Medicine › Surgery

Colorectal and Anal Carcinomas

Works Count: 31722

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Description

This cluster of papers focuses on the treatment and management of anal cancer, including the use of chemoradiation, intensity-modulated radiation therapy, and chemotherapy. It also explores the impact of HIV infection on treatment outcomes, imaging techniques such as FDG-PET/CT, and the long-term quality of life for survivors. Additionally, it delves into salvage surgery for recurrent or persistent anal cancer.

Keywords

Anal Cancer; Chemoradiation; Intensity-Modulated Radiation Therapy; Squamous-Cell Carcinoma; Chemotherapy; HIV-positive Patients; Metastatic Anal Cancer; FDG-PET/CT Imaging; Quality of Life; Salvage Surgery

5-Fluorouracil: Forty-Plus and Still Ticking. A Review of its Preclinical and Clinical Development

2000-11-01

Jean L. Grem

Survival after Postoperative Combination Treatment of Rectal Cancer

1986-11-13

H O Douglass , C G Moertel , Robert J. Mayer +5 more

Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups.

1997-05-01

Harry Bartelink , F. Roelofsen , F. Eschwège +6 more

To investigate the potential gain of the concomitant use of radiotherapy and chemotherapy in improving local control and reducing the need for colostomy, a randomized phase III trial was performed … To investigate the potential gain of the concomitant use of radiotherapy and chemotherapy in improving local control and reducing the need for colostomy, a randomized phase III trial was performed in patients with locally advanced anal cancer.From 1987 to 1994, 110 patients were randomized between radiotherapy alone and a combination of radiotherapy and chemotherapy. The patients had T3-4NO-3 or T1-2N1-3 anal cancer. Radiotherapy consisted of 45 Gy given in 5 weeks, with a daily dose of 1.8 Gy. After a rest period of 6 weeks, a boost of 20 or 15 Gy was given in case of partial or complete response, respectively. Surgical resection as part of the primary treatment was performed if possible in patients who had not responded 6 weeks after 45 Gy or with residual palpable disease after the completion of treatment. Chemotherapy was given during radiotherapy: 750 mg/m2 daily fluorouracil as a continuous infusion on days 1 to 5 and 29 to 33, and a single dose of mitomycin 15 mg/m2 administered on day 1.The addition of chemotherapy to radiotherapy resulted in a significant increase in the complete remission rate from 54% for radiotherapy alone to 80% for radiotherapy and chemotherapy, and from 85% to 96%, respectively, if results are considered after surgical resections. This led to a significant improvement of locoregional control and colostomy-free interval (P = .02 and P = .002, respectively), both in favor of the combined modality treatment. The locoregional control rate improved by 18% at 5 years, while the colostomy-free rate at that time increased by 32% by the addition of chemotherapy to radiotherapy. No significant difference was found when severe side effects were considered, although anal ulcers were more frequently observed in the combined-treatment arm. The survival rate remained similar in both treatment arms. Skin ulceration, nodal involvement, and sex were the most important prognostic factors for both local control and survival. These remained significant after multivariate analysis. The improvement seen in local control by adding chemotherapy to radiotherapy also remained significant after adjusting for prognostic factors in the multivariate analysis. Event-free survival, defined as free of locoregional progression, no colostomy, and no severe side effects or death, showed significant improvement (P = .03) in favor of the combined-treatment modality. The 5-year survival rate was 56% for the whole patient group.The concomitant use of radiotherapy and chemotherapy resulted in a significantly improved locoregional control rate and a reduction of the need for colostomy in patients with locally advanced anal cancer without a significant increase in late side effects.

Patterns of recurrence after curative resection of carcinoma of the colon and rectum.

1992-01-01

Susan Galandiuk , Wieand Hs , Moertel Cg +4 more

Data on 818 patients who had undergone curative resection for Dukes' B2 or Dukes' C carcinoma of the colon and rectum were analyzed to determine the timing and patterns of … Data on 818 patients who had undergone curative resection for Dukes' B2 or Dukes' C carcinoma of the colon and rectum were analyzed to determine the timing and patterns of recurrence based on such tumor characteristics as location, Dukes' stage, grade, ploidy and the presence of obstruction, perforation or adherence to adjacent organs or tissues. Three hundred and fifty-three patients (43 per cent) had recurrent disease. There was recurrence in 52 per cent of patients with carcinoma of the rectum and in 40 per cent of patients with carcinoma of the colon. The median time to recurrence for all patients was 16.7 months, with a range from 1 month to 7.5 years. Dukes' C lesions and the presence of adhesion or invasion, or both, or perforation were associated with significantly earlier recurrence. Among patients with recurrence, the most frequent sites were hepatic in 33 per cent, pulmonary in 22 per cent, local or regional, or both, in 21 per cent, intra-abdominal in 18 per cent, retroperitoneal in 10 per cent and peripheral lymph nodes in 4 per cent. Rectal primary sites, when compared with colonic, had proportionally more local or regional, or both, recurrences (p = 0.00003) and fewer involving retroperitoneal nodes (p = 0.022). Both primaries of the rectum and colon at stage C, when compared with stage B, had fewer local or regional recurrences, or both (p = 0.01), but a greater tendency to involve retroperitoneal or peripheral nodes. Primaries of the colon with adhesion to, or invasion of, adjacent organs had a lesser tendency to pulmonary metastasis (p = 0.036). Whereas the grade of anaplasia and ploidy had a strong influence on the rate of recurrence, they did not influence timing or patterns of recurrence. Patterns of recurrence based on the characteristics of the tumor may facilitate selection of the most appropriate adjuvant procedures, particularly those directed toward local or regional recurrence, or both, and also may guide efforts at early recognition of recurrence.

Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study.

1996-09-01

Marshall S. Flam , Michelle E. St. John , Thomas F. Pajak +7 more

PURPOSE Definitive chemoradiation (CR) has replaced radical surgery as the preferred treatment of epidermoid carcinoma of the anal canal. To determine the importance of mitomycin (MMC) in the standard CR … PURPOSE Definitive chemoradiation (CR) has replaced radical surgery as the preferred treatment of epidermoid carcinoma of the anal canal. To determine the importance of mitomycin (MMC) in the standard CR regimen and to assess the role of salvage CR in patients who have residual tumor following CR, a phase III randomized trial was undertaken by the Radiation Therapy Oncology Group (RTOG)/Eastern Cooperative Oncology Group (ECOG). PATIENTS AND METHODS Between August 1988 and December 1991, 310 patients were randomized to receive either radiotherapy (RT) and fluorouracil (5-FU) or radiotherapy, 5-FU, and MMC. Of 291 assessable patients, 145 received 45 to 50.4 Gy of pelvic RT plus 5-FU at 1,000 mg/m2/d for 4 days, and 146 received RT, 5-FU, and MMC (10 mg/m2 per dose for two doses). Patients with residual tumor on posttreatment biopsy were treated with a salvage regimen that consisted of additional pelvic RT (9 Gy), 5-FU, and cisplatin (100 mg/m2). RESULTS Posttreatment biopsies were positive in 15% of patients in the 5-FU arm versus 7.7% in the MMC arm (P = .135). At 4 years, colostomy rates were lower (9% v 22%; P = .002), colostomy-free survival higher (71% v 59%; P = .014), and disease-free survival higher (73% v 51%; P = .0003) in the MMC arm. A significant difference in overall survival has not been observed at 4 years. Toxicity was greater in the MMC arm (23% v 7% grade 4 and 5 toxicity; P < or = .001). Of 24 assessable patients who underwent salvage CR, 12 (50%) were rendered disease-free. CONCLUSION Despite greater toxicity, the use of MMC in a definitive CR regimen for anal cancer is justified, particularly in patients with large primary tumors. Salvage CR should be attempted in patients with residual disease following definitive CR before resorting to radical surgery.

The prognostic significance of intratumoral natural killer cells in patients with colorectal carcinoma

1997-06-15

Santiago Coca , J Pérez-Piqueras , David Martínez +5 more

BACKGROUND Natural killer (NK) cells have a spontaneous cytotoxic capacity against tumor cells. These cells represent a small proportion of human colon carcinoma-infiltrating lymphocytes. Their prognostic significance in these tumors … BACKGROUND Natural killer (NK) cells have a spontaneous cytotoxic capacity against tumor cells. These cells represent a small proportion of human colon carcinoma-infiltrating lymphocytes. Their prognostic significance in these tumors has yet to be determined. METHODS One hundred and fifty-seven patients who each had a colectomy for large bowel adenocarcinoma were studied. No patient received adjuvant therapy. Immunohistochemical stains were performed for NK cells using the monoclonal antibody CD57. The number of NK cells was counted using a MICRON image analyzer. The total area studied for each tumor was 1 cm2. In this area, 50 intratumoral fields of 0.173 mm2 were selected. The degree of NK infiltration was classified as little (<50 NK cells), moderate (50-150 NK cells), and extensive (>150 NK cells). The Kaplan-Meier method was used to obtain survival figures. Multivariate analyses were performed using the Cox regression model. RESULTS At 5 years, patients with little and moderate NK infiltration showed significantly shorter survival rates (overall and disease free survival) than those with extensive infiltration (P < 0.01). Three significant factors affecting survival were selected in a stepwise fashion in increasing order as follows: TNM stage, NK infiltration, and lymphocytic infiltration. Patients with TNM Stage III disease and extensive NK infiltration showed significantly longer survival rates than those with little or moderate infiltration (P < 0.001). In these patients, multivariate analysis using the Cox regression model identified two significant variables: number of involved lymph nodes and NK cell infiltration. CONCLUSIONS In patients with colorectal carcinoma, an extensive intratumoral infiltration of NK cells is associated with a favorable tumor outcome. Intratumoral infiltration of NK cells can be used as a variable with prognostic value, especially in patients with TNM Stage III disease. Cancer 1997; 79:2320-8. © 1997 American Cancer Society.

Late effects of radiation therapy on the gastrointestinal tract

1995-03-01

Lawrence R. Coia , Robert J. Myerson , Joel E. Tepper

Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid

1951-11-01

J C Goligher , C. E. Dukes , H J R Bussey

Journal Article Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid Get access J C Goligher, J C Goligher St. Mark's Hospital, London Search for other works … Journal Article Local recurrences after sphincter-saving excisions for carcinoma of the rectum and rectosigmoid Get access J C Goligher, J C Goligher St. Mark's Hospital, London Search for other works by this author on: Oxford Academic Google Scholar C E Dukes, C E Dukes St. Mark's Hospital, London Search for other works by this author on: Oxford Academic Google Scholar H J R Bussey H J R Bussey St. Mark's Hospital, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 39, Issue 155, November 1951, Pages 199–211, https://doi.org/10.1002/bjs.18003915504 Published: 13 December 2005

The Spread of Rectal Cancer and its Effect on Prognosis

1958-09-01

C E Dukes , H J R Bussey

Epidermoid anal cancer: Treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C

1991-10-01

B. Cummings , Thomas J. Keane , Brian O’Sullivan +2 more

Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer

2009-09-09

Catherine Liebig , Gustavo Ayala , Jonathan A. Wilks +5 more

Purpose Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential … Purpose Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients. Patients and Methods We identified 269 consecutive patients who had CRC resected at our institution. Tumors were rereviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test. Results PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival. Conclusion PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.

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The clinical significance of invasion of veins by rectal cancer

1980-06-01

Ian C. Talbot , Sheila Ritchie , Monica Leighton +3 more

A histopathological study of 703 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52 per cent. Follow-up studies on the … A histopathological study of 703 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52 per cent. Follow-up studies on the patients showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present. Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thick-walled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick-walled extramural veins had the greatest adverse influence of all. Venous spread of tumour takes place in parallel with local spread as measured by the Dukes' stage but exerts an influence on prognosis independent of the Dukes' stage. Similarly, vein invasion parallels the number of lymph node metastases but appears to exert an independent influence on prognosis. Observation of venous spread provides a precise assessment of the likely behaviour of rectal carcinoma and supplements, but does not replace indices such as the Dukes' stage or the number of lymph node metastases in routine use. The implications for surgical technique and management are discussed.

