Suspected Colon Cancer Research Articles

Potentially Avoidable Admissions and Prolonged Hospitalization in Patients with Suspected Colon Cancer.

Suspicion of cancer in the Emergency Department (ED) may lead to potentially avoidable and prolonged admissions. We aimed to examine the reasons for potentially avoidable and prolonged hospitalizations after admissions from the ED for new colon cancer diagnoses (ED-dx). A retrospective, single-institution analysis was conducted of patients with ED-dx between 2017 and 2018. Defined criteria were used toidentify potentially avoidable admissions. Patients without avoidable admissions were examined for ideal length of stay (iLOS), using separate defined criteria. Prolonged length of stay (pLOS) was defined as actual length of stay (aLOS) being greater than 1 day longer than iLOS. Of 97 patients with ED-dx, 12% had potentially avoidable admissions, most often (58%) forcancer workup. Very little difference in demographic, tumor characteristics, or symptoms were found, except patients with potentially avoidable admissions were more functional (Eastern Cooperative Oncology Group [ECOG] score 0-1: 83% vs. 46%; p=0.049) and had longer symptom duration prior to ED presentation {24 days (interquartile range [IQR] 7-75) vs. 7 days (IQR 2-21)}. Among the 60patients who had necessary admissions but did not require urgent intervention, 78% hadpLOS, most often for non-urgent surgery (60%) and further oncologic workup. The median difference between iLOS and aLOS was 12 days (IQR 8-16) for pLOS. Potentially avoidable admissions following Ed-dx were uncommon but were mostly for oncologic workup. Once admitted, the majority of patients had pLOS, most often for definitive surgery and further oncologic workup. This suggests a lack of systems to safely transition to outpatient cancer management.

Colorectal Cancer (CRC): Investigating the Expression of the Suppressor of Fused (SuFu) Gene and Its Relationship with Several Inflammatory Blood-Based Biomarkers

Suppressor of fused (SuFu) is a tumor-suppressor gene that regulates hedgehog signaling. Its involvement in some malignancies is broadly accepted. However, its association with colorectal cancer (CRC) pathogenesis is not clear. Likewise, no study has clearly associated blood-based inflammatory biomarkers with cancer diagnosis/prognosis as yet. Our goal was to look at SuFu expression levels in CRC patients and its relationship with other clinicopathological factors. Additionally, we looked into the function of a few blood-based biomarkers in CRC and whether or not a combined strategy at the genetic and clinical levels can be applied in CRC. The investigation included 98 histopathologically confirmed CRC samples and adjacent normal tissues (controls). A colonoscopy was followed by a targeted biopsy for each suspected colon cancer patient. A CT scan and MRI were also performed on every patient with rectal cancer. Real-time polymerase chain reaction and immunohistochemistry (IHC) were used for assessment. A Beckman Coulter DxH900 was used to examine blood parameters. A Beckman Coulter DxI800 was used to identify pretreatment carcinoma embryonic antigens (CEA) and carbohydrate antigens (CA 19-9) in CRC patients. The expression of SuFu was associated with gender, education, passive smoking, tumor grade, perineural invasion (PNI), lymph node metastasis (LNM), node status, stage, vital status, and recurrence (p < 0.05). In the combined analysis, the areas under the curve produced by the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW) were the greatest (AUCRDW+PLR+NLR = 0.91, 95% CI: 0.86-0.93, p < 0.05). Furthermore, the most severe pathological features were linked to RDW, PLR, NLR, and HPR. SuFu expression, node status, LNM, PNI, and stage all had significant correlations with OS and DFS rates in IHC-based univariate survival analysis (p < 0.05). According to the Cox regression, CA-19.9 had a strong independent predictive link with 3-year DFS (p < 0.05). In CRC, SuFu was downregulated both transcriptionally and translationally, was primarily nucleo-cytoplasmic, and was expressed less in high-grade tumors. In addition, SuFu was linked to a poor overall and disease-free survival rate. It may be possible to use SuFu as a therapeutic target for CRC in the future. However, SuFu expression had no effect on RDW, PLR, NLR, or HPR serum levels.

