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Simon EG, Dhus U, Rao AS, M K, Yedupati KR, George JT, K P, Swarna A, Somasundaram A, Ramakrishnan A, L V, Thomas D, V A, S P AM, M S R, Jha R, S J, Devakumar S, Pl A, Gade SV, Manickavasagam K, Agarwal D, V G MP, Prasad M, B M, Abirami D, T S C, B J G, Natrayan R, Sampathkumar HM, B S R, Chand N, S JJB, Ashokan S, S A, Srinivasan K, A A, N L, R S A, Kumar AEP, A R, N A R, A C A, Balaji G, P P, Verma S, V J. Clinical profile of 1208 newly diagnosed colorectal cancer patients in Tamil Nadu-A multi-centric survey. Indian J Gastroenterol 2024; 43:660-667. [PMID: 38372944 DOI: 10.1007/s12664-023-01496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/28/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND An increasing incidence of colorectal cancer (CRC) is being reported in developing countries, including India. Most Indian studies on CRC are retrospective and single-centered. The present study is an attempt to understand the current clinical profile and stage of newly diagnosed CRCs across multiple centers in Tamil Nadu, India. METHODS A multi-centric observational survey was conducted between September 1, 2021, and August 31, 2022, under the aegis of the Indian Society of Gastroenterology - Tamil Nadu chapter. Patients 18 years of age and older with a recent diagnosis of CRC fulfilling the inclusion criteria were prospectively recruited at the participating centers. Their demographic, clinical, biochemical, endoscopic, histopathologic, radiologic and risk factor details were systematically collected and analyzed. RESULTS Across 23 centers in Tamil Nadu, 1208 patients were recruited. The male:female ratio was 1.49:1, while mean (SD) age was 57.7 (13.5) years. A majority (81.9%) were Tamils and 78.5% belonged to lower socioeconomic classes. The predominant symptoms were hematochezia (30.2%) and a change in bowel habits (27.5%). The most common locations were the rectum (34.3%) and rectosigmoid (15.1%). Synchronous CRCs were seen in 3.3% and synchronous colorectal polyps in 12.8%. Predisposing factors for CRC were seen in 2%. A past history of any cancer among CRC patients was obtained in 3.1% and a family history of any cancer was found in 7.6%. Patients who were either overweight or obese constituted 46.4% of the study population. At presentation, the predominant stages were stage III (44.7%) and stage IV (20.8%). CONCLUSIONS A majority of patients with newly diagnosed CRC in Tamil Nadu belonged to the lower socioeconomic classes. About 60% had CRCs located within the reach of the flexible sigmoidoscope. Two-thirds of the patients exceeded stage II disease at presentation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ebby George Simon
- Department of Medical Gastroenterology, Christian Medical College, Vellore, 632 004, India.
| | - Ubal Dhus
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai, 600 006, India
| | - Amara Sadguna Rao
- Department of Medical Gastroenterology, Apollo Hospitals, Chennai, 600 006, India
| | - Kannan M
- Department of Medical Gastroenterology, Madurai Medical College, Madurai, 625 020, India
| | - Kondala Rao Yedupati
- Department of Medical Gastroenterology, Madurai Medical College, Madurai, 625 020, India
| | - John Titus George
- Department of Medical Gastroenterology, Christian Medical College, Vellore, 632 004, India
| | - Premkumar K
- Institute of Medical Gastroenterology, Madras Medical College, Chennai, 600 003, India
| | - Anupama Swarna
- Institute of Medical Gastroenterology, Madras Medical College, Chennai, 600 003, India
| | | | - Arulraj Ramakrishnan
- GI and Liver Unit, Kovai Medical Center and Hospital, Coimbatore, 641 014, India
| | - Venkatakrishnan L
- Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Dhanush Thomas
- Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Arulselvan V
- Department of Medical Gastroenterology, Coimbatore Medical College, Coimbatore, 641 018, India
| | - Arshiya Mubin S P
- Department of Medical Gastroenterology, Coimbatore Medical College, Coimbatore, 641 018, India
| | - Revathy M S
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Rakesh Jha
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Jeswanth S
- Department of Surgical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Satish Devakumar
- Department of Surgical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Alagammai Pl
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Sujata V Gade
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Kanagavel Manickavasagam
- Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600 004, India
| | - Deepak Agarwal
- Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600 004, India
| | - Mohan Prasad V G
- Department of Medical Gastroenterology, VGM Hospital, Coimbatore, 641 005, India
| | - Madhura Prasad
- Department of Medical Gastroenterology, VGM Hospital, Coimbatore, 641 005, India
| | - Mahadevan B
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Dinu Abirami
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Chandrasekar T S
- Department of Medical Gastroenterology, MedIndia Hospitals, Chennai, 600 034, India
| | - Gokul B J
- Department of Medical Gastroenterology, MedIndia Hospitals, Chennai, 600 034, India
| | - Rajesh Natrayan
- Department of Medical Gastroenterology, Sri Gokulam Hospital, Salem, 636 004, India
| | | | - Ramakrishna B S
- Department of Medical Gastroenterology, SRM Institutes for Medical Science, Chennai, 600 083, India
| | - Naveen Chand
- Department of Medical Gastroenterology, SRM Institutes for Medical Science, Chennai, 600 083, India
| | | | - Sindhu Ashokan
- Department of Gastroenterology, Annai Arul Hospital, Chennai, 600 063, India
| | - Arulprakash S
- Department of Gastroenterology and Hepatology, MGM Healthcare, Chennai, 560 070, India
| | - Karishma Srinivasan
- Department of Gastroenterology and Hepatology, MGM Healthcare, Chennai, 560 070, India
| | - Aravind A
- Department of Digestive Health and Diseases, Govt. Kilpauk Medical College, Chennai, 600 010, India
| | - Lavanya N
- Department of Digestive Health and Diseases, Govt. Kilpauk Medical College, Chennai, 600 010, India
| | - Arun R S
- Department of Medical Gastroenterology, Madras Medical Mission, Chennai, 600 037, India
| | | | - Rathnaswami A