Carcinoma of the anal canal, a clinical and pathologic study of 188 cases

1984-07-01

Bruce M. Boman , Charles G. Moertel , Michael J. OʼConnell +5 more

Among 188 patients presenting with carcinoma of the anal canal the predominant cell types were squamous cell (56%) and nonkeratinizing basaloid (35%). Thirteen patients who had predominantly small (≤2 cm) … Among 188 patients presenting with carcinoma of the anal canal the predominant cell types were squamous cell (56%) and nonkeratinizing basaloid (35%). Thirteen patients who had predominantly small (≤2 cm) and only superficially invasive squamous cell lesions were treated with local excision, and although one required later abdominal perineal (AP) resection for local recurrence, all were apparently cured. Local excision should be preferred as initial treatment for such lesions. One hundred eighteen patients with squamous cell and nonkeratinizing basaloid carcinomas were primarily treated with AP resection. The operative mortality rate was 2.5%. Among 114 patients who survived surgery and had adequate follow-up, 40% developed recurrent disease, and 71% have survived 5 or more years. Pathologic staging based on depth of tumor invasion and regional nodal involvement was strongly predictive of survival as was tumor histology with progressively poorer survival rates from low-grade squamous cell to high-grade squamous cell to nonkeratinizing basaloid types. Tumor size was inversely related to prognosis and was strongly associated with stage. Squamous cell anal carcinoma was dominantly a local disease with approximately 70% of patients presenting with tumor apparently limited to the bowel wall, only 20% with regional node involvement and only 2% with distant metastasis. Even among those patients who recurred after AP resection approximately 80% had all known disease still limited to the pelvic area. Corresponding figures for nonkeratinizing basaloid tumors were 50 percent presenting limited to the bowel wall, 30% with regional nodes, 20% with distant metastasis, and 60% with initial recurrence limited to the pelvis. Among the 13 patients studied with small cell anal carcinoma, the authors found the disease to be very virulent either initially presenting with or rapidly evolving into diffuse dissemination. Only one of the seven patients who could be treated surgically survived 5 years. As is true for small cell carcinomas primary to other sites, this neoplasm should be regarded as a systemic disease. With these findings as a foundation, possible future strategies for management of anal carcinoma are discussed.

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Combined therapy for cancer of the anal canal

1974-05-01

Norman D. Nigro , V. K. Vaitkevicius , Basil Considine

Nigro, Norman D. M.D.; Vaitkevicius, V. K. M.D.; Considine, Basil Jr. M.D. Author Information Nigro, Norman D. M.D.; Vaitkevicius, V. K. M.D.; Considine, Basil Jr. M.D. Author Information

Anal cancer incidence and survival: The Surveillance, Epidemiology, and End Results experience, 1973–2000

2004-06-14

Lisa Johnson , Margaret M. Madeleine , Laura M. Newcomer +2 more

Anal cancer is a rare malignancy of the anogenital tract that historically has affected women at a greater rate than men.The authors analyzed changing trends in incidence rates and 5-year … Anal cancer is a rare malignancy of the anogenital tract that historically has affected women at a greater rate than men.The authors analyzed changing trends in incidence rates and 5-year relative survival percentages for patients with anal cancer. The publicly available data used in the current study were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program, a system of population-based tumor registries in the United States.The incidence of anal cancer was similar for men and women between 1994 and 2000 (2.04 per 100,000 and 2.06 per 100,000, respectively), the most recent period for which data were available, whereas men had lower rates than did women between 1973 and 1979 (1.06 per 100,000, compared with 1.39 per 100,000), the earliest period for which data were available. In addition, recently, black men had higher incidence rates than did other race-specific and gender-specific groups (2.71 per 100,000). From the earliest period for which data were available to the most recent period, relative 5-year survival improved from 59% to 73% among women, was unchanged among men ( approximately 60%), and decreased from 45% to 27% among black men. Eighteen percent of patients who had distant disease were alive at 5 years, compared with 78% of patients who had localized disease.The incidence of anal cancer in the United States increased between 1973 and 2000, particularly among men. There were higher incidence rates and lower survival rates for black men compared with other race-specific and gender-specific groups. Later disease stage was inversely associated with the survival rate, indicating that earlier detection may improve the survival of patients with anal cancer.

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Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: A study of distal intramural spread and of patients' survival

1983-03-01

Nicholas Williams , Michael F. Dixon , D Johnston

Abstract Fifty consecutive specimens, obtained in the course of potentially curative abdominoperineal resection for rectal carcinoma situated 5–10 cm from the anal verge, were examined for the presence of microscopic … Abstract Fifty consecutive specimens, obtained in the course of potentially curative abdominoperineal resection for rectal carcinoma situated 5–10 cm from the anal verge, were examined for the presence of microscopic distal intramural spread. Thirty-eight patients (76 per cent) were found to have no distal intramural spread. Seven patients (14 per cent) had spread for 1 cm or less and only 5 patients (10 per cent) had spread of more than 1 cm. Each of these 5 patients had a poorly differentiated Dukes' C carcinoma and each was dead or dying from distant metastases within 3 years of the operation. The results of anterior resection for carcinoma of the rectum were reviewed a minimum of 5 years after operation, to find out whether patients with a wide distal margin of resection had fared better than patients with a small margin. Seventy-nine patients had undergone a potentially curative resection, 48 with a distal margin of less than 5 cm (mean 2·8 cm; group 1) and 31 with a distal margin greater than 5 cm (mean 6·5 cm; group 2). The two groups were well matched for age, sex, degree of differentiation of the tumours and distance of the lesion from the anal verge, but 54 per cent of patients in group 1 had Dukes' grade C tumour whereas only 23 per cent of the patients in group 2 had Dukes' C tumours. Despite the higher proportion of unfavourable tumours in group 1, the outcome, in terms both of survival and of recurrence, was as good in the patients with the small distal margin as in the patients with the wide distal margin of clearance. The rigid, routine application of the 5 centimetre rule' of distal excision may cause patients with low rectal cancer to lose their anal sphincter unnecessarily.

Risk of Lymph Node Metastasis in T1 Carcinoma of the Colon and Rectum

2002-02-01

Riccardo Nascimbeni , Lawrence J. Burgart , Santhat Nivatvongs +1 more

PURPOSE: Several recent reports of high local recurrence and lymph node metastasis in T1 carcinoma of the rectum prompted us to study the risk factors for lymph node metastasis in … PURPOSE: Several recent reports of high local recurrence and lymph node metastasis in T1 carcinoma of the rectum prompted us to study the risk factors for lymph node metastasis in these lesions. METHODS: We reviewed the clinical records of 7,543 patients who underwent operative treatment for carcinoma of the colon and rectum from 1979 to 1995. Only patients with sessile T1 lesions who underwent colorectal resection were included in the study, yielding an analysis cohort of 353 patients. The following carcinoma-related variables were assessed: size, mucinous subtype, carcinomatous component, grade, site in colon and rectum, lymphovascular invasion, and depth of submucosal invasion. For the depth, the submucosa was divided into upper third (sm1), middle third (sm2), and lower third (sm3). Chi-squared tests and logistic regression were used to evaluate the variables as potential risk factors for lymph node metastasis. RESULTS: The incidence of T1 lesions was 8.6 percent. In the analysis cohort, the lymph node metastasis rate was 13 percent. Significant predictors of lymph node metastasis both univariately and multivariately were sm3 (P = 0.001), lymphovascular invasion (P = 0.005), and lesions in the lower third of the rectum (P = 0.007). Poorly differentiated carcinoma was significant univariately (P = 0.001) but not in the multivariate model. No other parameter was associated with a significant risk. CONCLUSIONS: T1 colorectal carcinomas with lymphovascular invasion, sm3 depth of invasion, and location in the lower third of the rectum have a high risk of lymph node metastasis. These lesions should have an oncologic resection. In a case of the lesion in the lower third of the rectum, local excision plus adjuvant chemoradiation may be an alternative.

Mucinous carcinoma of the colon and rectum

1976-04-01

Daniel A. Symonds , Austin L. Vickery

The clinicopathologic significance of mucus production by adenocarcinoma of the colon and rectum was analyzed in retrospective study with stage matched non-mucus producing control carcinomas. Mucinous carcinoma of the colon … The clinicopathologic significance of mucus production by adenocarcinoma of the colon and rectum was analyzed in retrospective study with stage matched non-mucus producing control carcinomas. Mucinous carcinoma of the colon and rectum comprised 132 (15%) of 893 cases of colorectal carcinoma. The rectum was the most common site (33% of cases). While 120 mucinous cancers had a poorer five-year survival than non-mucinous tumors (34% vs. 53%, p less than .005), these had a particularly bad prognosis in the rectum (18% 5 year survival vs. 49% for the non-mucinous tumor controls, p less than .00k). The theoretical basis for this location-dependent behavior is considered. From this study, distinctive clinico-pathologic features emerge. There were seven documented cases of ulcerative colitis and 8 additional patients gave a history of "colitis". An additional five patients had received prior pelvic irradiation. Of particular note was the fact that 31% of mucinous carcinomas were associated with villous adenomas, implying a histogenetic relationship. Moreover, this finding again emphasizes the neoplastic potential of the villous adenoma, especially in the rectum where the development of mucinous carcinoma is particularly ominous.

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Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I)

2010-03-01

John Northover , Rob Glynne‐Jones , David Sebag‐Montefiore +5 more

The first UKCCCR Anal Cancer Trial (1996) demonstrated the benefit of chemoradiation over radiotherapy (RT) alone for treating epidermoid anal cancer, and it became the standard treatment. Patients in this … The first UKCCCR Anal Cancer Trial (1996) demonstrated the benefit of chemoradiation over radiotherapy (RT) alone for treating epidermoid anal cancer, and it became the standard treatment. Patients in this trial have now been followed up for a median of 13 years. A total of 577 patients were randomised to receive RT alone or combined modality therapy using 5-fluorouracil and mitomycin C. All patients were scheduled to receive 45 Gy by external beam irradiation. Patients who responded to treatment were recommended to have boost RT, with either an iridium implant or external beam irradiation. Data on relapse and deaths were obtained until October 2007. Twelve years after treatment, for every 100 patients treated with chemoradiation, there are an expected 25.3 fewer patients with locoregional relapse (95% confidence interval (CI): 17.5–32.0 fewer) and 12.5 fewer anal cancer deaths (95% CI: 4.3–19.7 fewer), compared with 100 patients given RT alone. There was a 9.1% increase in non-anal cancer deaths in the first 5 years of chemoradiation (95% CI +3.6 to +14.6), which disappeared by 10 years. The clear benefit of chemoradiation outweighs an early excess risk of non-anal cancer deaths, and can still be seen 12 years after treatment. Only 11 patients suffered a locoregional relapse as a first event after 5 years, which may influence the choice of end points in future studies.

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Elective Clinical Target Volumes for Conformal Therapy in Anorectal Cancer: A Radiation Therapy Oncology Group Consensus Panel Contouring Atlas

2008-12-30

Robert J. Myerson , Michael Garofalo , Issam El Naqa +7 more

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THE PROGNOSTIC SIGNIFICANCE OF DIRECT EXTENSION OF CARCINOMA OF THE COLON AND RECTUM

1954-06-01

Vernon B. Astler , Frederick A. Coller

Preoperative Radiotherapy as Adjuvant Treatment in Rectal Cancer

1988-11-01

A Gérard , Marc Buyse , Bernard Nordlinger +7 more

A randomized clinical trial was conducted by the European Organization for Research and Treatment for Cancer (EORTC) Gastrointestinal Cancer Cooperative Group to study the effectiveness of irradiation therapy administered in … A randomized clinical trial was conducted by the European Organization for Research and Treatment for Cancer (EORTC) Gastrointestinal Cancer Cooperative Group to study the effectiveness of irradiation therapy administered in a dosage of 34.5 Gy, divided into 15 daily doses of 2.3 Gy each before radical surgery for rectal cancer (T2, T3, T4, NX, MO). Four hundred sixty-six patients were entered in the clinical trial between June 1976 and September 1981. Tolerance and side effects of pre- operative irradiation were acceptable. The overall 5-year survival rates were similar in both groups. When considering only the 341 patients treated by surgery with a curative aim, the 5-year survival rates were 59.1% and 69.1% in the control group and in the combined modality group, respectively (p = 0.08). The local recurrence rates at 5 years were 30% and 15% in the control group and the adjuvant radiotherapy group, respectively (p = 0.003). Although this study did not show preoperative radiotherapy to have a statistically significant benefit on overall survival, it does have a clear effect on local control of rectal cancer. Therefore, before performing radical surgery, this adjuvant therapy should be administered to patients who have locally extended rectal cancer.