The application of lean technologies to optimize oncological screening in the periodic health examination of adult population groups

Background. Improving organizational technologies for early detection of cancer using targeted programs for large-scale cancer screening is a priority task of primary health care.The aim: to assess the potential of lean technologies to optimize cancer screening during periodic health examination of the adult population.Materials and methods. To develop an optimal organizational and functional model of cancer screening, a working group was created; information about the current state of the process was collected.Results. A comprehensive analysis of the state of the process revealed the following problems: violation of the algorithms of oncological screening at stage 1 of periodic health examination (13.8 %); cases of non-completion of stage 2 of periodic health examination by patients with suspected colon cancer (20.4 %); queues for endoscopic examinations (14 days) and, as a consequence, not a quick visit to the oncologist of the primary oncology department (17–18 days). After optimization of the periodic health examination: there is no queue for endoscopy for patients with suspected oncopathology; accelerated access of patients with suspected oncopathology to the oncologist of the primary oncology department (from 17–18 to 5 days; p &lt; 0.01). Increased awareness of patients about the rules for preparing for endoscopic examination and a reminder of the date and time of the upcoming endoscopy, there was an increase in the number of patients who completed stage 2 of health examination to exclude/confirm oncopathology (from 79.6 to 90 %; p &lt; 0.05). The frequency of violations by doctors of the oncological screening algorithm decreased from 13.8 to 2.3 % (p &lt; 0.01).Conclusion. The use of lean manufacturing marketing strategies in primary health care has helped to identify, eliminate and control the causes of problems during the first and second stages of clinical examination of patients with suspected oncopathology.

IgG4-related focal retroperitoneal fibrosis in ureter suggestive of colon cancer recurrence and resected laparoscopically: a case report

BackgroundImmunoglobulin G4-related disease (IgG4-RD) is a novel disease concept of unknown cause that is characterized by abundant infiltration of IgG4-positive cells, mass-forming lesions, and elevated serum IgG4 levels. The infiltration of IgG4-positive plasma cells and lymphocytes causes swelling, inflammation, fibrosis, and obliterative phlebitis in multiple organs. On the other hand, IgG4-RD occurring in the ureters has rarely been reported. To our knowledge, this is the first report of laparoscopic partial ureteral resection for IgG4-related focal retroperitoneal fibrosis in a ureter with suspected colon cancer recurrence.Case presentationA 72-year-old man with a history of sigmoid colon cancer visited Shiga University of Medical Science Hospital for regular follow-up in December 2019. Enhanced abdominal computed tomography revealed a mass involving the left ureter. Furthermore, fluorine-18 fluorodeoxyglucose positron emission tomography showed significant accumulation of fluorodeoxyglucose uptake in the same region. Due to the possibility of colon cancer recurrence, a laparoscopic excisional biopsy with partial ureteral resection was performed. Histologically, IgG4-positive plasma cell infiltration exceeding 10 cells per high-power field and a high ratio of IgG4-positive/IgG-positive cells exceeding 40% were observed. The postoperative serum IgG4 level was 384 mg/dL. With the application of these findings to the diagnostic algorithm in the comprehensive diagnostic criteria for IgG4-RD, the mass-forming lesion was diagnosed as definitive IgG4-related focal retroperitoneal fibrosis.ConclusionsIgG4-RD should be considered in the differential diagnosis of retroperitoneal lesions. Moreover, laparoscopic surgery may be useful for making the diagnosis in difficult-to-biopsy cases.

The diagnostic accuracy of colonic ultrasound, to problem solve suspected colon cancer following diagnostic CT. Can we reduce the need for Colonoscopy?

Purpose: Residual faecal material, poor insufflation, complex diverticular disease, segmental colitis and spasm can mimic tumours on diagnostic Computed Tomography (CT). We aim to evaluate the diagnostic accuracy of focused ultrasound (US) in characterisation of colonic pathology in patients following abdominal CT and CT colonography (CTC). US is used in our service to allow patients to proceed direct to surgery without confirmatory colonoscopy.

Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion for the diagnosis of colorectal polyp and cancer.

Diffusion-weighted whole-body imaging with background body signal suppression/T2 image fusion (DWIBS/T2) is useful for the diagnosis of cancer as it presents a clear contrast between cancerous and non-cancerous tissue. The present study investigated the limitations and advantages of DWIBS/T2 with regards to the diagnosis of colorectal polyp (CP) or cancer (CRC). The current study included patients diagnosed with CP or CRC following colonoscopy, who were subjected to DWIBS/T2 between July 2012 and March 2015. Patient records were analyzed retrospectively. Patients were subjected to DWIBS/T2 when they presented with abdominal cancers or inflammation. Colonoscopy was performed as part of screening, or if patients had suspected colon cancer or inflammatory bowel disease. A total of 8 male and 7 female patients were enrolled in the present study. All patients, with the exception of one who had been diagnosed with CRC following colonoscopy, had positive results and all patients diagnosed with CP following a colonoscopy, with the exception of one, had negative results on DWIBS/T2. Thus, CRC was detected by DWIBS/T2, while CP was not (P=0.0028). The diameter of CRC lesions was significantly larger than that of CP (P<0.0001) and that of lesions positive on DWIBS/T2 was significantly larger than that of negative lesions (P=0.0004). The depth of invasion tended to be greater for lesions positive on DWIBS/T2 compared with that of negative ones. This indicated that DWIBS/T2 may be suitable for the detection of CRC but not for detection of CP. The results of DWIBS/T2 may also be affected by lesion diameter and depth of invasion.

PWE-004 Extracolonic Findings On Ct Colonography

IntroductionColonoscopy is often the first line investigation for detection of lesions within the large bowel and remains the gold standard in investigating for suspected colon cancer. However if endoscopy is...

Indications and findings at colonoscopy in Ilorin, Nigeria

Background:Colonoscopy is a safe and effective means of visual inspection of the large bowel from the distal rectum to the caecum. It may be carried out for diagnostic and or therapeutic reasons. There is a paucity of data on this procedure in Nigeria. We, therefore, determined the indications, findings, and diagnostic yield in Nigerians at colonoscopy.Materials and Methods:This was a hospital-based cross-sectional study carried out at the Endoscopy unit of Crescent hospital, Ilorin from January 2010 to May, 2012. The endoscopy register was reviewed, and the biodata, indications and colonoscopic findings were recorded on a pro forma.Results:A total of 103 patients had colonoscopy. Seventy (68.0%) were males while 33 (32.0%) were females. The indications for colonoscopy were rectal bleeding 41 (39.8%), suspected colon cancer 32 (31.1%), chronic constipation and chronic diarrhoea nine each (8.7%), abdominal/anal pain five (4.9%), suspected anorectal cancer and enterocutaneous fistula two each (1.9%), faecal incontinence, occult gastrointestinal bleeding, post-colostomy for Hirschsprung disease one each (1.0%). Endoscopic findings were normal findings 21 (20.4%), diverticulosis 17 (16.5%), polyps 16 (15.5%), haemorrhoids 16 (15.5%), anorectal cancer 13 (12.6%), angiodysplasia 12 (11.7%), colon cancer eight (7.8%), colitis 7 (6.8%), anorectal ulcer 4 (3.9%), anal warts two (1.9%), anal fissure, caecal tumour, faecal impaction and proctitis one each (1.0%). The diagnostic yield was 79.6%.Conclusions:The commonest indication for colonoscopy was rectal bleeding, while the most frequent pathology was diverticulosis. The diagnostic yield was high.