- Department of Surgical Gastroenterology, SRM Medical College Hospital and Research Centre, Chennai, 603 211, India
| | - Rajesh N A
- Department of Medical Gastroenterology, SRM Medical College Hospital and Research Centre, Chennai, 603 211, India
| | - Arun A C
- Department of Medical Gastroenterology, Velammal Medical College Hospital and Research Institute, Madurai, 625 009, India
| | - Ganga Balaji
- Department of Medical Gastroenterology, Velammal Medical College Hospital and Research Institute, Madurai, 625 009, India
| | - Padmanabhan P
- Department of Medical Gastroenterology, Meenakshi Medical College Hospital and Research Institute, Kancheepuram, 631 552, India
| | - Somnath Verma
- Department of Medical Gastroenterology, Meenakshi Medical College Hospital and Research Institute, Kancheepuram, 631 552, India
| | - Jayanthi V
- Department of Hepatology, Gleneagles Global Health City, Chennai, 600 100, India
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Raj S, Kishor K, Devi S, Sinha DK, Madhawi R, Singh RK, Prakash P, Kumar S. Epidemiological trends of colorectal cancer cases in young population of Eastern India: A retrospective observational study. J Cancer Res Ther 2024; 20:817-821. [PMID: 39023588 DOI: 10.4103/jcrt.jcrt_2367_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 07/20/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) is a disease of the older population in developed countries where the incidence among the young is rising despite the decline in the overall incidence. Contrary to this, in India, which is a low-incidence country for CRCs, the incidence among all age groups including the young is rising. This study aimed at describing the clinico-demographic profile of young CRC cases and the epidemiological trend of the proportion of young cases from 2014 to 2021 in a tertiary cancer center in Eastern India. METHODS This retrospective observational study was conducted at Department of Radiation Oncology, State Cancer Institute, IGIMS Patna, India a prominent tertiary cancer care center of Bihar. All histopathologically confirmed CRC cases in the 0-39 years age group were considered young and evaluated for the clinical, demographic profile as well as yearly trends in proportion out of total CRC cases. Microsoft Excel (2021) was used for statistical analysis. A P value of 0.05 was considered significant. RESULTS Young colorectal (less than 40 years) patients constituted a third (n = 344, 33.4%) of total colorectal (n = 1028) cases. The median age among the young CRC cases was 30 years (range: 12 to 39 years). Rectum was the most common subsite noted (n = 255,74.1%) among this group of young patients. The most commonly encountered stage of the disease was III (n = 107, 31.1%) and chemotherapy was the most common treatment offered (n = 153, 44.5%). The proportion of young (0-39 years) CRC cases ranged between 29.4 and 37.4 (mean 33.5 ± 2.77, P value = 0.725) over the calendar years of the study period. CONCLUSION The proportion of young (<40 years of age) cases out of total CRC cases in our study is higher than that in developed countries. However, the trends of this proportion have been consistent over the study period, i.e., from 2014 to 2021 without any significant change in our hospital-based cancer registry. Rectal cancer affected nearly three out of every four CRC patients in this age group. More advanced disease at presentation emphasizes the need for measures of screening, early diagnosis, and adequate infrastructure for treatment.
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Affiliation(s)
- Shraddha Raj
- Department of Radiation Oncology, State Cancer Institute, IGIMS, Patna, Bihar, India
| | - Kunal Kishor
- Department of Radiation Oncology, State Cancer Institute, IGIMS, Patna, Bihar, India
| | - Seema Devi
- Department of Radiation Oncology, State Cancer Institute, IGIMS, Patna, Bihar, India
| | - Dinesh K Sinha
- Department of Radiation Oncology, State Cancer Institute, IGIMS, Patna, Bihar, India
| | - Richa Madhawi
- Department of Radiation Oncology, State Cancer Institute, IGIMS, Patna, Bihar, India
| | - Rajesh K Singh
- Department of Radiation Oncology, State Cancer Institute, IGIMS, Patna, Bihar, India
| | | | - Saket Kumar
- Department of Gastrosurgery, IGIMS, Patna, Bihar, India
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Gholami Chahkand MS, Esmaeilpour Moallem F, Ghasemi-Kebria F, Malekzadeh R, Roshandel G, Taher M. Descriptive Epidemiology of Early-Onset Gastrointestinal Cancers in Iran, 2014-2018. Middle East J Dig Dis 2024; 16:28-33. [PMID: 39050103 PMCID: PMC11264827 DOI: 10.34172/mejdd.2024.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/11/2023] [Indexed: 07/27/2024] Open
Abstract
Background We aim to present incidence rates and geographical distribution of most common early-onset gastrointestinal cancers (EOGICs), including early-onset esophageal cancer (EOEC), gastric cancer (EOGC) and colorectal cancer (EOCRC) in Iran, 2014-2018. Methods Data on new cases of EOEC, EOGC and EOCRC were obtained from publicly available annual reports of the Iranian National Population-based Cancer Registry (INPCR). Incidence rates were calculated using the population data available from the Statistical center of Iran. We considered the World standard population for calculation of age-standardized incidence rates (ASR). We also calculated 95% confidence intervals (CIs) for ASR. All rates are presented per 100000 person-years. Results Overall, 19,679 new cases of EOGIC were registered by the INPCR between 2014 and 2018. The ASRs (95% CI) of EOEC, EOGC and EOCRC were 0.49 (95% CI: 0.47-0.51), 1.67 (1.63-1.71), and 3.07 (3.01-3.13) per 100,000 person-years, respectively. Our findings indicate decreasing and constant trends in the ASR of EOEC and EOGC during the study period, 2014-2018. There was an increasing trend in the ASR of EOCRC. We also found geographical disparities in the incidence rates of EOGICs across provinces of Iran, suggesting the highest ASRs of EOEC in Golestan (1.3), EOGC in Ilam (2.99) and EOCRC in Ilam (4.49). Conclusion Our findings suggested that the incidence rate of EOCRC is consistently increasing. We also found variations in the incidence of EOGICs among different provinces. Further investigations are recommended to clarify the time trends and risk factors of EOGICs in Iran.