Sexually Transmitted Infection as a Cause of Anal Cancer

1997-11-06

Morten Frisch , Bengt Glimelius , Adriaan J. C. van den Brule +7 more

The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based case–control study in Denmark and Sweden. The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based case–control study in Denmark and Sweden.

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Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum

1986-02-01

F Lazorthes , P Fages , P Chiotasso +2 more

Rectal resection with colo-anal anastomosis was performed in 65 patients with carcinoma of the lower rectum. In 20 a pelvic colonic reservoir was constructed while in 45 a direct anastomosis … Rectal resection with colo-anal anastomosis was performed in 65 patients with carcinoma of the lower rectum. In 20 a pelvic colonic reservoir was constructed while in 45 a direct anastomosis was carried out. There were no postoperative deaths and morbidity was comparable in the two groups. Functional results were determined by clinical examination and manometry. The frequency of bowel movements was inversely related to the maximum tolerated volume (P less than 0.001). During the first year 60 per cent of the patients with a reservoir and 33 per cent of the patients without had one or two stools per day (P less than 0.05). After one year, 86 per cent of the patients with a reservoir and 33 per cent of the patients without had one or two bowel movements per day (P less than 0.01). The maximum tolerated volume was increased by the reservoir (P less than 0.05). The loss of reservoir capacity of the rectum increases frequency of bowel movements in colo-anal anastomosis. The creation of a colonic reservoir improves function by increasing the maximum tolerated volume without any increase in mortality or morbidity.

Fluorouracil, Mitomycin, and Radiotherapy vs Fluorouracil, Cisplatin, and Radiotherapy for Carcinoma of the Anal Canal

2008-04-22

Jaffer A. Ajani

Chemoradiation as definitive therapy is the preferred primary therapy for patients with anal canal carcinoma; however, the 5-year disease-free survival rate from concurrent fluorouracil/mitomycin and radiation is only approximately 65%.To … Chemoradiation as definitive therapy is the preferred primary therapy for patients with anal canal carcinoma; however, the 5-year disease-free survival rate from concurrent fluorouracil/mitomycin and radiation is only approximately 65%.To compare the efficacy of cisplatin-based (experimental) therapy vs mitomycin-based (standard) therapy in treatment of anal canal carcinoma.US Gastrointestinal Intergroup trial RTOG 98-11, a multicenter, phase 3, randomized controlled trial comparing treatment with fluorouracil plus mitomycin and radiotherapy vs treatment with fluorouracil plus cisplatin and radiotherapy in 682 patients with anal canal carcinoma enrolled between October 31, 1998, and June 27, 2005. Stratifications included sex, clinical nodal status, and tumor diameter.Participants were randomly assigned to 1 of 2 intervention groups: (1) the mitomycin-based group (n = 341), who received fluorouracil (1000 mg/m2 on days 1-4 and 29-32) plus mitomycin (10 mg/m2 on days 1 and 29) and radiotherapy (45-59 Gy) or (2) the cisplatin-based group (n = 341), who received fluorouracil (1000 mg/m2 on days 1-4, 29-32, 57-60, and 85-88) plus cisplatin (75 mg/m2 on days 1, 29, 57, and 85) and radiotherapy (45-59 Gy; start day = day 57).The primary end point was 5-year disease-free survival; secondary end points were overall survival and time to relapse.A total of 644 patients were assessable. The median follow-up for all patients was 2.51 years. Median age was 55 years, 69% were women, 27% had a tumor diameter greater than 5 cm, and 26% had clinically positive nodes. The 5-year disease-free survival rate was 60% (95% confidence interval [CI], 53%-67%) in the mitomycin-based group and 54% (95% CI, 46%-60%) in the cisplatin-based group (P = .17). The 5-year overall survival rate was 75% (95% CI, 67%-81%) in the mitomycin-based group and 70% (95% CI, 63%-76%) in the cisplatin-based group (P = .10). The 5-year local-regional recurrence and distant metastasis rates were 25% (95% CI, 20%-30%) and 15% (95% CI, 10%-20%), respectively, for mitomycin-based treatment and 33% (95% CI, 27%-40%) and 19% (95% CI, 14%-24%), respectively, for cisplatin-based treatment. The cumulative rate of colostomy was significantly better for mitomycin-based than cisplatin-based treatment (10% vs 19%; P = .02). Severe hematologic toxicity was worse with mitomycin-based treatment (P < .001).In this population of patients with anal canal carcinoma, cisplatin-based therapy failed to improve disease-free-survival compared with mitomycin-based therapy, but cisplatin-based therapy resulted in a significantly worse colostomy rate. These findings do not support the use of cisplatin in place of mitomycin in combination with fluorouracil and radiotherapy in the treatment of anal canal carcinoma.clinicaltrials.gov Identifier: NCT00003596.

Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer

2004-06-02

Janet R. Daling , Margaret M. Madeleine , Lisa Johnson +7 more

Abstract BACKGROUND The incidence of anal cancer has increased among both men (160%) and women (78%) from 1973 to 2000 in the U.S. The authors conducted a population‐based case–control study … Abstract BACKGROUND The incidence of anal cancer has increased among both men (160%) and women (78%) from 1973 to 2000 in the U.S. The authors conducted a population‐based case–control study of anal cancer to examine factors that may account for this increase. METHODS Men ( n = 119 patients) and women ( n = 187 patients) who were diagnosed with anal cancer between 1986 and 1998 in the Seattle area were ascertained through the local Surveillance, Epidemiology, and End Results registry. Control participants ( n = 1700) were ascertained through random‐digit telephone dialing. Participants were interviewed in person and provided blood samples. Archival tumor tissue was tested for human papilloma virus (HPV) DNA, and serum samples were tested for HPV type 16 (HPV‐16). RESULTS Overall, 88% of tumors (all histologies) in the study were found to be positive for HPV. HPV‐16 was the most frequent HPV type detected (73% of all tumors), followed by HPV‐18 (6.9%), regardless of gender. However, 97.7% of tumors from men who were not exclusively heterosexual contained HPV DNA. The risk of anal cancer increased among men (odds ratio [OR], 5.3; 95% confidence interval [95% CI], 2.4–12.0) and women (OR, 11.0; 95% CI, 5.5–22.1) who had ≥ 15 sexual partners during their lifetime. Among men who were not exclusively heterosexual and women, receptive anal intercourse was related strongly to the risk of anal cancer (OR, 6.8 [95% CI, 1.4–33.8] and OR, 2.2 [95% CI, 1.4–3.3], respectively). Current smokers among men and women were at particularly high risk for anal cancer, independent of age and other risk factors (OR, 3.9 [95% CI, 1.9–8.0] and OR, 3.8 [95% CI, 2.4–6.2], respectively). CONCLUSIONS The high proportion of tumors with detectable HPV suggests that infection with HPV is a necessary cause of anal cancer, similar to that of cervical cancer. Increases in the prevalence of exposures, such as cigarette smoking, anal intercourse, HPV infection, and the number of lifetime sexual partners, may account for the increasing incidence of anal cancer in men and women. Cancer 2004. © 2004 American Cancer Society.

Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up

2014-09-16

Rob Glynne‐Jones , Per J. Nilsson , C. Aschele +4 more

Cancer Of The Colon

1967-09-01

RUPERT B. TUHNBULL , Kenneth Kyle , FRANK R. WATSON +1 more

TUHNBULL, RUPERT B. JR. M.D.; KYLE, KENNETH M.B., M.CH.; WATSON, FRANK R. PH.D.; SPRATT, JOHN M.D. Author Information TUHNBULL, RUPERT B. JR. M.D.; KYLE, KENNETH M.B., M.CH.; WATSON, FRANK R. PH.D.; SPRATT, JOHN M.D. Author Information

RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Carcinoma of the Anal Canal

2012-11-12

Lisa A. Kachnic , Kathryn Winter , Robert J. Myerson +7 more

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A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer

1985-09-01

P. H. Chapuis , O. F. Dent , Richard Fisher +4 more

Abstract Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several … Abstract Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.

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Human papillomavirus type distribution in anal cancer and anal intraepithelial lesions

2008-12-17

Brooke Hoots , Joel M. Palefsky , Jeanne M. Pimenta +1 more

A systematic review was conducted of HPV type distribution in anal cancer and anal high-grade and low-grade squamous intraepithelial lesions (HSIL and LSIL). A Medline search of studies using PCR … A systematic review was conducted of HPV type distribution in anal cancer and anal high-grade and low-grade squamous intraepithelial lesions (HSIL and LSIL). A Medline search of studies using PCR or hybrid capture for HPV DNA detection was completed. A total of 1,824 cases were included: 992 invasive anal cancers, 472 HSIL cases and 360 LSIL cases. Crude HPV prevalence in anal cancer, HSIL, and LSIL was 71, 91 and 88%, respectively. HPV16/18 prevalence was 72% in invasive anal cancer, 69% in HSIL and 27% in LSIL. The HPV 16 and/or 18 prevalence in invasive anal cancer cases was similar to that reported in invasive cervical cancer. If ongoing clinical trials show efficacy in preventing anal HPV infection and associated anal lesions, prophylactic HPV vaccines may play an important role for the primary prevention of these cancers in both genders.

Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria

2015-08-19

Hiroshi Katayama , Yukinori Kurokawa , Kenichi Nakamura +7 more

Prior to publication of the Clavien-Dindo classification in 2004, there were no grading definitions for surgical complications in either clinical practice or surgical trials. This report establishes supplementary criteria for … Prior to publication of the Clavien-Dindo classification in 2004, there were no grading definitions for surgical complications in either clinical practice or surgical trials. This report establishes supplementary criteria for this classification to standardize the evaluation of postoperative complications in clinical trials.The Japan Clinical Oncology Group (JCOG) commissioned a committee. Members from nine surgical study groups (gastric, esophageal, colorectal, lung, breast, gynecologic, urologic, bone and soft tissue, and brain) specified postoperative complications experienced commonly in their fields and defined more detailed grading criteria for each complication in accordance with the general grading rules of the Clavien-Dindo classification.We listed 72 surgical complications experienced commonly in surgical trials, focusing on 17 gastroenterologic complications, 13 infectious complications, six thoracic complications, and several other complications. The grading criteria were defined simply and were optimized for surgical complications.The JCOG postoperative complications criteria (JCOG PC criteria) aim to standardize the terms used to define adverse events (AEs) and provide detailed grading guidelines based on the Clavien-Dindo classification. We believe that the JCOG PC criteria will allow for more precise comparisons of the frequency of postoperative complications among trials across many different surgical fields.

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Phase II Multicenter Study of the Antiepidermal Growth Factor Receptor Monoclonal Antibody Cetuximab in Combination With Platinum-Based Chemotherapy in Patients With Platinum-Refractory Metastatic and/or Recurrent Squamous Cell Carcinoma of the Head and Neck

2005-07-12

José Baselga , José Trigo , Jean Bourhis +7 more

To evaluate the efficacy and safety of the antiepidermal growth factor receptor monoclonal antibody cetuximab in combination with platinum-based chemotherapy in patients with platinum-refractory recurrent or metastatic squamous cell carcinoma … To evaluate the efficacy and safety of the antiepidermal growth factor receptor monoclonal antibody cetuximab in combination with platinum-based chemotherapy in patients with platinum-refractory recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN).Ninety-six eligible patients received cetuximab (initial dose of 400 mg/m2 followed by subsequent weekly doses of 250 mg/m2) followed by platinum chemotherapy at the same dose and schedule at which progressive disease was documented before entry onto the study.The response rate, based on an independently read assessment, in the intent-to-treat population was 10%, with a disease control rate (complete response, partial response [PR], and stable disease) of 53%. The median time to progression and overall survival were 85 and 183 days, respectively; both were longest in patients achieving a PR (median, 203.5 and 294 days, respectively). Treatment was well tolerated. The most common cetuximab-related adverse events were skin reactions, particularly an acne-like rash.The combination of cetuximab and platinum chemotherapy is an active and well-tolerated approach to the treatment of this poor-prognosis patient population with platinum-refractory recurrent or metastatic SCCHN for whom there are no recommended standard therapeutic options.

