Furthermore, after adjusting for other risk factors, the ORs (95%CIs) for colon cancer according to MPV quartiles were 1.000, 2.238 (1.014-4.943), 3.410 (1.528-7.613), and 5.379 (2.372-12.198), respectively. The findings show that patients with colon cancer have higher MPV levels compared with controls, and these are reduced after surgery. In addition, MPV was found to be independently associated with the presence of colon cancer. Further studies are warranted to assess the utility of MPV as a novel diagnostic screening tool for colon cancer.

Abstract 14038: Multiple Infective Coronary Arteritis Complicated with Bacterial Pericarditis

A 69 year old male was referred to our institute because of dyspnea, chest compression, and fever (39.1 o C). He had had Sjögren’s syndrome, diabetes mellitus, and hypertension and had been taking a low dose of steroid orally for Sjögren’s syndrome. Serum white blood cell count and C-reactive protein were 22100/μL and 37.7mg/dl respectively. Transthoracic echocardiography revealed massive pericardial effusion and on pericardiocentesis, 200ml of purulent pericardial effusion was obtained. Pneumococcus was detected from blood culture and intravenous injection of antibiotics was started. Open-heart surgery was performed with maintenance of pericardial effusion and 300ml of purulent pericardial effusion was extracted. Inflammatory cells including neutrophils and lymphocytes were observed in the extract. On transesophageal echocardiography, presence of an abscess around the left coronary cusp was suspected and cardiac CT was performed. On CT, pericardial effusion and aneurysm with thickened wall, but without luminal stenosis in right coronary artery (RCA), aneurysm with thickened wall in left main (LM) trunk; and luminal stenosis with thickened wall in left anterior descending artery (LAD) were observed. From those findings, presence of coronary arteritis complicated with pericarditis was suspected. The patient had bloody bowel diarrhea, and colonoscopy revealed presence of colon cancer. As infection was not controlled, he died 31 days after admission. Subsequent autopsy showed macro-level findings of aneurysm with thickened wall complicated with hemorrhage in RCA and with thrombus in LM trunk. Thickened and hardened epicardium was also observed, which was in accordance with the clinical diagnosis of pericarditis. On hematoxylin and eosin staining, remarkable fibrous thickening of the intima and inflammatory cell invasion into vessel wall, mainly media, was observed. The epicardium was thickened and inflamed with fibrinous deposition.

Incidence of Venous Thromboembolism in Patients Undergoing Surgical Treatment for Malignancy: An Analysis of ACS NSQIP Data 2005-2008