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Affiliation(s)
| | - Fatemeh Esmaeilpour Moallem
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Ghasemi-Kebria
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Taher
- Division of Gastroenterology and Hepatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Mishra R, Pandey A, Mishra H, Singh TB, Mandal A, Asthana AK. Clinico-epidemiological profile and treatment outcome in adolescents and young patients of rectal cancer attending a tertiary cancer center. J Cancer Res Ther 2023; 19:2005-2011. [PMID: 38376310 DOI: 10.4103/jcrt.jcrt_319_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/08/2022] [Indexed: 02/21/2024]
Abstract
INTRODUCTION The incidence of colorectal cancer in young adults is on an increasing trend. It is observed that this subgroup of patients has an aggressive disease and carries a poorer prognosis compared to its older counterpart. This study aimed to analyze the incidence, treatment outcome, and prognostic factors in adolescents and young adults with rectal cancer attending a tertiary cancer center in North India. MATERIALS AND METHODS We retrospectively analyzed 50 patients of histologically proven rectal cancer, aged up to 30 years, treated at our center between 2015 and 2019. The clinical, demographic, and pathological parameters were studied in all these patients. Kaplan-Meier survival analysis was used to find out survival. Univariate analysis was performed to assess prognostic factors. RESULTS The incidence was 26.4% at our center with a median age of 28 years. Bleeding per rectum was the commonest complaint. Most of them had signet ring cell histology (26%). The median overall survival was 16 months. Survival was significantly better in patients having bleeding per rectum as an initial complaint (P = 0.009), absence of lymphovascular invasion (LVI) (P = 0.005), and perineural invasion (PNI) (P = 0.002), who received complete planned treatment compared to patients who could not receive either of the modality (P < 0.001). Patients who did not receive radiotherapy (RT) had the worst outcomes compared to those who received RT in any form. RT dose of 50.4 Gy was found to be superior as compared to other schedules. There was no significant difference in survival with gender, tumor stage, grade, type of surgery, or chemotherapy regimen. CONCLUSION The majority of patients presented in an advanced stage. Therefore, bleeding per rectum should be properly and timely investigated in all these young patients. Early detection and complete treatment are paramount to improving the outcome.
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Affiliation(s)
- Ritusha Mishra
- Department of Radiotherapy and Radiation Medicine, BHU, Varanasi, Uttar Pradesh, India
| | - Ankita Pandey
- Department of Radiotherapy and Radiation Medicine, BHU, Varanasi, Uttar Pradesh, India
| | - Himanshu Mishra
- Department of Radiotherapy and Radiation Medicine, BHU, Varanasi, Uttar Pradesh, India
| | - Tej B Singh
- Centre of Biostatistics, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, BHU, Varanasi, Uttar Pradesh, India
| | - Anupam K Asthana
- Department of Radiotherapy and Radiation Medicine, BHU, Varanasi, Uttar Pradesh, India
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Ahmad A, Prakash R, Khan MS, Altwaijry N, Asghar MN, Raza SS, Khan R. Nanoparticle-Mediated PRDX2 Inhibition for Specific Targeting of CHK2-Null Colorectal Cancer. ACS Biomater Sci Eng 2022; 8:5210-5220. [PMID: 36446128 DOI: 10.1021/acsbiomaterials.2c01073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Synthetic lethality is a pragmatic targeted cancer therapy approach in which cancer cells harboring genetic alterations are exploited for the specific killing of cancer cells. Earlier, we have established a synthetic lethal (SL) interaction between two genes that are CHK2 and PRDX2 in colorectal cancer (CRC) cells. The SL interaction between CHK2 and PRDX2 resulted in selective targeting of CHK2-defective CRC cells. N-Carbamoyl alanine (NCA) is a PRDX2 inhibitor and is a peptide-like organic compound, which degrades after oral administration in harsh gastric pH. To overcome the limitations of NCA, a chitosan-based nanocarrier was developed for the entrapment of NCA. In this study, we targeted the SL interaction between PRDX2 and CHK2 using NCA-loaded chitosan nanoparticles (NCA-Chit NPs) to selectively inhibit the CHK2-null HCT116 cells. NCA-Chit NPs were assessed for various physicochemical characterizations such as the hydrodynamic diameter (size), zeta potential, and polydispersity index using a Zetasizer. Additionally, morphological studies for the shape and size of NPs were confirmed by transmission electron microscopy, scanning electron microscopy, and atomic force microscopy. Cellular uptake of NPs was confirmed using confocal microscopy, which exhibited that nanoparticles were able to internalize into the HCT116 cells. Blank Chit NPs were found to be cytocompatible as they did not exert any cytotoxic effects on hTERT, L929, and Caco-2 cells (intestinal epithelial cells). Importantly, NCA-Chit NPs were quite hemocompatible also. In the form of an NCA-chitosan nanoformulation, the efficacy was enhanced by about 8 times compared to free form of NCA towards selective killing of CHK2-null HCT116 cells as compared to HCT116 cells. The chitosan-based nanoformulation for NCA was developed to augment the efficacy of the NCA for enhanced cell death of colorectal cancer cells having CHK2 defects.