Pathological features of rectal cancer after preoperative radiochemotherapy

1997-03-24

O. Dworák , Ludwig Keilholz , Alexander Hoffmann

Comparison of Three Management Strategies for Patients With Atypical Squamous Cells of Undetermined Significance: Baseline Results From a Randomized Trial

2001-02-21

D. Solomon , Mark Schiffman , Robert E. Tarone

Background: More than 2 million U.S. women receive an equivocal cervical cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]) each year. Effective colposcopy triage strategies are needed to identify … Background: More than 2 million U.S. women receive an equivocal cervical cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]) each year. Effective colposcopy triage strategies are needed to identify the minority of women who have clinically significant disease while avoiding excessive follow-up evaluation for others. Methods: The ASCUS/LSIL (i.e., low-grade squamous intraepithelial lesion) Triage Study (ALTS) is a multicenter, randomized trial comparing the sensitivity and specificity of the following three management strategies to detect cervical intraepithelial neoplasia grade 3 (CIN3): 1) immediate colposcopy (considered to be the reference standard), 2) triage to colposcopy based on human papillomavirus (HPV) results from Hybrid Capture 2™ (HC 2) and thin-layer cytology results, or 3) triage based on cytology results alone. This article summarizes the cross-sectional enrollment results for 3488 women with a referral diagnosis of ASCUS. All statistical tests are two-sided. Results: Among participants with ASCUS, the underlying prevalence of histologically confirmed CIN3 was 5.1%. Sensitivity to detect CIN3 or above by testing for cancer-associated HPV DNA was 96.3% (95% confidence interval [CI] = 91.6% to 98.8%), with 56.1% of women referred to colposcopy. Sensitivity of a single repeat cytology specimen with a triage threshold of HSIL or above was 44.1% (95% CI = 35.6% to 52.9%), with 6.9% referred. Sensitivity of a lower cytology triage threshold of ASCUS or above was 85.3% (95% CI = 78.2% to 90.8%), with 58.6% referred. Conclusions: HC 2 testing for cancer-associated HPV DNA is a viable option in the management of women with ASCUS. It has greater sensitivity to detect CIN3 or above and specificity comparable to a single additional cytologic test indicating ASCUS or above.

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<b>TNM Classification of Malignant Tumors.</b>5th ed

1998-04-01

Richard A. Szucs

TNM residual tumor classification revisited

2002-04-25

Christian Wittekind , Carolyn C. Compton , Frederick L. Greene +1 more

For cancer patients, prognosis is strongly influenced by the completeness of tumor removal at the time of cancer-directed surgery or disease remission after nonsurgical treatment with curative intent. These parameters … For cancer patients, prognosis is strongly influenced by the completeness of tumor removal at the time of cancer-directed surgery or disease remission after nonsurgical treatment with curative intent. These parameters define the relative success of definitive treatment and can be codified by an additional subclassification within the TNM system, the residual tumor (R) classification. Despite the importance of residual tumor status in designing clinical management after treatment, misinterpretation and inconsistent application of the R classification frequently occur that diminish or abrogate its clinical utility.An analysis of the relevant literature regarding the use and prognostic importance of the R classification was undertaken.In the current study, the prognostic importance of the R classification for different kinds of tumors is discussed. Problems that arise in using the R classification are described. Special issues regarding the use of the R classification are addressed.The R classification is a strong indicator of prognosis and facilitates the comparison of treatment results if applied in a consistent manner. Uniform use and interpretation of this classification is essential for the standardization of posttreatment data collection.

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Long-Term Update of US GI Intergroup RTOG 98-11 Phase III Trial for Anal Carcinoma: Survival, Relapse, and Colostomy Failure With Concurrent Chemoradiation Involving Fluorouracil/Mitomycin Versus Fluorouracil/Cisplatin

2012-11-14

Leonard L. Gunderson , Kathryn Winter , Jaffer A. Ajani +7 more

Purpose On initial publication of GI Intergroup Radiation Therapy Oncology Group (RTOG) 98-11 [A Phase III Randomized Study of 5-Fluorouracil (5-FU), Mitomycin, and Radiotherapy Versus 5-Fluorouracil, Cisplatin and Radiotherapy in … Purpose On initial publication of GI Intergroup Radiation Therapy Oncology Group (RTOG) 98-11 [A Phase III Randomized Study of 5-Fluorouracil (5-FU), Mitomycin, and Radiotherapy Versus 5-Fluorouracil, Cisplatin and Radiotherapy in Carcinoma of the Anal Canal], concurrent chemoradiation (CCR) with fluorouracil (FU) plus mitomycin (MMC) decreased colostomy failure (CF) when compared with induction plus concurrent FU plus cisplatin (CDDP), but did not significantly impact disease-free survival (DFS) or overall survival (OS) for anal canal carcinoma. The intent of the updated analysis was to determine the long-term impact of treatment on survival (DFS, OS, colostomy-free survival [CFS]), CF, and relapse (locoregional failure [LRF], distant metastasis) in this patient group. Patients and Methods Stratification factors included sex, clinical node status, and primary size. DFS and OS were estimated univariately by the Kaplan-Meier method, and treatment arms were compared by log-rank test. Time to relapse and CF were estimated by the cumulative incidence method and treatment arms were compared by using Gray's test. Multivariate analyses used Cox proportional hazard models to test for treatment differences after adjusting for stratification factors. Results Of 682 patients accrued, 649 were analyzable for outcomes. DFS and OS were statistically better for RT + FU/MMC versus RT + FU/CDDP (5-year DFS, 67.8% v 57.8%; P = .006; 5-year OS, 78.3% v 70.7%; P = .026). There was a trend toward statistical significance for CFS (P = .05), LRF (P = .087), and CF (P = .074). Multivariate analysis was statistically significant for treatment and clinical node status for both DFS and OS, for tumor diameter for DFS, and for sex for OS. Conclusion CCR with FU/MMC has a statistically significant, clinically meaningful impact on DFS and OS versus induction plus concurrent FU/CDDP, and it has borderline significance for CFS, CF, and LRF. Therefore, RT + FU/MMC remains the preferred standard of care.

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Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2×2 factorial trial

2013-04-09

R.D. James , Rob Glynne‐Jones , Helen Meadows +7 more

Signet-Ring Cell Carcinoma of the Colon: A Case Report and Review of the Literature

2015-11-03

Peter Y. Park , Teresa A. Goldin , John C. S. Chang +2 more

Colorectal adenocarcinoma (CRC) is the third leading cause of death in the United States. One of the histologic subtypes of CRC is signet-ring cell carcinoma (SRCC), which has a distinct … Colorectal adenocarcinoma (CRC) is the third leading cause of death in the United States. One of the histologic subtypes of CRC is signet-ring cell carcinoma (SRCC), which has a distinct molecular and tumor biology from that of adenocarcinoma. Primary SRCC diagnosed at an early stage is very rare as most cases are detected at an advanced stage. Therefore, overall prognosis of SRCC is poor.A 36-year-old female presented to her primary care physician with new-onset progressive right lower quadrant pain without any significant past medical or family history. Computed tomography scan of the abdomen and pelvis with contrast showed a 4.9 × 3.5 × 3.1 cm, lobulated, septated cystic mass arising from the cecum. The mass demonstrated wall enhancement and contained focal areas of coarse calcification. There was nodal involvement either locally or distally. The patient underwent right hemicolectomy, and pathology revealed a high-grade mucinous carcinoma with signet-ring cell variant invading through the muscularis propria and into the subserosal adipose tissue. The margins were negative for tumor, and no lymphovascular or perineural invasion was noted. None of the 14 resected pericolonic lymph nodes was positive for malignancy. Hence, she was staged as pT3, pN0, pMx-stage IIA. The appendix was not involved. Microsatellite instability testing showed the preservation of MLH1, PMS2, MSH2 and MSH6 proteins by IHC and PCR. Carcinoembryonic antigen level was within normal limits. Due to the patient's young age, aggressive histology and microsatellite-stable status, adjuvant fluropyrimidine (5-FU)-based therapy with the single agent capecitabine was initiated. The patient completed 6 months of adjuvant therapy and has been disease free for approximately 18 months.Primary SRCC of the cecum is a rare disease. Given the poor prognosis of these patients, early-stage disease with microsatellite-stable patients should be considered for adjuvant 5-FU-based therapy in an attempt to prevent recurrence.

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Sexual Practices, Sexually Transmitted Diseases, and the Incidence of Anal Cancer

1987-10-15

Janet R. Daling , Noel S. Weiss , T. Gregory Hislop +7 more

To elucidate the risk factors for anal cancer, we interviewed and obtained blood specimens from 148 persons with anal cancer and from 166 controls with colon cancer in whom these … To elucidate the risk factors for anal cancer, we interviewed and obtained blood specimens from 148 persons with anal cancer and from 166 controls with colon cancer in whom these diseases were diagnosed during 1978-1985. We found that in men, a history of receptive anal intercourse (related to homosexual behavior) was strongly associated with the occurrence of anal cancer (relative risk, 33.1; 95 percent confidence interval, 4.0 to 272.1). Anal intercourse was only weakly associated with the risk of anal cancer in women (relative risk, 1.8; 95 percent confidence interval, 0.7 to 4.2). Among the subjects with squamous-cell anal cancer, 47.1 percent of homosexual men, 28.6 percent of heterosexual men, and 28.3 percent of women gave a history of genital warts, as compared with only 1 to 2 percent of controls and no patients with transitional-cell anal cancer. In patients without a history of warts, anal cancer was associated with a history of gonorrhea in heterosexual men (relative risk, 17.2; 95 percent confidence interval, 2.0 to 149.4) and with seropositivity for herpes simplex type 2 (relative risk, 4.1; 95 percent confidence interval, 1.9 to 8.8) and Chlamydia trachomatis (relative risk, 2.3; 95 percent confidence interval, 1.1 to 4.8) in women. Current cigarette smoking was a substantial risk factor in both women (relative risk, 7.7; 95 percent confidence interval, 3.5 to 17.2) and men (relative risk, 9.4; 95 percent confidence interval, 2.3 to 38.5). We conclude that homosexual behavior in men is a risk factor for anal cancer, and that squamous-cell anal cancer is also associated with a history of genital warts, an association suggesting that papillomavirus infection is a cause of anal cancer. Certain other genital infections and cigarette smoking are also associated with anal cancer.

Combined Chemotherapy and Radiotherapy Compared with Radiotherapy Alone in Patients with Cancer of the Esophagus

1992-06-11

Arnold Herskovic , Karen Martz , Muhyi Al‐Sarraf +7 more

The efficacy of conventional treatment with surgery and radiation for cancer of the esophagus is limited. The median survival is less than 10 months, and less than 10 percent of … The efficacy of conventional treatment with surgery and radiation for cancer of the esophagus is limited. The median survival is less than 10 months, and less than 10 percent of patients survive for 5 years. Recent studies have suggested that combined chemotherapy and radiation therapy may result in improved survival.

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Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances.

1968-06-01

Kyoichi Nakamura , Hiroshi Sugano , K Takagi

Epidermoid anal cancer: Results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin

1996-10-19

S.J. Arnott , David Cunningham , James Gallagher +7 more

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer

2017-10-01

Kei Muro

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Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC

2018-09-25

Scott Antonia , Augusto Villegas , Davey B. Daniel +7 more

An earlier analysis in this phase 3 trial showed that durvalumab significantly prolonged progression-free survival, as compared with placebo, among patients with stage III, unresectable non-small-cell lung cancer (NSCLC) who … An earlier analysis in this phase 3 trial showed that durvalumab significantly prolonged progression-free survival, as compared with placebo, among patients with stage III, unresectable non-small-cell lung cancer (NSCLC) who did not have disease progression after concurrent chemoradiotherapy. Here we report the results for the second primary end point of overall survival.We randomly assigned patients, in a 2:1 ratio, to receive durvalumab intravenously, at a dose of 10 mg per kilogram of body weight, or matching placebo every 2 weeks for up to 12 months. Randomization occurred 1 to 42 days after the patients had received chemoradiotherapy and was stratified according to age, sex, and smoking history. The primary end points were progression-free survival (as assessed by blinded independent central review) and overall survival. Secondary end points included the time to death or distant metastasis, the time to second progression, and safety.Of the 713 patients who underwent randomization, 709 received the assigned intervention (473 patients received durvalumab and 236 received placebo). As of March 22, 2018, the median follow-up was 25.2 months. The 24-month overall survival rate was 66.3% (95% confidence interval [CI], 61.7 to 70.4) in the durvalumab group, as compared with 55.6% (95% CI, 48.9 to 61.8) in the placebo group (two-sided P=0.005). Durvalumab significantly prolonged overall survival, as compared with placebo (stratified hazard ratio for death, 0.68; 99.73% CI, 0.47 to 0.997; P=0.0025). Updated analyses regarding progression-free survival were similar to those previously reported, with a median duration of 17.2 months in the durvalumab group and 5.6 months in the placebo group (stratified hazard ratio for disease progression or death, 0.51; 95% CI, 0.41 to 0.63). The median time to death or distant metastasis was 28.3 months in the durvalumab group and 16.2 months in the placebo group (stratified hazard ratio, 0.53; 95% CI, 0.41 to 0.68). A total of 30.5% of the patients in the durvalumab group and 26.1% of those in the placebo group had grade 3 or 4 adverse events of any cause; 15.4% and 9.8% of the patients, respectively, discontinued the trial regimen because of adverse events.Durvalumab therapy resulted in significantly longer overall survival than placebo. No new safety signals were identified. (Funded by AstraZeneca; PACIFIC ClinicalTrials.gov number, NCT02125461 .).