Introduction: Venous thromboembolism (VTE) events have been associated with surgical procedures and cancer status. Pulmonary embolism is a potentially fatal event, and long term consequences of deep venous thrombosis can result in significant disability. Data regarding VTE by tumor type for surgical patients are sparse. the current study was designed to define the incidence, relative risk, and adjusted odds ratio of VTE following surgical intervention by cancer site. Methods: We performed a retrospective cohort study of patients entered into the ACS-NSQIP database from 2005-2008 who underwent a surgical procedure and had a post-operative neoplasm diagnosis. the incidence of VTE was calculated by tumor type for malignant and benign/CIS neoplasms. the relative risk of post-operative VTE for cancer was calculated by tumor site. An odds ratio was calculated for each neoplasm site using logistic regression, and controlled for body mass index (BMI), age, operative time, and sex. BMI, age and operative time were divided into categorical variables in concordance with those indicated by VTE prophylaxis guidelines. Results: All patients with a neoplasm were identified (n=130,284); 4289 cases were excluded due the uncertain behavior of the neoplasm. We identified 92,072 malignant neoplasms and 33,923 benign/CIS neoplasms, which were used as controls. the presence of colon cancer, rectal cancer, pancreatic cancer, uterine cancer, ovarian cancer, and breast cancer had statistically significant higher relative risk for VTE in patients with malignant neoplasms before controlling for patient characteristics. After controlling for age, sex, BMI and operative time, only malignancies of the large intestine, uterus, ovaries, and adrenals remained as having statically significant elevated odds ratio of developing VTE after a surgical procedure. Conclusions: The incidence of VTE is higher in patients with malignant neoplasm undergoing surgical procedures when compared to their benign counterparts. the relative risk of VTE varies by tumor type and is not uniform across patients undergoing surgical procedures. After controlling for patient characteristics known to be associated with VTE, the odds ratio of VTE remained elevated for malignancies of specific sites. Recommendations for VTE prophylaxis for patients undergoing surgical procedures should be based on the overall risk profile of the patient including an adjustment tailored to the specific type of malignancy. Table Site of Neoplasm Cancer patients with VTE (all cancer patients) Patients with benign/cis neoplasm with VTE (all benign/cis patients) Incidence per 1000 cases (cancer) Incidence per 1000 cases (benign/cis) RR P OR∗ P Gastrointestinal Esophageal 37 (730) 0 (33) 50.7 0.0 -- 0.19 -- -- Stomach 91 (2421) 5 (233) 37.6 21.5 1.78 0.14 1.52 0.38 Small Intestine 25 (994) 6 (279) 25.2 21.5 1.17 0.46 1.23+ 0.66 Large Intestine 321 (14346) 63 (4943) 22.4 12.7 1.77 <0.001 1.63 <0.001 Rectum 148 (8854) 7 (1150) 16.7 6.1 2.78 0.006 1.70 0.18 Hepatobiliary Liver 53 (1607) 11 (516) 33.0 21.3 1.57 0.18 0.86 0.68 Gallbladder 27 (1191) 10 (478) 22.7 20.5 1.11 0.78 1.09+ 0.82 Pancreas 169 (5053) 20 (933) 33.4 21.4 1.58 0.05 1.40 0.17 Endocrine/Breast Breast 71 (31451) 12 (11780) 2.3 1.0 2.22 0.009 1.22 0.53 Thyroid 5 (6416) 2 (2547) 0.8 0.8 0.99 0.64 0.99‡ 0.99 Adrenal 5 (135) 4 (788) 37.0 5.1 7.54 0.005 5.83 0.01 Parathyroid 0 (36) 3 (2657) 37.0 1.1 0 0 -- -- GU/GYN Uterus 11 (585) 8 (2490) 18.8 3.2 5.95 <0.001 8.94+ <0.001 Ovarian 13 (368) 1 (434) 35.3 2.3 15.86 <0.001 13.26 0.02 Prostate 15 (1302) 0 (3) 11.5 0.0 -- 0.97 -- -- Bladder 10 (954) 1 (52) 10.5 19.2 0.54 0.44 0.37 0.38 Open table in a new tab

Risk factors for secondary proctectomy in patients with familial adenomatous polyposis

Colectomy and ileorectal anastomosis (IRA) or restorative proctocolectomy are performed for prophylaxis in familial adenomatous polyposis (FAP). After IRA patients may require secondary proctectomy for worsening polyposis or rectal cancer. Outcomes after IRA were evaluated and risk factors predictive of progressive rectal disease identified. Parametric survival analysis was used to identify predictors of progressive rectal disease in all patients undergoing an IRA for FAP at a single centre. Hazard ratios (HRs) were calculated for phenotype, genotype, sex, age at surgery and presence of colonic cancer. Of 427 patients who underwent IRA, 48 (11.2 per cent) developed rectal cancer and 77 (18.0 per cent) required proctectomy for worsening polyposis over a median follow-up of 15 (range 7-25) years. By the age of 60 years half of the patients retained their rectum. Rectal polyp count exceeding 20 (HR 30.99, 95 per cent confidence interval 9.57 to 100.32; P < 0.001), APC mutation codon 1250-1450 (HR 3.91, 1.45 to 10.51; P = 0.007), colonic polyp count 500 or more (HR 2.18, 1.24 to 3.82; P = 0.006) and age less than 25 years at the time of surgery (HR 1.99, 1.17 to 3.37; P = 0.011) were independent predictors of progressive rectal disease. The risk of proctectomy after IRA for FAP is based on patient genotype, phenotype and age at surgery.

Causes of death and postsurgical survival in familial adenomatous polyposis: results from the Italian Registry. Italian Registry of Familial Polyposis Writing Committee.