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Affiliation(s)
- Anas Ahmad
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali140306, Punjab, India
| | - Ravi Prakash
- Laboratory for Stem Cell & Restorative Neurology, Department of Biotechnology, Era's Lucknow Medical College Hospital, Sarfarazganj, Lucknow226003, Uttar Pradesh, India
| | - Mohd Shahnawaz Khan
- Department of Biochemistry, College of Sciences, King Saud University, Riyadh, Riyadh Province11451, Saudi Arabia
| | - Nojood Altwaijry
- Department of Biochemistry, College of Sciences, King Saud University, Riyadh, Riyadh Province11451, Saudi Arabia
| | - Muhammad Nadeem Asghar
- Department of Medical Biology, University of Québec at Trois-Rivieres, Trois-Rivieres, QuébecG9A 5H7, Canada
| | - Syed Shadab Raza
- Laboratory for Stem Cell & Restorative Neurology, Department of Biotechnology, Era's Lucknow Medical College Hospital, Sarfarazganj, Lucknow226003, Uttar Pradesh, India
| | - Rehan Khan
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali140306, Punjab, India
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Rahadiani N, Habiburrahman M, Abdullah M, Jeo WS, Stephanie M, Handjari DR, Krisnuhoni E. Analysing 11 years of incidence trends, clinicopathological characteristics, and forecasts of colorectal cancer in young and old patients: a retrospective cross-sectional study in an Indonesian national referral hospital. BMJ Open 2022; 12:e060839. [PMID: 36691171 PMCID: PMC9454011 DOI: 10.1136/bmjopen-2022-060839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To obtain annual incidence trends, understand clinicopathological characteristics, and forecast the future burden of colorectal cancer (CRC) in Indonesia. DESIGN 11-year retrospective cross-sectional study. SETTING A national referral hospital in Jakarta, Indonesia. PARTICIPANTS Data from 1584 eligible cases were recorded for trends and forecasting analyses; 433 samples were analysed to determine clinicopathological differences between young (<50 years) and old (≥50 years) patients. METHODS Trend analyses were done using Joinpoint software, expressed in annual percentage change (APC), and a regression analysis was executed to generate a forecasting model. Patients' characteristics were compared using χ2 or non-parametric tests. MAIN OUTCOMES Analysis of trends, forecasting model, and clinicopathological features between the age groups. RESULTS A significant increase in APC was observed among old patients (+2.38%) for CRC cases. Colon cancer increased remarkably (+9.24%) among young patients; rectal cancer trends were either stable or declining. The trend for right-sided CRC increased in the general population (+6.52%) and old patients (+6.57%), while the trend for left-sided CRC was stable. These cases are expected to be a significant health burden within the next 10 years. Patients had a mean age of 53.17±13.94, 38.1% were young, and the sex ratio was 1.21. Prominent characteristics were left-sided CRC, tumour size ≥5 cm, exophytic growth, adenocarcinoma, histologically low grade, pT3, pN0, inadequately dissected lymph nodes (LNs), LN ratio <0.05, no distant metastasis, early-stage cancer, no lymphovascular invasion, and no perineural invasion (PNI). Distinct features between young and old patients were found in the histological subtype, number of dissected LN, and PNI of the tumour. CONCLUSIONS Epidemiological trends and forecasting analyses of CRC cases in Indonesian patients showed an enormous increase in colon cancer in young patients, a particularly concerning trend. Additionally, young patients exhibited particular clinicopathological characteristics that contributed to disease severity.
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Affiliation(s)
- Nur Rahadiani
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, Indonesia
| | | | - Murdani Abdullah
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- Division of Gastroenterology, Pancreatobilliary, and Endoscopy, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, Indonesia
- Human Cancer Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
| | - Wifanto Saditya Jeo
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- Division of Digestive Surgery, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, Indonesia
| | - Marini Stephanie
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, Indonesia
| | - Diah Rini Handjari
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, Indonesia
| | - Ening Krisnuhoni
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, DKI Jakarta, Indonesia
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo Hospital, Central Jakarta, DKI Jakarta, Indonesia
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Patel G, Patil P. Worrisome Trends in Young-Onset Colorectal Cancer: Now Is the Time for Action. Indian J Surg Oncol 2022; 13:446-452. [PMID: 36187542 PMCID: PMC9515296 DOI: 10.1007/s13193-022-01496-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022] Open
Abstract
Colorectal cancer (CRC) in the young adult population is of increasing incidence and concern. Since 1994, CRC incidence in individuals younger than 50 years has been increasing by 2% per year. The surge of CRC incidence in young adults is particularly alarming as the overall CRC frequency has been decreasing. Young-onset CRCs are characterized by more advanced stage at diagnosis, poorer cell differentiation, higher prevalence of signet ring cell histology, and left-colon sided location of the primary tumor. Genetic predisposition and heritable syndromes contribute to this trend, but perhaps more concerning is the majority of new diagnoses that involve no traceable genetic risk factors are sporadic. This review provides a summary of key aspects related to colorectal cancer in young adults, including epidemiology, etiology, genetics, clinical difficulties, early diagnosis, and prevention with emphasis on screening age.
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Affiliation(s)
- Gaurav Patel
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine lines, Mumbai, 400020 India
| | - Prakash Patil
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine lines, Mumbai, 400020 India
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Hoseini B, Rahmatinejad Z, Goshayeshi L, Bergquist R, Golabpour A, Ghaffarzadegan K, Rahmatinejad F, Darrudi R, Eslami S. Colorectal Cancer in North-Eastern Iran: a retrospective, comparative study of early-onset and late-onset cases based on data from the Iranian hereditary colorectal cancer registry. BMC Cancer 2022; 22:48. [PMID: 34998373 PMCID: PMC8742430 DOI: 10.1186/s12885-021-09132-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The incidence rate of colorectal cancer (CRC) is increasing among patients below 50 years of age. The reason for this is unclear, but could have to do with the fact that indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent mann er. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and clinicopathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran. METHODS This retrospective study, carried out over a three-year follow-up period (2014-2017), included 562 consecutive CRCs diagnosed in three Mashhad city hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and hereditary features together with information on the presence of mismatch repair (MMR) gene deficiency with respect to recovery versus mortality. Patients with mutations resulting in absence of the MMR gene MLH1 protein product and normal BRAF status were considered to be at high risk of Lynch syndrome (LS). Analyses using R studio software were performed on early-onset CRC (n = 222) and late-onset CRC (n = 340), corresponding to patients ≤50 years of age and patients > 50 years. RESULTS From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC than men (56% vs. 44%), while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, with 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal and proximal), the frequencies were 61, 28 and 11%, respectively, but the variation did not reach statistical significance. However, there was a dramatic difference with regard to the history of CRC in second-degree relatives between two age categories, with much higher numbers of family-related CRCs in the early-onset group. Expression of the MLH1 and PMS2 genes were significantly different between recovered and deceased, while this finding was not observed with regard to the MSH6 and the MSH2 genes. Mortality was significantly higher in those at high risk of LS. CONCLUSION The variation of demographic, pathological and genetic characteristics between early-onset and late-onset CRC emphasizes the need for a well-defined algorithm to identify high-risk patients.