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Carcinoma of the Colon and Rectum

1962-02-01

Claude E. Welch , John F. Burke

CARCINOMA of the colon and rectum is now the most common type of malignant tumor other than cancer of the skin. It is moreover one of the varieties to which … CARCINOMA of the colon and rectum is now the most common type of malignant tumor other than cancer of the skin. It is moreover one of the varieties to which a great deal of attention has been devoted in an attempt to control cancer, since a change in bowel habit and rectal bleeding have been emphasized repeatedly in the past decade as the prime warning symptoms of internal cancer.The importance of this type of neoplastic disease is shown by the estimate that in the United States, in 1961, there will be 70,000 new cases of cancer of the colon . . .

Carcinoma of the Anal Canal

2000-03-16

David P. Ryan , Carolyn C. Compton , Robert J. Mayer

Carcinoma of the anal canal accounts for 1.5 percent of digestive-system cancers in the United States, with an estimated 3400 new cases in 2000.1 Thirty years ago, anal cancer was … Carcinoma of the anal canal accounts for 1.5 percent of digestive-system cancers in the United States, with an estimated 3400 new cases in 2000.1 Thirty years ago, anal cancer was believed to be caused by chronic, local inflammation of the perianal area2,3 and was treated with an abdominoperineal resection, necessitating a permanent colostomy.4 As the result of a series of epidemiologic studies, it is now apparent that the development of anal cancer is associated with infection by human papillomavirus, which is usually sexually transmitted. Moreover, in the majority of patients, the condition can be cured by concurrent chemotherapy and . . .

Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition [Secondary Publication]

2019-10-29

Based on literature evidence and expert consensus, the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 1,2) (JCCRC) has been developed and sustained by the Japanese Society for Cancer of … Based on literature evidence and expert consensus, the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 1,2) (JCCRC) has been developed and sustained by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) since 1977.Through defining detailed rules for evaluating and documenting clinical and pathological findings, and handling specimens of colorectal cancer, the JCCRC has contributed to the standardization and improvement of the diagnosis and treatment of colorectal cancer in Japan.Furthermore, the JSCCR guidelines for colorectal cancer treatment 3) , which have been revised several times since the first edition was issued in 2005, describe treatment algorithms conforming to the JCCRC; therefore, its importance is continuing to increase.Under these circumstances, the revisions have to maintain the classification's role to further improve treatment outcomes for colorectal cancer in Japan, which are already among the best in the world.At the same time, there is a focus on harmonizing with the eighth edition of the TNM classification 4) and classification of cancers in other organs in Japan.Stage grouping of colorectal cancer was compromised with that of the TNM classification.However, some differences were caused by the classification of lymph node metastasis.Expertise built up over several years emphasizes the importance of the main and lateral lymph nodes (N3) in Japan.Further, the definition of "extramural cancer deposits without lymph node structure (EX)" differs from that of "tumor deposits" in the TNM classifications.Meanwhile, be-cause of the low prevalence of appendiceal and anal cancers arising from the anoderm in Japan, the current edition incorporates the TNM classification in these clinical entities. Aims and Subjects AimsThis classification presents the anatomical extent of colorectal cancer as a means to broadly share clinicopathological information on colorectal cancer and serves as the basis for improving treatment outcomes for colorectal cancer in Japan. SubjectsThis classification applies to primary carcinomas of the colon and rectum and does not apply to recurrence or metastasis.It is recommended that findings for primary colorectal tumors other than carcinomas be recorded according to this classification.The large intestine comprises the colon (cecum, ascending colon, transverse colon, descending colon, and sigmoid colon) and rectum (rectosigmoid junction, upper rectum, and lower rectum).The current edition also pertains to the appendix and anal canal; tumors occurring in these regions are tallied separately from those occurring in the colorectum.

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Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin

1996-10-01

R.D. James

[Progress in neoadjuvant immunotherapy for locally advanced rectal cancer].

2025-06-25

Yan Wang , Feng Tian , C Q Jing | PubMed

Neoadjuvant chemoradiotherapy (NACRT) is the standard treatment for locally advanced rectal cancer (LARC), yet the pathological complete response (pCR) rates remain suboptimal. The introduction of immunotherapy has opened new avenues … Neoadjuvant chemoradiotherapy (NACRT) is the standard treatment for locally advanced rectal cancer (LARC), yet the pathological complete response (pCR) rates remain suboptimal. The introduction of immunotherapy has opened new avenues for LARC management, particularly in patients with mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H) status. In this subset, anti-programmed cell death protein-1 (PD-1) monoclonal antibodies demonstrate marked efficacy, achieving high rates of clinical complete response (cCR) and pCR, thereby facilitating non-operative watch-and-wait (W&W) strategies. However, long-term outcomes and large-scale validation are still awaited. Conversely, in patients with LARC who have proficient mismatch repair (pMMR) or microsatellite stability (MSS), PD-1 inhibition alone shows limited benefit. Current research thus focuses on combinatorial approaches. Combining immunotherapy with chemoradiotherapy has shown promise in improving pCR rates in pMMR/MSS LARC, without significantly exacerbating severe adverse events. However, the discordance between post-treatment imaging assessments and pathological findings complicates clinical decision-making. Future directions include optimizing immune checkpoint inhibitor (ICI) regimens for pMMR/MSS LARC, with ongoing investigations into dual immunotherapy and anti-angiogenic synergism. Additionally, biomarker discovery, which is leveraging multi-omics and artificial intelligence (AI), will be pivotal in achieving precision therapy that balances short-term efficacy with long-term survival benefits.

Survival Outcomes and Prognostic Factors in Spindle Cell Variants of Squamous Cell Carcinoma: A Machine Learning Analysis of 1,086 Patients from the SEER Database

2025-06-25

Akef Obeidat , Tarek Ziad Arabi , Belal Nedal Sabbah +3 more | Annals of Medicine and Surgery

Cetuximab increases LGR5 expression and augments LGR5-targeting antibody-drug conjugate efficacy in patient-derived colorectal cancer models

2025-06-24

Peyton C. High , Zhengdong Liang , Cara Guernsey-Biddle +5 more | bioRxiv (Cold Spring Harbor Laboratory)

Colorectal cancer (CRC) remains the second-leading cause of cancer-associated deaths, indicating an urgent need for improved therapeutic options. We previously generated antibody-drug conjugates (ADCs) targeting the cancer stem-like cell marker … Colorectal cancer (CRC) remains the second-leading cause of cancer-associated deaths, indicating an urgent need for improved therapeutic options. We previously generated antibody-drug conjugates (ADCs) targeting the cancer stem-like cell marker leucine-rich repeat-containing G protein-coupled receptor 5 (LGR5). However, tumor relapse due to LGR5 downregulation and suboptimal payload selection warranted strategies to improve ADC efficacy. Here we report cetuximab, an EGFR-targeting monoclonal antibody indicated for RASWT metastatic CRC, augments LGR5 expression independent of RAS/PIK3CA mutation status and promotes EGFR-LGR5 interactions. Furthermore, we describe the development of LGR5 ADCs incorporating a camptothecin-derived payload that is well-tolerated and significantly inhibits tumor growth. Importantly, cetuximab in combination with LGR5 ADCs results in enhanced tumor inhibition or regression versus single-agent treatment and extends survival in RAS MUT patient-derived xenografts. These findings support growing evidence that ADC combination therapies may be more effective than monotherapies and suggests a broader clinical use for cetuximab in treating RAS MUT CRC.

Evolving Options and Views on Anal Dysplasia

2025-06-23

Marianna J. Steele , Scott R. Steele | Clinics in Colon and Rectal Surgery

18F-FDG PET/CT of Sacrococcygeal Pilonidal Sinus Carcinoma

2025-06-23

Mali Wang , Jianwei Zhu , Jing Wang +1 more | Clinical Nuclear Medicine

Pilonidal sinus carcinoma is rare, with a poor prognosis, often misinterpreted as infection or perianal fistula. We present 18F-FDG PET/CT imaging in a 69-year-old woman with a chronic pilonidal sinus … Pilonidal sinus carcinoma is rare, with a poor prognosis, often misinterpreted as infection or perianal fistula. We present 18F-FDG PET/CT imaging in a 69-year-old woman with a chronic pilonidal sinus that progressed to an abscess and drained spontaneously. The retrorectal-precoccyx irregular mass with sinus tract formation and apparent glucose metabolism, connecting with an intergluteal cyst, was confirmed pathologically as pilonidal sinus carcinoma.

Applicability of cCR assessment criteria in pmmr rectal cancer patients treated with neoadjuvant chemoradiotherapy combined with immunotherapy

2025-06-23

Jun‐Peng Pei , Haijun Xu , Qiushi Dong +7 more | International Journal of Surgery

This study aimed to assess whether clinical complete response (cCR) criteria developed for neoadjuvant chemoradiotherapy (NACRT) are applicable to patients with proficient mismatch repair locally advanced rectal cancer (LARC) who … This study aimed to assess whether clinical complete response (cCR) criteria developed for neoadjuvant chemoradiotherapy (NACRT) are applicable to patients with proficient mismatch repair locally advanced rectal cancer (LARC) who are treated with NACRT combined with immunotherapy (NAICRT). This retrospective study included 49 LARC patients who received NAICRT and 128 who received NACRT. Clinical response was assessed using two established criteria: the Memorial Sloan Kettering Cancer Center (MSKCC) criteria and the Chinese Watch-and-Wait Database (CWWD) criteria. These criteria integrate findings from digital rectal examination, endoscopy, MRI, and, optionally, carcinoembryonic antigen levels and biopsy results. Pathological complete response (pCR), determined from surgical specimens, was used as the reference standard. The diagnostic performance of these criteria in predicting pCR was evaluated using sensitivity, specificity, accuracy, and area under the curve (AUC). Among the 177 patients, 54 achieved pCR (18 in the NAICRT group and 36 in the NACRT group). MSKCC and CWWD criteria showed comparable performance in the NACRT and NAICRT groups, respectively. Sensitivities were 0.11 and 0.28; specificities, 0.99 and 1.00; accuracies, 0.74 and 0.73; and AUCs, 0.55 and 0.64, with no significant differences between groups. Endoscopy demonstrated sensitivities of 0.28 and 0.61, specificities of 0.96 and 0.90, accuracies of 0.77 and 0.80, and AUCs of 0.67 and 0.76 in the NACRT and NAICRT groups, respectively, with a significant difference in sensitivity (P = 0.02). MRI showed sensitivities of 0.50 and 0.39, specificities of 0.91 and 0.90, accuracies of 0.80 and 0.71, and AUCs of 0.71 and 0.65, without significant differences. The cCR assessment criteria originally developed for NACRT are also applicable to NAICRT patients, showing excellent specificity but suboptimal sensitivity, which may lead to overtreatment of patients with actual pCR. Future studies should focus on enhancing sensitivity to better support organ preservation.