Assessment of water enema computed tomography: an effective imaging technique for the diagnosis of colon cancer

The aim of this study was to assess the accuracy of water enema computed tomography (WECT) for the diagnosis of colon cancer. A total of 191 patients referred for clinically suspected colon cancer were prospectively evaluated by WECT in a multicenter trial. Examination was contrast enhanced helical CT after colon filling through a rectal tube. For all the cases, final diagnosis was obtained by colonoscopy and/or surgery. CT data were interpreted both locally and at a centralized site by a specialized and general radiologist. Seventy-one patients were diagnosed with colon cancer. Overall, WECT sensitivity and specificity were 98.6 and 95.0%, respectively. Positive and negative predictive values were 92.1 and 99.1%, respectively. In a subgroup of 33 patients with unclean bowel, the sensitivity and specificity of WECT were 95.0 and 92.3%, respectively. The correlation between local radiologists and the specialized radiologist was excellent (Kappa = 0.87) as was the correlation between the general radiologist and the specialist (Kappa = 0.92). This prospective analysis demonstrates that WECT is an effective, safe, and simple imaging technique for the diagnosis of colon cancer and can be proposed when a strong clinical suspicion of colon cancer is present, especially in frail patients.

The value of abdominal ultrasound in the diagnosis of colon cancer – ten-year experience

Aim: We aimed to assess the importance of abdominal ultrasound in detecting colon cancer, comparatively with endoscopic exam. We present our ten-year experience with abdominal ultrasound in patients with suspected colon cancer.

Zum 100. Todestag Ernst von Bergmanns

"dear aunt lina. i do not know any big letters yet, but i want to thank you in small letters for the beautiful pens. say hello to grandpa and to everybody. yours truly, ernst." These are the first surviving written words of Ernst von Bergmann. Between them and his last words about his suspected colon cancer on 25 March 1907 ("I diagnosed this 5 years ago, and now it has come to pass.") lie many years in a vigorous life characterised by untiring activity and creativity, self-discipline, and care for patients and his family. They were years of enormous success in surgery and private happiness but also of professional setbacks and tragic family loss. Ernst von Bergmann became a leading German surgeon not only because of his surgical and scientific achievements, particularly in the fields of asepsis and war surgery, but also due to his exemplary character, reliability, engaging personality, and commitment to medical training in various medical societies. Of these, the German Society of Surgery is most indebted to him. After assuming a chair in surgery in 1882, he continued to play a leading role in this society, not least as its five-time president from 1888 to 1890 and in 1896 and 1900. A worthy successor to Bernhard von Langenbeck, he was a full professor at the Berlin University Hospital for 25 years. He also taught at the Medical and Surgical Academy for the Military after being appointed there by Emperor Wilhelm I on 16 November 1882. This position was important to him and corresponded to his patriotic views.

Clinical Value of CT Colonography in Patients with Strong Relative Medical Contraindications for Colonoscopy

Purpose: CT colonography (CTC) is a potentially valuable complimentary tool to conventional colonoscopy (CC). CTC may be particularly valuable in patients who are at high risk for CC due to severe medical illness, administration of anticoagulant therapy, blood dyscrasia, or intraabdominal conditions. We analyze the clinical feasibility and efficacy of CTC in this previously unstudied subgroup of patients. Methods: Of 160 patients undergoing CTC at our institution from April 2005 through May 2006, 31 patients underwent CTC, rather than CC, due to medical contraindications. Patients undergoing CTC for colon cancer screening or for prior incomplete CC were excluded. CTC was performed by 64 or 16 slice detectors and read using Vitrea software. The colonic preparation was Fleet's prep 1. Adequacy of colonic evaluation was quantitatively scored by dividing the colon into 9 segments e.g. cecum = 9, asc.colon = 8, rectum = 1. Results: Of 31 patients satisfying the study criteria, 17 (55%) were female, 55% were black, and 42% were Caucasian. The mean age was 73.8 ± 13.3 years. Relative contraindications to CC included severe medical illness in 14 (45%), anticoagulation in 13 (42%), and other in 4. Twenty-nine (94%) of patients tolerated the procedure (2 [6%] did not tolerate air insufflation). Evaluation of all colonic segments was performed in 17 patients (55%), but was not possible in 14 patients (45%) due to inadequate colonic preparation. Colonic visualization at CTC was inferior in these 31 patients compared to 100 patients undergoing CTC for incomplete CC (mean visualization: 6.3 ± 3.7 vs 7.6 ± 2.6, p= 0.03). Eleven patients had colonic polyps (total 28 polyps). Nine had at least one polyp ≥ 0.5 cm or ≥ 3 polyps. The yield of colonic polyps was similar when CTC was performed for medical contraindications versus CTC performed for prior incomplete CC (p= 0.56). One suspected colon cancer on CTC (poor prep) was a false positive. One villous carpet of cecum was missed at CTC (poor prep). Diverticulosis was reported in 52% of patients. Conclusions: CTC is technically feasible in patients with relative medical contraindications to CC, but often (45%) have incomplete colonic evaluation due to poor colonic preparation. False positive or false negative reporting can occur due to poor colonic preparation. Better colonic preparation may improve colonic evaluation by CTC in these patients.