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Affiliation(s)
- Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Robert Bergquist
- Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
- Ingerod, SE-454 94, Brastad, Sweden
| | - Amin Golabpour
- School of Paramedical , Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kamran Ghaffarzadegan
- Pathology Department, Education and Research Department, Razavi Hospital, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Health Information Technology, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Darrudi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Saeid Eslami
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Sugara M, Chowdappa R, Kumar KVV, Gawari R, Swamy SN, Kumar SS. Aberrant Promoter Hypermethylation of p16 and RASSF1a Genes in Colorectal Cancer - Significance in Young Patients. Indian J Surg Oncol 2021; 12:454-459. [PMID: 34658570 PMCID: PMC8490567 DOI: 10.1007/s13193-021-01325-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/15/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The clinical profile of colorectal cancers (CRC) in India is different from that described in western countries. Microsatellite instability and APC mutation explain the molecular biology of up to 50% of colorectal cancers. Global genome hypermethylation may be the cause in at least 20% of cases. Few studies from India have examined the epigenetic profile of colorectal cancers. This study was designed to study aberrant promoter hypermethylation of two select tumour suppressor genes (p16, RASSF1a) in patients with colorectal cancer and their association with clinicopathologic features. METHODS A total of 41 samples including controls were collected from colorectal cancer patients. DNA was isolated from tumour tissue, and methylation-specific PCR was performed for the 2 genes. RESULTS p16 and RASSF1a promoter hypermethylation was found in 26% and 48% of CRC cases, respectively. RASSF1a promoter hypermethylation was more often seen in young CRC patients aged 40 years or less, and this was found to be statistically significant (p value = 0.037). CONCLUSION RASSF1a hypermethylation is peculiar to rectal cancers and left-sided colonic tumours in young patients. Large-scale population-based studies with extensive genetic and epigenetic characterization are required for a better understanding and further validation of our findings. For individuals diagnosed with sporadic CRC, these studies on specimen might help predict prognosis and response to therapy.
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Affiliation(s)
- Medha Sugara
- Department of Surgical oncology, St. John’s Medical College, Bengaluru, Karnataka 560034 India
| | - Ramachandra Chowdappa
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - K. V. Veerendra Kumar
- Department of Surgical Oncology, Jawaharlal Nehru Medical College, Belgaum, Karnataka 590010 India
| | - Ramesh Gawari
- Department of Biochemistry, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - Shalini N. Swamy
- Department of Biochemistry, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
| | - Sandeep S. Kumar
- Department of Biochemistry, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka 560029 India
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Hani U, Honnavalli YK, Begum MY, Yasmin S, Osmani RAM, Ansari MY. Colorectal cancer: A comprehensive review based on the novel drug delivery systems approach and its management. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Extricating the Association Between the Prognostic Factors of Colorectal Cancer. J Gastrointest Cancer 2020; 52:1022-1028. [PMID: 33047269 DOI: 10.1007/s12029-020-00535-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Colorectal cancer (CRC) is one of the recurring and lethal gastrointestinal tract disease rankings as the primary cause of worldwide morbidity and mortality. In general, the tumour node metastasis (TNM) and Dukes classification assist in diagnosis, prognosis and treatments of CRC along with haematological examinations and tumour demographic characterisations in patients. METHODS The present investigation is carried out on clinically acknowledged sixty-five CRC patients based on haematological findings and are sorted into stages using TNM and Dukes. The present study is to find the association between haematological findings, demographic characters, differentiation position, lymph node invasion and tumour node metastasis in CRC patients in accordance with their age. RESULTS We observed significant (p < 0.05) nexus between lymph node metastasis and tumour node metastasis on the basis of tumour's differentiation demographic positioning and age of the individuals. CONCLUSION Earlier location tracing and medicinal treatment or surgery lessen the chance of CRC morbidity and mortality along with prolonging survival rate via prognostic factors and disease position determination.
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12
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Voluntary perioperative colorectal cancer registry from Kerala-An initial overview. Indian J Gastroenterol 2020; 39:243-252. [PMID: 32936377 DOI: 10.1007/s12664-019-00998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although colorectal cancer (CRC) may not be uncommon in India, accurate data regarding its demographics and surgical outcomes is sparse. METHODS With an aim to assess demographics and perioperative outcomes of CRC in Kerala, all members of Association of Surgical Gastroenterologists of Kerala (ASGK) were invited to participate in a registry. Data of operated cases of CRC were entered on a web-based questionnaire by participating members from January 2016. Analysis of accrued data until March 2018 was performed. RESULTS From 25 gastrointestinal surgical centers in Kerala, 15 ASGK member hospitals contributed 1018 CRC cases to the database (M:F 621:397; median age-63.5 years [15-95 years]). Rectum (39.88%) and rectosigmoid (20.33%) cancers comprised the majority of the patients. Among them, preoperative bowel preparation was given to 37.68%, minimally invasive surgery (MIS) was performed in 73%, covering stoma in 47% and had an overall leak rate of 3.58%. In colonic malignancies, MIS was performed in 56.74%, covering stoma created in 13% and had a leak rate of 2.71%. Of 406 patients with rectal cancers, neo-adjuvant radiotherapy/chemoradiotherapy was given to 51.23%. The mean hospital stay for MIS in both rectal and colonic cancer patients was significantly shorter than open approach (10.46 ± 5.08 vs. 12.26 ± 6.03 days; p = 0.001and 10.29 ± 4.58 vs. 12.46 ± 6.014 days; p = <0.001). Mortality occurred in 2.2% patients. CONCLUSION A voluntary non-funded registry for CRC surgery was successfully created. Initial data suggest that MIS was performed in majority, which was associated with shorter hospital stay than open approach. Overall mortality and leak rate appeared to be low.