Outcomes of endoscopic submucosal dissection for the treatment of superficial anal squamous cell carcinoma: A multicenter international experience

2025-06-23

Miguel Fraile López , Mathieu Pioche , Jérôme Rivory +7 more | Endoscopy International Open

Background and Study Aims: Data on the feasibility of endoscopic submucosal dissection (ESD) for the treatment of superficial anal squamous cell carcinoma (ASCC) is limited. This study aimed to evaluate … Background and Study Aims: Data on the feasibility of endoscopic submucosal dissection (ESD) for the treatment of superficial anal squamous cell carcinoma (ASCC) is limited. This study aimed to evaluate the outcomes of ESD in this anatomical location. Patients and methods: This is a multicenter retrospective study including patients who underwent ESD for the treatment of superficial ASCC. Results: A total of 23 patients with superficial ASCC were included. The median lesion size was 24 mm (range, 9-65 mm), and the median procedure time was 62 minutes (range, 26-210 minutes). The accuracy of optical diagnosis using JES IPCL to predict final histology was 63.6%. En bloc and R0 resection were achieved in 22 (95.6%) and 18 (78.3%) patients, respectively. The curative resection rate was 73.9% (17/23). Three patients received additional complementary treatment. Delayed bleeding was observed in 4 patients (17.4%), with two of them requiring endoscopic hemostasis. Anal pain was reported in 9 (39.1%) patients and was effectively managed with analgesics. Fecal incontinence and anal stenosis occurred both in one patient during the perioperative period. During a median follow-up of 10.1 months (range, 0-69.6 months), no recurrences were observed. Conclusions: ESD is a feasible and effective treatment for superficial ASCC. Adverse events were successfully managed with medical or endoscopic therapy. ESD should be considered as first-line resection technique to prevent recurrence while preserving anal sphincter function.

Anal Dysplasia: Epidemiology, Risk Factors, and Progression to Malignancy

2025-06-23

Michael Boyer , Zhaomin Xu | Clinics in Colon and Rectal Surgery

Abstract This review aims to address the framework for classification of anal dysplasia, immunogenic and behavioral risk factors for development of disease, the progression to anal cancer, and key intervention … Abstract This review aims to address the framework for classification of anal dysplasia, immunogenic and behavioral risk factors for development of disease, the progression to anal cancer, and key intervention points to guide contemporary practice. Although anal cancer is rare, its rising incidence and disproportionate impact on racial minorities, immunocompromised individuals, and older adults require attention to combat high disease burden within these communities. Concentrated efforts with targeted resource allocation are required to address this rising disease incidence, following new screening guidelines developed to identify groups that are considered high-risk for anal dysplasia and the development of anal squamous cell carcinoma.

Mucoepidermoid Carcinoma of Esophagus with No Mass Lesion

2025-06-21

Katyayni Singh , Sudipta Saha , Manoj Andley +6 more | Asian Journal of Case Reports in Surgery

Total neoadjuvant immunochemotherapy for proficient mismatch repair or microsatellite stable locally advanced rectal cancer

2025-06-20

Xing Li , Ligong Tang , Fangyuan Cheng +1 more | Frontiers in Immunology

Objective Our goal was to assess the efficacy of integrating PD-1 inhibitors with total neoadjuvant treatment (iTNT) in enhancing complete response (CR) rates and the propensity for watch-and-wait (WW) strategies … Objective Our goal was to assess the efficacy of integrating PD-1 inhibitors with total neoadjuvant treatment (iTNT) in enhancing complete response (CR) rates and the propensity for watch-and-wait (WW) strategies in patients with proficient mismatch repair or microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Methods A retrospective analysis of data prospectively collected was performed. Enrolled patients were divided into Group SCRT-IC, which received short-course radiotherapy (SCRT) followed by six cycles of consolidation immunotherapy with capecitabine and oxaliplatin, or to Group IC-SCRT, which underwent two cycles of induction immunotherapy followed by SCRT and the remaining four cycles of chemotherapy. The primary endpoint was CR. Results A total of 141 patients were included (72 in Group SCRT-IC and 69 in Group IC-SCRT). At a median follow-up of 29 months, the CR rates were 55.6% in Group SCRT-IC and 53.6% in Group IC-SCRT. The pCR rates were reported at 50% for both groups. Seventeen patients in each group were treated with WW and remained disease-free. The most prevalent grade 3 to 4 toxicities were thrombocytopenia and neutropenia. The cCR rate was a little higher in Group SCRT-IC (56.9% compared to 53.6%), and the incidence of grade 3 to 4 thrombocytopenia was lower in Group SCRT-IC (24.2% vs. 33.9%). Conclusion iTNT regimen has significantly improved the CR rate for pMMR/MSS LARC compared to historical standards, with acceptable toxicity. The approach of prioritizing SCRT followed by immunotherapy is a promising strategy for definitive investigation in future studies.

Anal squamous cell carcinoma with mucinous microcysts represents anal gland duct differentiation

2025-06-20

Newton A C S Wong , Guzin Bostanci | Histopathology

Aims The subtype of anal cancer known as squamous cell carcinoma with mucinous microcysts (SCC‐MM) is recognised to portend a poorer prognosis. However, the clinical significance of identifying this subtype … Aims The subtype of anal cancer known as squamous cell carcinoma with mucinous microcysts (SCC‐MM) is recognised to portend a poorer prognosis. However, the clinical significance of identifying this subtype has been downplayed more recently because of the frequent admixture of other SCC subtypes with SCC‐MM and subjectivity in diagnosing the latter. This study aimed to immunohistochemically assess an anecdotal observation that SCC‐MM morphologically resembles anal gland ducts and to thus determine whether SCC‐MM has a unique immunoprofile which could then assist its distinction from differential diagnoses. Methods and results Ten immunohistochemical markers were applied to five cases of SCC‐MM, three cases each of basaloid SCC and conventional SCC of the anus, as well as physiological anal tissue including anal gland ducts and both transitional and squamous epithelia. Of the latter three, the immunophenotype of SCC‐MM most resembled anal gland duct epithelium, whereas the immunophenotype of basaloid SCC most resembled transitional epithelium. SCC‐MM differed from basaloid SCC by expressing MUC5AC, expressing GATA3 more diffusely and showing only peripheral p63 positivity. Conclusions SCC‐MM represents anal gland duct differentiation and can be reliably distinguished from its closest and commonest differential diagnosis, basaloid SCC, by the histological identification of mucin containing cysts and by immunohistochemistry for MUC5AC, GATA3 and p63. This distinction may be clinically important for the prognostication and pathological staging of anal carcinoma in excision specimens.

Misdiagnosis of rectal misplaced glands as rectal cancer: A rare case report

2025-06-20

Weitao Huang , Xiaowei Han , Guozheng Zhang | Medicine

We report a rare case of rectal misplaced glands (RMG) with a 2-year disease course. Digital rectal examination identified a semi-circumferential mass approximately 4 cm from the anal verge. Imaging … We report a rare case of rectal misplaced glands (RMG) with a 2-year disease course. Digital rectal examination identified a semi-circumferential mass approximately 4 cm from the anal verge. Imaging studies revealed irregular thickening of the middle and lower rectal walls with multiple mildly enlarged surrounding lymph nodes. Colonoscopic biopsy excluded a diagnosis of rectal cancer. Upon further evaluation of the patient's history, it was determined that chronic inflammation caused by prolonged soapstick enema use led to ectopic glandular proliferation within the rectal wall. A 72-year-old female presented with a 2-year history of altered bowel habits and a 1-week history of anal fullness. Imaging studies, including computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography, suggested rectal cancer. However, colonoscopic biopsy pathology revealed extensive inflammatory exudates, necrotic tissue, focal granulation tissue formation, and severe compression artifact. Considering the patient's 20-year history of soapstick enema use, clinicians diagnosed the condition as RMG. The patient was advised to discontinue the use of soapstick enemas and was managed with regular follow-up and observation. Misdiagnosis of RMG as rectal cancer could lead to unnecessary radical surgical interventions. Raising awareness of this rare condition and accurately interpreting pathological findings are critical to improving patient outcomes. This case highlights the importance of considering rare conditions like RMG in the diagnosis of rectal masses. A detailed patient history, such as prolonged soapstick enema use, was crucial in identifying the cause. Imaging may suggest rectal cancer, but biopsy findings showing inflammation helped differentiate RMG.

Results of treatment of patients with tumor lesions of the lateral pelvic wall. Experience of 10 years

2025-06-19

A. N. Cheglakov , K. G. Shostka , N. V. Mankevich +1 more | Surgery and Oncology

Introduction . Pelvic side wall could be involved by tumor or desmoplastic reaction in patients with gynaecological pelvic malignancies and rectal cancer. Up until recently surgery was considered to have … Introduction . Pelvic side wall could be involved by tumor or desmoplastic reaction in patients with gynaecological pelvic malignancies and rectal cancer. Up until recently surgery was considered to have no prospects due to high frequency of palliative procedures and low survival rate. Aim . To conduct a retrospective analysis of short- and long-term results in patients after laterally extended endopelvic resection. Materials and methods . This study included consecutive patients between 2013 and 2023, who undergone laterally extended endopelvic resection at the Leningrad Regional Oncology Center named by L.D. Roman. Principal data were collected and classified. G. Vizzielli and R. Naik classification formed the grounds for surgery type selection. Procedure was considered to be radical with no signs of macro- and microscopic tumor presence in surgical margins. Results . Over the 2013 to 2023 period 54 laterally extended endopelvic resections were performed. Of these, 50 (92.6 %) were woman and 4 (7.4 %) men. An R0 resection was performed in 44 (81 %) of 54 cases, postoperative morbidity was 67 % with 5,6 % mortality, and 5-year overall survival of 23 %. 5-year overall survival was reached only in patients with colorectal cancer (44 %) and uterus tumors (40 %). In case of palliative procedures (R1/R2 resection) overall survival was less than 3 years. Conclusion . Clear resection margin was considered to be the crucial prognostic factor. An improvement of surgical techniques, an exploration of pelvic side wall structures, and sensible patient selection could improve short- and long-term outcomes in this complex group of patients.

External beam radiation therapy for cell carcinoma of the anal canal: preparation, planning, details of treatment

2025-06-19

М. В. Черных , V. A. Uymanov , D. V. Kurenkov +6 more | Surgery and Oncology

In the absence of a unified approach in numerous recommendations and consensuses for chemoradiotherapy of patients with squamous cell non-metastatic anal canal cancer, medical practitioners need a practical consolidating “tool” … In the absence of a unified approach in numerous recommendations and consensuses for chemoradiotherapy of patients with squamous cell non-metastatic anal canal cancer, medical practitioners need a practical consolidating “tool” combining all information sources, which is the purpose of this article. Based on international recommendations and consensuses on radiation therapy, the expert group analyzed the data and compiled the most optimal approaches to target volume delineation. This was done based on a balanced analysis of the advantages and disadvantages of the fractionation modes used and the criteria for dose distribution in irradiated apparatus proposed by both other authors and the team of the radiotherapy department of the N. N. Blokhin National Medical Research Center of Oncology. Examples of delineating anatomical structures and target volumes are provided.

Long-term survival for locally advanced adenosquamous ASC colon cancer in ulcerative colitis: Case report

2025-06-18

Abdulrahman Alotaibi | Case Reports in Oncology

Adenosquamous carcinoma (ASC) of the colon is an exceedingly rare and aggressive subtype, with limited data available on long-term survival, particularly among patients with ulcerative colitis (UC). We present the … Adenosquamous carcinoma (ASC) of the colon is an exceedingly rare and aggressive subtype, with limited data available on long-term survival, particularly among patients with ulcerative colitis (UC). We present the case of a 39-year-old male with a nine-year history of UC who experienced severe anemia and hematochezia. Imaging and histopathological analysis confirmed a diagnosis of stage IIIB ASC of the right colon. The patient underwent total colectomy followed by adjuvant chemotherapy (XELOX), ileoanal pouch reconstruction, and stoma closure. After 56 months of follow-up, he remains disease-free with good pouch function. This case underscores the need for further research into UC-associated carcinogenesis and the development of ASC-specific treatment strategies

Expert Commentary on Tumor Deposits in Colon Cancer

2025-06-18

Sandy H. Fang | Diseases of the Colon & Rectum

Anal Dysplasia: A Review of Pathology with Focus on Current Terminology, Pathologic Diagnosis, and Diagnostic Challenges

2025-06-17

Buket Bagci , Huina Zhang , Dan Lu +1 more | Clinics in Colon and Rectal Surgery

Abstract Anal cancer, although rare, has been increasing in incidence, particularly among high-risk groups such as individuals with human immunodeficiency virus (HIV) and men who have sex with men. The … Abstract Anal cancer, although rare, has been increasing in incidence, particularly among high-risk groups such as individuals with human immunodeficiency virus (HIV) and men who have sex with men. The majority of anal cancers are squamous cell carcinomas, most of which are associated with high-risk human papillomavirus (HPV), particularly HPV16. The diagnosis of anal dysplasia requires a multifaceted approach involving clinical evaluation, cytology, high-resolution anoscopy, and histopathologic examination. This review highlights the current understanding of the pathogenesis, diagnostic challenges, and management of HPV-related anal dysplasia and cancer. The evolution of diagnostic terminology, notably the adoption of the two-tiered classification system for HPV-related anal squamous lesions, has improved the consistency of diagnosis. Early detection of anal dysplasia is crucial for effective treatment, particularly in high-risk populations. While anal cytology is a key screening tool, its low specificity necessitates confirmatory diagnosis through anal biopsy with the aid of ancillary tests, including p16 and Ki-67 staining, and HPV DNA/RNA testing. However, challenges still remain, such as interobserver variability and the potential for false positives or false negatives, highlighting the need for standardized reporting and multidisciplinary collaboration.