Minimal preparation computed tomography instead of barium enema/colonoscopy for suspected colon cancer in frail elderly patients: an outcome analysis study

AIM: To evaluate the efficacy of minimal preparation computed tomography (MPCT) in diagnosing clinically significant colonic tumours in frail, elderly patients. MATERIALS AND METHODS: A prospective study was performed in a group of consecutively referred, frail, elderly patients with symptoms or signs of anaemia, pain, rectal bleeding or weight loss. The MPCT protocol consisted of 1.5 l Gastrografin 1% diluted with sterile water administered during the 48 h before the procedure with no bowel preparation or administration of intravenous contrast medium. Eight millimetre contiguous scans through the abdomen and pelvis were performed. The scans were double-reported by two gastrointestinal radiologists as showing definite (>90% certain), probable (50–90% certain), possible (<50% certain) neoplasm or normal. Where observers disagreed the more pessimistic of the two reports was accepted. The gold standard was clinical outcome at 1 year with positive end-points defined as (1) histological confirmation of CRC, (2) clinical presentation consistent with CRC without histological confirmation if the patient was too unwell for biopsy/surgery, and (3) death directly attributable to colorectal carcinoma (CRC) with/without post-mortem confirmation. Negative end-points were defined as patients with no clinical, radiological or post-mortem findings of CRC. Patients were followed for 1 year or until one of the above end-points were met. RESULTS: Seventy-two patients were included (mean age 81; range 62–93). One-year follow-up was completed in 94.4% ( n=68). Mortality from all causes was 33% ( n=24). Five histologically proven tumours were diagnosed with CT and there were two probable false-negatives. Results were analysed twice: assuming all CT lesions test positive and considering “possible” lesions test negative [brackets] (95% confidence intervals): sensitivity 0.88 (0.47–1.0) [0.75 (0.35–0.97)], specificity 0.47 (0.34–0.6) [0.87 (0.75–0.94)], positive predictive value 0.18 [0.43], negative predictive value 0.97 [0.96], positive likelihood ratio result 1.6 [5.63], negative likelihood ratio result 0.27 [0.29], kappa 0.31 [0.43]. Tumour prevalence was 12%. A graph of conditional probabilities was generated and analysed. A variety of unsuspected pathology was also found in this series of patients. CONCLUSIONS: MPCT should be double-reported, at least initially. “Possible” lesions should be ignored. Analysis of the graph of conditional probability applied to a group of frail, elderly patients with a high mortality from all causes (33% in our study) suggests: (1) if MPCT suggests definite or probable carcinoma, regardless of the pre-test probability, the post-test probability is high enough to warrant further action, (2) frail, elderly patients with a low pre-test probability for CRC and a negative MPCT should not have further investigation, (3) frail, elderly patients with a higher pre-test probability of CRC (such as those presenting with rectal bleeding) and a negative MPCT should have either double contrast barium enema (DCBE) or colonoscopy as further investigations or be followed clinically for 3–6 months. MPCT was acceptable to patients and clinicians and may reveal significant extra-colonic pathology.