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13
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Wang Y, Wu J, He H, Ma H, Hu L, Wen J, Lyu J. Nomogram predicting cancer-specific mortality in early-onset rectal cancer: a competing risk analysis. Int J Colorectal Dis 2020; 35:795-804. [PMID: 32078716 DOI: 10.1007/s00384-020-03527-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence of rectal cancer has meaningfully increased in young patients. However, quantitative evaluation for the competing data of early-onset rectal cancer is lacking. So, we performed a competing risk analysis to calculate the cumulative incidence of death for patients with early-onset rectal cancer and developed a nomogram to predict the probability of cancer-specific mortality for these patients. METHODS We abstracted data of patients with early-onset rectal cancer between 2004 and 2016 by using the Surveillance, Epidemiology, and End Results program database. The cumulative incidence function was used to calculate the crude cancer-specific mortality of early-onset rectal cancer. Fine and Gray's proportional sub-distribution hazard model was adopted to explore the risk factors of cancer-specific death. Then, we establish a nomogram to predict their 3-, 5-, and 10-year probabilities. RESULTS We identified 9917 patients with early-onset rectal cancer, and they were randomly divided into training (n = 6941) and validation (n = 2976) cohorts. In the training cohort, the 3-, 5-, and 10-year cumulative incidences of cancer-specific death after diagnosis for early-onset rectal cancer were 11.4%, 19.9%, and 28.8%, respectively. Fine and Gray's model showed that sex, race, marital status, histology, T stage, N stage, M stage, examined lymph nodes, and pretreatment carcinoembryonic antigen were independently associated with cancer-specific mortality. Such factors were selected to develop a prognostic nomogram. CONCLUSION The competing risk nomogram has an ideal performance for predictive cancer-specific mortality in early-onset rectal cancer.
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Affiliation(s)
- Yufeng Wang
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
- School of Public Health, Guangdong Medical University, No. 2, Wenmin East Road, Zhanjiang, 524023, Guangdong, People's Republic of China
| | - Jiayuan Wu
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Hairong He
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Huan Ma
- School of Public Health, Guangdong Medical University, No. 2, Wenmin East Road, Zhanjiang, 524023, Guangdong, People's Republic of China
| | - Liren Hu
- School of Public Health, Guangdong Medical University, No. 2, Wenmin East Road, Zhanjiang, 524023, Guangdong, People's Republic of China.
| | - Jiyu Wen
- Department of Oncology, Affiliated Hospital of Guangdong Medical University, No. 57, South of Renmin Avenue, Zhanjiang, 524001, Guangdong, People's Republic of China.
| | - Jun Lyu
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
- Clinical Research Center, First Affiliated Hospital of Jinan Unversity, Guangzhou, Guangdong, People's Republic of China.
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Paul J. Colonoscopic Finding of Patients with Lower Gastrointestinal Bleeding at Different Age Group in Eastern Part of India - An Observational Study. Prague Med Rep 2020; 121:25-34. [PMID: 32191617 DOI: 10.14712/23362936.2020.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Incidence of lower gastrointestinal (GI) bleeding (LGIB) is increasing over time. It can be seen in all age group patients, commonly associated with pre-existing comorbidities and is one of the common indications of colonoscopy. This study was done to identify common causes of LGIB in eastern part of India, because there is no previous study from Eastern India to identify the common causes of lower GI bleeding diagnosed by colonoscopy in different age group patients. Consecutive 64 patients with LGIB were included in this study from June 2018 to March 2019. We divided our study population into three groups, such as group A (20 years to 40 years), group B (41 years to 60 years), and group C (more than 60 years). Data were entered into Excel and then transferred into SPSS version 22 for statistical analysis. Mean age of study population was 49.83 ± 19.06 years. Normal colonoscopic finding was seen in 7 patients (10.9%). Most common colonoscopic findings of our study population were hemorrhoids (n=32; 50%), anal fissure (n=11; 17.2%) and isolated rectal ulcer (n=9; 14.1%). Colorectal growth was seen in 6 patients (9.4%), among them female patients were more commonly affected than male patients. Therefore, most common causes of LGIB in eastern part of India are hemorrhoids, anal fissure and isolated rectal ulcer. Male individuals are more commonly affected by LGIB.
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Affiliation(s)
- Jayanta Paul
- Department of Gastroenterology, Desun Hospital and Heart Institute, Kolkata, India.
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15
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Kocián P, Svobodová I, Krejčí D, Blaha M, Gürlich R, Dušek L, Hoch J, Whitley A. Is colorectal cancer a more aggressive disease in young patients? A population-based study from the Czech Republic. Cancer Epidemiol 2019; 63:101621. [PMID: 31634775 DOI: 10.1016/j.canep.2019.101621] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The incidence of colorectal cancer in young patients is increasing. The goal of this study was to investigate whether clinicopathological features and survival differed between young, middle-aged and elderly patients. METHODS The Czech National Cancer Registry was searched to identify all cases of colorectal cancer between 1982 and 2014. Three subgroups of patients were created: young patients, defined as being between 18 and 40 years of age, middle-aged patients, defined as being between 41 and 74 years of age, and elderly patients, defined as being over the age of 75 years. RESULTS A total of 192,241 patients diagnosed with colorectal cancer between the years 1982 and 2014 were included in the study. Out of these, 3,287 patients (1.7%) were between 18 and 40 years of age, 134,139 patients (69.8%) were between 41 and 74 years of age and 54,815 patients (28.5%) were 75 years of age or older. The young patients had a higher incidence of mucinous adenocarcinoma and signet ring cell carcinoma, more advanced disease and more rectal tumours than elderly patients. Nonetheless, young patients received treatment more frequently and had better cancer-specific survival than the older patients. CONCLUSION The better prognosis in young patients is presumably due to their better physiological reserve and lower incidence of comorbidities. Efforts should be made in younger patients to diagnose early and treat aggressively.