Dosimetric Advantage of Scanning Beam Proton Therapy in Gynecologic Patients Receiving Adjuvant Radiotherapy

2025-06-17

Rachel Ger , Jarrod M. Lentz , Joshua S. Niedzielski +7 more | Cancers

Background/Objectives: Adjuvant radiation for gynecologic malignancies often exposes organs at risk (OARs), such as the bone marrow, bowel, rectum, and bladder, to radiation, leading to toxicities that impact treatment tolerance … Background/Objectives: Adjuvant radiation for gynecologic malignancies often exposes organs at risk (OARs), such as the bone marrow, bowel, rectum, and bladder, to radiation, leading to toxicities that impact treatment tolerance and patient quality of life. Scanning proton beam therapy, particularly with Individual Field Simultaneous Optimization (IFSO), may offer dosimetric and biological advantages over volumetric modulated arc therapy (VMAT). This study evaluates the clinical impact of IFSO-based proton planning in post-operative gynecologic cancer patients. Materials and Methods: Fourteen patients receiving adjuvant proton therapy to 45 Gy in 25 fractions were retrospectively analyzed. Comparison VMAT plans were generated on the same datasets. Dose-volume metrics for key OARs and normal tissue complication probabilities (NTCPs) were compared using paired statistical tests. Robustness evaluations accounted for setup and range uncertainties. Results: Proton plans significantly reduced dose to bone marrow (V10Gy: 58% vs. 86%, p < 0.00001; V20Gy: 47% vs. 58%, p < 0.00001), small bowel (V20Gy: 21% vs. 56%, p < 0.00001), and femoral heads (left femoral head mean: 11Gy vs. 13Gy, p = 0.032; right femoral head mean: 11Gy vs. 13Gy, p = 0.022). NTCP modeling predicted significantly lower rates of bowel urgency (9.4% vs. 3.3%, p < 0.001) and hematologic toxicity (10.2% vs. 4.9%, p < 0.001) with proton therapy. Plans remained robust across uncertainty scenarios. Conclusions: IFSO-based scanning proton therapy provides clinically meaningful sparing of bone marrow and bowel, with the potential to reduce hematologic and gastrointestinal toxicities. These findings support its use in patients receiving adjuvant pelvic radiotherapy, particularly those undergoing extended field treatment or chemotherapy.

Screening for Anal Cancer Among Men Who Have Sex With Men With HIV: Benefits, Harms, and Cost-Effectiveness Analyses

2025-06-16

Ashish A. Deshmukh , Haluk Damgacioglu , Keith Sigel +7 more | Annals of Internal Medicine

Following the success of the ANCHOR (Anal Cancer-HSIL Outcomes Research) trial, the U.S. Department of Health and Human Services recommends anal cancer screening for high-risk persons, particularly men who have … Following the success of the ANCHOR (Anal Cancer-HSIL Outcomes Research) trial, the U.S. Department of Health and Human Services recommends anal cancer screening for high-risk persons, particularly men who have sex with men (MSM) with HIV. To quantify the cost-effectiveness and benefits versus harms of different anal cancer screening strategies. Microsimulation model. The ANCHOR trial and published literature. MSM with HIV. Lifetime. Health care sector. Cytology alone and human papillomavirus (HPV) testing (high-risk HPV [hrHPV], HPV16/18, and HPV16), co-testing, and triage options; ages at which to begin screening (≥35, ≥40, or ≥45 years); screening interval (annual, biennial, triennial, or quadrennial). Incremental cost-effectiveness ratios (ICERs) of dollars per quality-adjusted life-year (QALY) and the tradeoff of harms (high-resolution anoscopies [HRAs]) versus benefits (cancer cases averted and life-years gained). Screening initiation at age 35 years or older using cytology dominated initiation at ages 40 and 45 years or older, with ICERs ranging from $87 731 for a quadrennial interval to $350 100 for an annual interval. In the comparative analysis, the following unique strategies were on the cost-effectiveness frontier: quadrennial HPV16, quadrennial HPV16/18, triennial HPV16/18, triennial hrHPV, biennial HPV16/18, biennial hrHPV, annual cytology with hrHPV triage, and annual hrHPV; ICERs ranged from $81 341 to $2 510 847. In the harm-to-benefit analysis, triage options offered the most efficient HRA use. ICERs decreased for newly eligible persons. For 35-year-old newly eligible MSM with HIV, ICERs for cytology ranged from $70 750 (quadrennial) to $223 895 (annual). Findings are not generalizable to other high-risk populations. Anal cancer screening among MSM with HIV aged 35 years or older is cost-effective, but value-based prioritization of strategies is needed to optimize screening use. National Cancer Institute.

Improving diagnosis and treatment for patients with rectal cancer

2025-06-16

Caroline Martin , Gina Brown | http://isrctn.com/

Colorectal and Anal Malignancies in Makurdi, North Centra Nigeria: Insights from a 10-Year Registry Analysis

2025-06-16

Gbaa LZ , Ojo BA , E. Ba +7 more | Asian Journal of Medicine and Health

Colorectal and anal cancers (CRACs) are increasingly reported in sub-Saharan Africa due to rising life expectancy, dietary shifts, and improved diagnostics. This study presents a 10-year review of CRACs in … Colorectal and anal cancers (CRACs) are increasingly reported in sub-Saharan Africa due to rising life expectancy, dietary shifts, and improved diagnostics. This study presents a 10-year review of CRACs in Makurdi, North Central Nigeria, analysing demographic, anatomical, and histological patterns. A retrospective review was conducted of histologically confirmed CRAC cases from January 1, 2016, to December 31, 2024. Data on age, sex, anatomical site, and histological subtype were analysed using descriptive statistics. We had a total of 2341 cancers, 129 (5.5%) of which were CRACs. Males constituted 56.6% (M: F ratio 1.3:1), with a peak age incidence between 51–60 years (27%). Rectum (27%) and anus (17%) were the most common sites. Adenocarcinoma (64%) was the most prevalent histological type, followed by mucinous adenocarcinoma (16%). Notably, 19.4% of cases were recorded in patients under the age of 40. CRACs represent a burgeoning oncological issue in Makurdi, characterised by a rising incidence among younger patients and a prevalence of aggressive histological variants. Enhancing diagnostic infrastructure and implementing population-based screening programs are crucial to mitigate the increasing burden in Nigeria and sub-Saharan Africa.

An Alteration to Standardized Treatments: Defunctioning Colostomy in Ultra-Low Stage IIIC Rectal Adenocarcinoma

2025-06-16

Veronica J Ramage , Christopher Rupe | Kansas Journal of Medicine

Exploring the Clinical Characteristics and Survival Outcomes in Colorectal Cancer Patients in Hatyai Hospital: A Retrospective Cohort Study

2025-06-14

Makusee Masae , Ajira Nasawat , Natthawut Sangsakul +2 more | Journal of Current Science and Technology

Colorectal cancer (CRC) is considered a significant public health concern worldwide, with substantial morbidity and mortality rates. In Thailand, several campaigns have been implemented to address this issue, such as … Colorectal cancer (CRC) is considered a significant public health concern worldwide, with substantial morbidity and mortality rates. In Thailand, several campaigns have been implemented to address this issue, such as the establishment of local treatment centers. The Cancer Center of Hatyai Hospital (CCHH) is the latest cancer center affiliated with a tertiary public hospital in the southernmost part of Thailand. However, a systematic assessment of cancer treatment outcomes, including those for CRC patients, has yet to be conducted. Therefore, the current study utilized a retrospective analysis approach to elucidate the survival probability of CRC patients treated at CCHH. A secondary data analysis was conducted using electronic medical records (EMRs), and the selected data were validated and filtered by a certified oncologist and pharmacist. Time-to-event analysis was used to model survival probability across subgroups, and visualized using Kaplan-Meier (KM) plots. Additionally, restricted mean survival time (RMST) analysis was performed to estimate the 3-year survival time of this patient cohort, with an estimated survival time of 24.8 months. The univariate Cox proportional hazards (PH) model was used as an exploratory analysis to identify the influence of clinical variables on survival outcomes. Subsequently, a multivariable Cox PH model was constructed with a set of selected variables. T2 tumor status, the presence of distant metastasis, ECOG score of 4, and poorly differentiated tumor were identified as the strongest predictors of reduced survival among the included variables. As such, this study provides practical insights based on real-world data regarding cancer survivorship and the survival outcomes of CRC patients treated at a public hospital. Additionally, it offers a snapshot of the recent implementation of an early diagnosis campaign.

A rare case of synchronous anal metastasis from sigmoid adenocarcinoma: case report and literature review

2025-06-13

Souad Ghattas , Jad El Bitar , Hani Maalouf +3 more | International Journal of Surgery Case Reports

Anal metastasis from colorectal cancer is extremely rare, since most cases in the literature are associated with a history of anal disease, such as anal fistula, fissure, hemorrhoidectomy, and anastomotic … Anal metastasis from colorectal cancer is extremely rare, since most cases in the literature are associated with a history of anal disease, such as anal fistula, fissure, hemorrhoidectomy, and anastomotic injury. Herein, we report the case of a 63-year-old male patient, who presented with synchronous anal metastasis from a sigmoid cancer in the absence of epithelial damage treated with trimodality therapy that consisted of neoadjuvant chemoradiotherapy followed by abdominoperineal resection. True cutaneous metastases to the anal skin from colonic carcinomas are exceedingly uncommon and are likely underpinned by diverse mechanisms such as lymphatic dissemination, transperitoneal extension, direct extension, retrograde vascular dissemination, or systemic hematogenous spread. This pattern of metastasis is particularly observed in advanced tumor presentations. This report guides clinicians to think about this rare type of metastasis. However, more clinical data is necessary to establish treatment and postoperative management plan for anal metastasis derived from colorectal cancer.

Tumor-derived CXCL5 promotes 5-fluorouracil resistance in colorectal cancer cells via p21 downregulation

2025-06-13

Wanjun Xu , Jianjun Wang , Wencan Han +4 more | Medical Oncology

Textbook Outcomes of Minimally Invasive Total Mesorectal Excision: A Composite Tool to Assess and Compare Outcomes or Benchmarking

2025-06-13

Vipul Gupta , Akash Mor , Rohit Mundhada +5 more | Diseases of the Colon & Rectum

BACKGROUND: Textbook outcome is an integrated measure including both clinical as well as oncological outcomes. Within minimally invasive rectal cancer surgery, if achievement of textbook outcome translates into improved oncological … BACKGROUND: Textbook outcome is an integrated measure including both clinical as well as oncological outcomes. Within minimally invasive rectal cancer surgery, if achievement of textbook outcome translates into improved oncological outcomes is not studied. OBJECTIVE: To evaluate textbook outcome and its associated factors for patients undergoing minimally invasive total mesorectal excision. DESIGN: Single center retrospective study. SETTINGS: The study was conducted at a high-volume tertiary referral cancer center in India. PATIENTS: All patients receiving elective laparoscopic or robotic total mesorectal excision from 2013- 2023 were included. MAIN OUTCOME MEASURES: The number of patients achieving textbook outcome, institute’s time trend, factors affecting textbook outcome and intermediate oncological outcomes were evaluated. RESULTS: Of the 1394 patients who underwent minimally invasive total mesorectal excision, 831 patients (60%) achieved textbook outcome. The conversion rate to open surgery is 0.2% with complications ≥ Clavien-Dindo 3 in 1.6% of patients. Twenty-seven percent patients had prolonged hospital stay with 30-day readmission rate being 3%. Four percent patients had a poor lymph node yield, R0 resection rate is 98% and adjuvant therapy delay is observed in 6% patients. The achievement of textbook outcome resulted in improved 3- year overall survival (92.1% vs 83.7%, p <0.001) and disease-free survival (81.5% vs 75.7%, p = 0.007). LIMITATION: The results of our study cannot be generalized to open total mesorectal excision, beyond total mesorectal excision and extended total mesorectal excision, where benchmark criteria definitions vary. CONCLUSION: Textbook outcomes for minimally invasive total mesorectal excision was achieved in 60% rectal cancer patients at a high-volume tertiary cancer institute. It could be used for benchmarking, thus improving results of minimally invasive total mesorectal excision and also as a quality indicator in nationwide surgical audits. See Video Abstract .