Causes of death were evaluated among 350 deceased patients with familial adenomatous polyposis (FAP) recorded in the Italian Polyposis Registry: 78.1% were due to colorectal cancer, 9.5% to extracolonic cancer (more than half of the upper gastrointestinal tract), 3.6% to desmoid tumors, and 8.8% to other causes. The age at diagnosis among 604 patients was studied in relation to presence of symptoms at presentation and presence of colonic cancer at surgery. In asymptomatic patients younger than 30 years the risk of colonic cancer was 3.3% and in symptomatic patients older than 40 it was 80%. A life-table analysis showed that postsurgical survival among patients without cancer at colectomy was 68% after 30 years, whereas that of patients with cancer was 41% after 10 years. The alternative prophylactic treatments of total colectomy with ileorectal anastomosis versus total proctocolectomy (IRA vs. IAA) were compared in terms of postsurgical survival. Both treatments showed a survival of 83% after 10 years. The risk of cancer in the rectal stump after IRA was 14.5% after 15 years and 25.2% after 25 years; the corresponding risks of dying from it were 4.3% and 9.3%, respectively.

Effect of various biological factors on spontaneous marmoset and tamarin colitis

Histological sections of colons from 69 tamarins (46 Saguinus oedipus and 23 Saguinus fuscicollis illigeri) and 27 marmosets (Callithrix jacchus) that died between 1979 and 1984 were examined for colitis. Evaluated biological factors were species, age at death, source of animals, manner of death, presence of colon cancer, and time after importation. Most normal colons were found in young animals (dead at less than 1 years of age). Nearly all (approximately 96%) animals had colitis; 70-80% of most groups were graded as chronic colitis. Usually, one grade adequately described the condition of the entire colon. The strongest observed correlation of factors (P less than 0.05) was between acute colitis and colon cancer in S. oedipus. A higher percentage of S. oedipus had acute colitis than did the other two species. When colitis incidence data were adjusted for S. oedipus with colon cancer, there were no observed species differences between colons of colony-born and imported animals nor between those that died naturally and those that were euthanized. In an additional group of 18 S. oedipus that were imported in 1975, acute colitis was found in 60% of those dying immediately after importation (less than 1 year of colony age) and those that survived greater than 3 years. At this time, no causative agent has been identified in marmoset colitis.

The role of histamine antagonists on the development of experimental cancer in the rat.

“The effect of the H1-receptor antagonist Diphenhydramine and the H2-receptor antagonist, Cimetidine, on the incidence, degree of histological differentiation and histological staging of 1–2 Dimethylhyd-razine (DMH) induced colonic cancer in Sprague-Dawley rats was studied. DMH was administered to 60 rats by subcutaneous injection of 20 mgs/Kg body weight per week for 16 weeks. Diphenhydramine and Cimetidine were given at a dose of 100 mgs/Kg body weight per day for 26 weeks. All rats were killed at 26 weeks and examined histologically for the presence of colonic cancer, degree of differentiation, lym-phocytic infiltration and staging. A total and a differential white cell count was examined in blood samples.

Carcinoembryonic Antigen (CEA) in Inflammatory Bowel Disease

Serum radioimmunoassay indicated the presence of carcinoembryonic antigen (CEA) in seven of 61 patients with inflammatory bowel disease. The only patient with a persistently positive assay result had proven colonic adenocarcinoma complicating chronic ulcerative pancolitis. Six patients without evidence of colonic cancer had transient antigenemia, which occurred in four during acute onset or flare-up of disease and disappeared with remission in three of the latter. Thus, a transiently positive CEA level in a patient with inflammatory bowel disease does not necessarily indicate the presence of colonic cancer.

Carcinoma of the right colon

A review of eighty-nine consecutive patients with cancer of the right colon has been undertaken as a medical audit and to determine those factors supporting long-term survival and those which make early detection difficult. The most important factor in indefinite survival without recurrent disease has been and still remains the absence of involved regional lymph nodes. In this series, when regional nodes were uninvolved and the patient survived the operative period, the chance for survival was 80 per cent at five years and 64 per cent at ten years. Twenty per cent of the patients with positive nodes in this series survived five years; death from carcinoma had occurred by the four year mark in those patients who were to die of the disease. The duration of disease in these patients, as ascertained by history taking, sheds little light on their prognosis. Patients with lesions of the right transverse colon seemed to have the same prognosis as patients with lesions of the cecum and ascending colon. Family incidence of carcinoma may be significant in raising an early suspicion of disease by either patient or family physician. It seems to have no further significance in determining longevity. Diverticulosis of the colon and colonic polyps should be viewed as associated lesions which may obscure awareness and the urgency of early precise diagnosis in the presence of colonic cancer. In this series 40 per cent of the patients were treated by resident surgeons. These patients fared as well as did those operated on by their more experienced colleagues.