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Affiliation(s)
- Petr Kocián
- Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ivana Svobodová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Denisa Krejčí
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Milan Blaha
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Robert Gürlich
- Department of Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ladislav Dušek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic; Institute of Biostatistics and Analyses, Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jiří Hoch
- Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Limaiem F, Azzabi S, Sassi A, Mzabi S, Bouraoui S. Colorectal cancer in young adults: a retrospective study of 32 tunisian patients. Pan Afr Med J 2019; 31:62. [PMID: 31007809 PMCID: PMC6457724 DOI: 10.11604/pamj.2018.31.62.11043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 08/09/2018] [Indexed: 11/11/2022] Open
Abstract
Young people under the age of 40 with colorectal cancer represent a distinct subgroup with a more aggressive disease behaviour compared to older patients. This study aim to provide an updated overview on clinicopathological features, treatment and outcome of colorectal cancer in young adults under the age of 40. In our retrospective study, we reviewed 32 cases of colorectal cancer in young adults aged less than 40 years that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (April 2000 - November 2014). Our study group included 13 male and 19 female patients (sex-ratio M/F = 0,68) between 17 and 39 years of age (mean = 31,25 years). The presenting clinical symptoms were dominated by altered bowel habits (n=17), followed by bleeding per rectum (n=16). Histopathological examination of the surgical and biopsy specimens established the diagnosis of mucinous adenocarcinoma in nine cases, well-differentiated adenocarcinoma in 11 cases, moderately differentiated adenocarcinoma in six cases, poorly differentiated adenocarcinoma in four cases and signet ring cell carcinoma in two cases. The tumours were classified after surgery as stage I (n = 2) (6%), stage IIA (n = 7) (22%), stage IIB (n=4) (13%), stage IIC (n=1) (3%), stage IIIB (n=8) (25%), stage IIIC (n= 4) (12%), stage IVA (n=4) (13%) and stage IVB (n=2) (6%). During the follow-up period which ranged between one month and 9 years, local recurrence of the tumour occurred in six cases, seven patients had hepatic metastases and seven patients died after a mean follow-up period of seven months. Molecular genetic studies are increasing the understanding of the pathobiology of colorectal cancer and may ultimately allow at-risk patients to be identified at an earlier stage.
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Affiliation(s)
- Faten Limaiem
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Sonia Azzabi
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Asma Sassi
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Sabeh Mzabi
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Saadia Bouraoui
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
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CR-Possum-Can It Be Used to Predict Morbidity? A Single-Centre Retrospective Study. Indian J Surg Oncol 2019; 10:174-179. [PMID: 30948895 DOI: 10.1007/s13193-018-0841-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/23/2018] [Indexed: 12/23/2022] Open
Abstract
Preoperative prediction of morbidity in colorectal cancer (CRC) surgery helps to optimize the surgical outcome. In this study, we aim to develop a dedicated equation for predicting operative morbidity using colorectal possum scoring system and also to validate the predictive accuracy of CR-POSSUM scoring system in prognosticating actual complications. We did a retrospective analysis of 322 patients undergoing colorectal cancer surgery from a single centre in South India from 2004 to 2016. Mortality and morbidity risk factors as defined by CR POSSUM were collected from 322 patients who underwent CRC surgery and were used to derive equations to predict morbidity, and the results were compared with the observed morbidity. Logistic regression analysis was used to derive the equation. The model fit and model discrimination were analysed using the Hosmer-Lemeshow statistical test for goodness of fit, the Nagelkerke R 2 and area under the receiver operating characteristic (ROC) curve respectively. Out of 322 patients, 103 (32%) patients developed complications and 10 (3%) died due to complications. The regression equation we derived has an overall correct classification of about 70% (P < 0.01) with positive and negative predictive value of 60% and 73% respectively. The Hosmer-Lemeshow goodness of fit was 3.147 (P = 0.829), and the Nagelkerke R 2 was 17% and area under ROC as model discrimination was 71.6%. Hence, CR-POSSUM scoring which was originally used for predicting mortality risk can also be extrapolated to predict morbidity.
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18
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Zhang Q, Berger FG, Love B, Banister CE, Murphy EA, Hofseth LJ. Maternal stress and early-onset colorectal cancer. Med Hypotheses 2018; 121:152-159. [PMID: 30396471 DOI: 10.1016/j.mehy.2018.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
Early-onset colorectal cancer (EOCRC) is defined as colorectal cancer (CRC) diagnosed before the age of 50. Alarmingly, there has been a significant increase in EOCRC diagnoses' worldwide over the past several decades. Emerging data suggest EOCRCs have distinguishing clinical, pathological, biological and molecular features; and thus, are a fundamentally different subtype of CRCs. Unfortunately, there is no simple explanation for the causes of EOCRC. Scientifically rigorous studies are needed to determine what may be driving the challenging epidemiology of EOCRC. We contend here that a reasonable hypothesis is that prenatal risk factors such as maternal stress and associated sleeping disorders influence offspring epigenetic make-up, and shape immune system and gut health contributing to an increased risk for EOCRC.
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Affiliation(s)
- Qi Zhang
- Department of Drug Discovery and Biomedical Science, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Franklin G Berger
- Department of Biology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Bryan Love
- Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Carolyn E Banister
- Department of Drug Discovery and Biomedical Science, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Elizabeth A Murphy
- Department of Pathology, Microbiology and Immunology, University of South Carolina, Columbia, SC, USA
| | - Lorne J Hofseth
- Department of Drug Discovery and Biomedical Science, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
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Patra T, Ghosh P, Alam N, Murmu N. Supra-physiological concentration of glyoxylate inhibits proliferation of human colon cancer cells through oxidative stress. Life Sci 2018; 207:80-89. [PMID: 29852189 DOI: 10.1016/j.lfs.2018.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/03/2018] [Accepted: 05/26/2018] [Indexed: 12/13/2022]
Abstract
AIMS The cytotoxic response of an intermediate metabolite glyoxylate (Glx) on colon carcinoma has been evaluated in vitro. MAIN METHODS The anti-proliferative effect of Glx was assessed on HT-29 and HCT-116 cells by performing MTT assay as well as beta-hexosaminidase assay. Evaluation of apoptotic event of Glx treated cells was measured by flow cytometry using annexin-V/PI staining. The mitochondrial membrane potential and level of ROS were estimated using DiOC6(3)/CCCP and DCFH-DA method, respectively. The assessment of catalase, LDH and IDH were performed. KEY FINDINGS The results of MTT assay indicated that treatment with Glx significantly inhibited the proliferation of HT-29 and HCT-116 cells. Beta-hexosaminidase assay also confirmed the inhibition of cellular viability. The dose-dependent Glx treatment indicated lowering the colony forming ability of HT-29 and HCT-116 cells. Flow cytometric data demonstrated the significant increment of late apoptotic event after Glx treatment. In addition, substantial LDH activity was noticed in both the colon cancer cells whereas the IDH activity was unaltered after extra-cellular addition of Glx. Further, dissipation of mitochondrial membrane potential and subsequently elevated ROS generation was also detected in the Glx treated colon cancer cells. However, gradual elevation of catalase activities indicated that Glx treatment on colon cancer cells exhibit oxidative stress. SIGNIFICANCE This study depicts that supra-physiological concentration of Glx inhibits the proliferation of colon cancer cells due to oxidative stress.