Primary squamous cell carcinoma of the descending colon with pancreatic metastasis: A case report

2025-06-13

Hu Ruirui , Mei Liu , Hongyun Li | World Journal of Gastrointestinal Oncology

BACKGROUND Squamous cell carcinoma (SCC) of the colon is a rare malignant tumor with an unclear pathogenesis. Its clinical presentation is similar to that of adenocarcinoma, and there are no … BACKGROUND Squamous cell carcinoma (SCC) of the colon is a rare malignant tumor with an unclear pathogenesis. Its clinical presentation is similar to that of adenocarcinoma, and there are no standard treatment guidelines. Treatment for SCC of the colon is mainly based on the protocols for colon adenocarcinoma. In advanced stages, colon SCC is highly invasive, prone to distant metastasis, and has a worse prognosis than adenocarcinoma. Furthermore, pancreatic metastasis from colon SCC is even rarer. CASE SUMMARY The patient presented with abdominal pain and was diagnosed with SCC of the descending colon following colonoscopy. Preoperative examinations did not reveal any obvious metastasis to other organs, and the patient underwent laparoscopic radical resection of the descending colon cancer. During surgery, suspicious metastases to the pancreatic body and tail, splenic vessels, and splenic hilum were found, leading to combined resection of the pancreatic body and tail along with the spleen. Postoperative pathology confirmed moderately to poorly differentiated SCC with nerve invasion. The patient developed postoperative complications, including abdominal cavity infection, acute myocardial infarction, and deep vein thrombosis in the lower limbs. Despite active symptomatic treatment and stabilization of the patient’s vital signs, the patient did not undergo adjuvant chemotherapy due to an Eastern Cooperative Oncology Group score of 3. The patient passed away 3 months postoperatively due to multiple organ failure. CONCLUSION This case highlights the aggressive nature of colorectal SCC with atypical metastasis and underscores the necessity for multidisciplinary perioperative management.

Definitive intensity-modulated radiotherapy for organ preservation in vulvar cancer: A multicenter study

2025-06-12

Anupam Rishi , Kevin Albuquerque , Anuja Jhingran +7 more | Gynecologic Oncology

Neoplasia Limfoid yang Menyerupai Mesotelioma

2025-06-10

Irianto , Made Widya Wirayanti Puteri , I Wayan Sunaka +1 more | Cermin Dunia Kedokteran

Pendahuluan : Neoplasma limfoid merupakan kelainan proses hematopoiesis lini limfoid, yang bisa mengarah ke limfoma ataupun leukemia. Mesotelioma merupakan pertumbuhan sel mesotel abnormal yang terkait kuat dengan paparan asbes. Pada … Pendahuluan : Neoplasma limfoid merupakan kelainan proses hematopoiesis lini limfoid, yang bisa mengarah ke limfoma ataupun leukemia. Mesotelioma merupakan pertumbuhan sel mesotel abnormal yang terkait kuat dengan paparan asbes. Pada gambaran radiologi, biasanya mesotelioma dideskripsikan sebagai lesi dengan densitas jaringan dengan batas yang tegas, spiculated yang menempel pada dinding toraks. Gambaran tersebut sebenarnya hanya menggambarkan suatu jaringan yang menempel pada toraks, dapat dicurigai mesotelioma, namun dapat juga akibat proses penyakit yang lain, seperti leukemia, limfoma, dan tuberkulosis. Kasus: Pria berusia 58 tahun datang ke IGD dengan keluhan sesak napas. Pasien awalnya dicurigai mesotelioma disertai kecurigaan keganasan darah, namun ternyata hasil biopsi lebih mengarah pada infiltrasi neoplasma limfoid. Simpulan: Pada pasien ini, neoplasma limfotik menginfiltrasi jaringan mesotel dan menghasilkan gambaran jaringan berbatas tegas dan spiculated yang menyerupai mesotelioma. Pemeriksaan biopsi sebagai baku emas belum dapat digantikan oleh pencitraan radiologi untuk saat ini, karena banyak proses penyakit lain yang dapat menyerupai suatu gambaran keganasan.

The immunosurveillance signature predicts the prognosis and immunotherapy sensitivity for colon adenocarcinoma

2025-06-06

Yan Xiong , Weiqiang Xiong , Yanhua Wang +5 more | Scientific Reports

Colon adenocarcinoma (COAD) is a leading cause of cancer-related mortality worldwide, with immune escape being a significant factor in the failure of immunotherapy. This study investigates the correlation between Immunosurveillance-related … Colon adenocarcinoma (COAD) is a leading cause of cancer-related mortality worldwide, with immune escape being a significant factor in the failure of immunotherapy. This study investigates the correlation between Immunosurveillance-related genes and the prognosis of COAD patients, utilizing data from 1140 patients across four public databases: The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), Array-express, and Gene Expression Omnibus (GEO). Employing Cox regression analysis, we identified 182 immune genes significantly linked to overall survival (OS) and established an Immunosurveillance score (ISs) based on 16 of these genes. The ISs score was validated using independent datasets, revealing that patients in the high-ISs group exhibited significantly poorer OS compared to those in the low-ISs group, as demonstrated by Kaplan-Meier curves and Cox regression analyses. Moreover, the ISs score showed a negative correlation with immune scores across multiple datasets. Notably, a higher ISs score was associated with improved recurrence-free survival (RFS) and OS in patients treated with PD-1 and CTLA4 inhibitors. Our findings suggest that the ISs score, derived from Immunosurveillance-related genes, has the potential to serve as a valuable prognostic marker and a tool for identifying COAD patients who may benefit from immunotherapy in clinical settings.

Successful Use of Combination 5% Fluorouracil and 0.005% Calcipotriene Cream for Peri-Anal HSIL and SCCIS in an HIV-Positive Patient

2025-06-05

S Michael Crawford , Emily S. Ruiz , Catherine Pisano | Journal of Dermatology and Skin Science

Purpose: The management of multifocal perianal high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma in situ (SCCIS) remains challenging, especially in immunosuppressed populations such as individuals with HIV. Current … Purpose: The management of multifocal perianal high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma in situ (SCCIS) remains challenging, especially in immunosuppressed populations such as individuals with HIV. Current treatments are often invasive and associated with high recurrence rates. This case report explores the use of combination 5% fluorouracil and 0.005% calcipotriene cream (5FU/C) as a non-invasive therapeutic alternative for recurrent perianal HSIL and SCCIS. Methods: We present a case of a 57-year-old HIV-positive male on antiretroviral therapy with recurrent HSIL and SCCIS involving the perianal, gluteal, perineal, and inguinal regions. After failing multiple surgical excisions, the patient was treated with 5FU/C cream applied topically twice daily for 8 days. Results: The patient experienced a strong inflammatory response and discontinued therapy prior to the recommended 10-day course. However, at 1-month follow-up, there was complete clinical resolution of external lesions. Four months later, internal recurrence was detected via digital rectal exam and high-resolution anoscopy, but external lesions remained clear. Biopsies confirmed HSIL without invasive disease. Conclusion: This case illustrates the potential of 5FU/C as a non-invasive treatment option for extensive external HSIL and SCCIS in immunocompromised patients. While external lesion resolution was achieved, internal disease recurrence at 4 months after 5-FU/C treatment emphasizes the importance of comprehensive internal evaluation. These findings support further investigation of 5FU/C as an adjunct or alternative to surgical treatment in the multidisciplinary management of anal neoplasia.

Utilidad de la PET/TC-FDG en el diagnóstico y seguimiento del adenocarcinoma mucinoso de colon

2025-06-02

Camila Rodriguez , Federico Carballo , P Farina | Revista Argentina de Coloproctología

Among the various histological subtypes of colorectal cancer, approximately 5% to 20% correspond to mucinous adenocarcinoma (MAC), a malignant variant with poor clinical prognosis, associated with higher metastasis rates, and … Among the various histological subtypes of colorectal cancer, approximately 5% to 20% correspond to mucinous adenocarcinoma (MAC), a malignant variant with poor clinical prognosis, associated with higher metastasis rates, and is often presenting at an advanced stage with multifocal metastatic involvement, in contrast to conventional colorectal adenocarcinoma. Multiple studies suggest that positron emission tomography with fluorodeoxyglucose (FDG-PET) has higher accuracy in staging metastatic or recurrent colorectal adenocarcinoma compared to computed tomography scans (TC). However, the routine application of FDG-PET in clinical practice remains controversial. We report two cases of recurrent or persistent macroscopic tumor with false-negative findings on this complementary imaging study used for follow-up in patients with colon mucinous adenocarcinoma. Despite studies showing FDG-PET to be more sensitive than CT for detecting metastatic or recurrent colorectal cancer, this imaging modality may not be equally effective for detecting metastases and recurrences of mucinous adenocarcinoma due to the hypocellularity of these tumors, resulting in decreased FDG accumulation. As a result, FDG-PET is not considered an effective imaging modality for surveillance in patients with mucinous adenocarcinoma.

Surgical Outcomes with Neoadjuvant Durvalumab Plus Chemotherapy Followed by Adjuvant Durvalumab in Resectable NSCLC

2025-06-01

Tetsuya Mitsudomi , John V. Heymach , Martin Reck +7 more | Journal of Thoracic Oncology

Transition from pulsed dose rate to high dose rate brachytherapy: Experience of a single centre

2025-06-01

S. Renard , Émilie Meknaci , C. Cuisinier +7 more | Brachytherapy

In February 2021, the Brachytherapy department of the Lorraine Cancer Institute began a transition away from pulsed dose rate (PDR) towards high dose rate (HDR) brachytherapy, for gynaecological cancer, cancers … In February 2021, the Brachytherapy department of the Lorraine Cancer Institute began a transition away from pulsed dose rate (PDR) towards high dose rate (HDR) brachytherapy, for gynaecological cancer, cancers of the oral cavity, oropharynx and anal canal, penile cancer and sarcoma. We describe our experience here; for the benefit of other brachytherapy departments that may be envisaging a similar transition in care. Fractionation. The 7 brachytherapists of our unit performed a literature search then validated, in a group meeting, the different fractionation regimens. The aim was to select HDR fractionation regimens that would produce comparable results to PDR in terms of tumor control and toxicity, following the recommendations of the GEC-ESTRO, when such guidelines exist. We also chose fractionation regimens that would avoid patients having the brachytherapy device in place over the weekend. The most difficult decisions related to rare indications where only very small series exist. Cohorts of patients treated with HDR will be followed up closely over time. To date, no unexpected toxicity has been observed. It is no longer necessary to have a physician on call at night. The discontinuation of PDR has made it possible to reduce the number of radiation sources present in the department, with a reduction of the working time needed for changing out radiation sources and for quality control. There are no longer any difficulties with night duties since all treatment is now performed during the day, in the presence of a physician during normal workday hours. Changes to the treatment planning schedules have been integrated, notably the calculation of biological equivalents for the most complex gynecological dosimetries. The work organization changed markedly, requiring the presence of at least 2 radiation therapists on treatment days, whereas previously, radiation therapists were mainly present on the days of insertion and removal of the brachytherapy source applicators. The schedule for the HDR delivery platform is similar to that of the radiotherapy accelerator. The radiation therapist team has observed benefits in terms of treatment safety, with visual control of the positioning of the equipment before each session, but also in terms of relations with the patient, with more regular interactions with patients. This creates a better atmosphere of trust for implant removal. With meticulous preparation and close collaboration between the different professions involved in brachytherapy delivery, the transition from PDR to HDR led to significant organizational changes in terms of treatment planning for different cancer sites. Nevertheless, overall, the whole team is satisfied with the new work model. The involvement of all the team members made it possible to anticipate and prepare, enabling a seamless and serene transition towards the scheduled termination of PDR.

Anal Canal Squamous Cell Carcinoma Metastasizing to the Thigh – A “Carcinoma en Cuirasse”-Like Rare Presentation

2025-06-01

S. M. Karandikar , Himanshi Joon , Shailesh Puntambekar | Medical Reports