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Affiliation(s)
- Tapas Patra
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute (CNCI), Kolkata 700026, India
| | - Paramita Ghosh
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute (CNCI), Kolkata 700026, India
| | - Neyaz Alam
- Department of Surgical Oncology, Chittaranjan National Cancer Institute (CNCI), Kolkata 700026, India
| | - Nabendu Murmu
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute (CNCI), Kolkata 700026, India.
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Colorectal Cancer in India: An Audit from a Tertiary Center in a Low Prevalence Area. Indian J Surg Oncol 2017; 8:484-490. [PMID: 29203978 DOI: 10.1007/s13193-017-0655-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/12/2017] [Indexed: 02/08/2023] Open
Abstract
Colorectal cancer (CRC) is a common cancer worldwide with a low reported incidence in India. There is significant geographical variation in the incidence rates, and the presentation may also vary. There are few studies evaluating the clinical profile of CRC in Indian patients. We analyzed a prospective database maintained at the Tata Memorial Hospital, a referral cancer center in Mumbai, of consecutive patients with CRC between August 2013 and August 2014. We captured details regarding the demography, symptoms, pathology, stage, and treatment plan. The aim was to assess the demographic and clinical details of patients with CRC in India and compare it with those of the reported literature. Eight hundred new patients with CRC were seen in the colorectal clinic in one year. The mean age was 47.2 years. Sixty-five percent were males. Patients were symptomatic for an average period of 4 months prior to presentation. The commonest symptoms were rectal bleeding (57%), pain (44%), and altered bowel habits (26%). Thirteen percent of the patients had signet ring tumors. The median CEA (carcinoembryonic antigen) level was 5.8 ng/mL. Most patients had localized or locally advanced disease. Twenty-eight percent of the patients had metastatic disease with liver being the commonest site of metastases (14%) followed by peritoneum and lung. More than half of the patients received treatment with a curative intent. Colorectal cancer in India differs from that described in the Western countries. We had more young patients, higher proportion of signet ring carcinomas, and more patients presenting with an advanced stage. Inadequate access to healthcare and socioeconomic factors may play a role in some of these differences.
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Haleshappa RA, Rao SA, Garg S, Kuntegowdanahalli CL, Kanakasetty GB, Dasappa L. Is Colorectal Cancer in Young (<40 Years) Different from those in the Elderly (>40 Years): Experience from a Regional Care Center. Indian J Med Paediatr Oncol 2017; 38:466-470. [PMID: 29333014 PMCID: PMC5759066 DOI: 10.4103/ijmpo.ijmpo_187_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Colorectal cancer (CRC) is considered a disease of elderly. There has been a steady decrease in the incidence in those aged >50 years, with an alarming increase noted in adults aged <50 years. Subjects and Methods: We retrospectively analyzed 89 patients diagnosed with CRC aged <40 years between the years 2010 and 2014. Their clinical profile, treatment, and outcomes were studied. Results: The median age was 33 years with a male preponderance (56.2%). Most common symptoms were lower gastrointestinal bleed (48.3%) followed by abdominal pain (46.1%). Most common sites were rectum (50.6%) followed by colon. Histology in all was adenocarcinoma. Most tumors were moderately differentiated (54%) and were stage 4 (36%). Most common sites of metastases were liver (46.9%) followed by peritoneum and ovaries. Majority underwent surgery with adjuvant chemotherapy, with/without radiotherapy. Chemotherapy was administered in 70 patients, majority receiving FOLFOX-4 regimen (88.6%). Median survival was 23 months. Survival in early stage[1],[2] was significantly higher than in advanced stages (3 and above), 34 and 19 months (P = 0.0287), in those aged >40 years compared to <40–35 versus 23 months (P = 0.0029), nonmetastatic compared to metastatic disease – 26 versus 14 months (P = 0.00196), and females compared to males – 26 and 18 months (P = 0.0242). There was no significant difference in survival with respect to tumor grade or site of metastases (hepatic versus extrahepatic). Conclusions: Colorectal carcinoma in young seems to be an emerging problem in India. Any young patient presenting with symptoms suggestive of a colonic malignancy should be evaluated promptly and treated aggressively.
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Affiliation(s)
- Rudresha A Haleshappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Suparna Ajit Rao
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Sunny Garg
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Govinda Babu Kanakasetty
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Lokanatha Dasappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Terpenoids as anti-colon cancer agents - A comprehensive review on its mechanistic perspectives. Eur J Pharmacol 2016; 795:169-178. [PMID: 27940056 DOI: 10.1016/j.ejphar.2016.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 02/06/2023]
Abstract
Multistep model of colon carcinogenesis has provided the framework to advance our understanding of the molecular basis of colon cancer. This multistage process of carcinogenesis takes a long period to transform from a normal epithelial cell to invasive carcinoma. Thus, it provides enough time to intervene the process of carcinogenesis especially through dietary modification. In spite of the in-depth understanding of the colon cancer etiology and pathophysiology and its association with diet, colon cancer remains a major cause of cancer mortality worldwide. Phytochemicals and their derivatives are gaining attention in cancer prevention and treatment strategies because of cancer chemotherapy associated adverse effects. Being the largest group of phytochemicals traditionally used for medicinal purpose in India and China, terpenoids are recently being explored as anticancer agents. Anticancer properties of terpenoids are associated with various mechanisms like counteraction of oxidative stress, potentiating endogenous antioxidants, improving detoxification potential, disrupting cell survival pathways and inducing apoptosis. This review gives a comprehensive idea of naturally occurring terpenoids as useful agents for the prevention of colon cancer with reference to their classes, sources and molecular targets. Based on the explored molecular targets further research in colon cancer chemoprevention is warranted.
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