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Colorectal cancer (CRC) is one of the recurring and lethal gastrointestinal tract disease rankings as the primary cause of worldwide morbidity and mortality. In general, the tumour node metastasis (TNM) and Dukes classification assist in diagnosis, prognosis and treatments of CRC along with haematological examinations and tumour demographic characterisations in patients. The present investigation is carried out on clinically acknowledged sixty-five CRC patients based on haematological findings and are sorted into stages using TNM and Dukes. The present study is to find the association between haematological findings, demographic characters, differentiation position, lymph node invasion and tumour node metastasis in CRC patients in accordance with their age. We observed significant (p < 0.05) nexus between lymph node metastasis and tumour node metastasis on the basis of tumour’s differentiation demographic positioning and age of the individuals. Earlier location tracing and medicinal treatment or surgery lessen the chance of CRC morbidity and mortality along with prolonging survival rate via prognostic factors and disease position determination.

Introduction: Colorectal carcinomas are global oncologic problem faced by medical fraternity as it is the third most common carcinoma in men after lung and prostate carcinomas also second in women after breast carcinoma worldwide. 1998 to 2003, and the death rate decreased from 2.8% annually over the period 2001 to 2003. A great majority (98%) of all carcinomas in the colorectum are adenocarcinomas. The cause and pathogenesis of colorectal carcinomas are related to both environmental and genetic factors. Both gross as well as histopathological typing helps in definitive diagnosis and further management of the patient. Materials and Methods: This one year retrospective study included forty-three (43) cases of colorectal carcinomas. All the resected specimens received in the laboratory were immediately fixed in 10% formalin for at least 24 hours. Gross features of specimen were noted and multiple representative sections were taken for routine processing. After detailed study of sections under the light microscope the final diagnosis was given along with disease stage (Dukes classification). The patient details like age, sex, clinical diagnosis were obtained from the requisition forms that were sent along with the specimen. Results: There were total of forty-three (43) patients of colorectal carcinomas during the study one year. Male to female ratio was 1.15:1. Majority of the patients belonged to the age group of 58-67 years. The most common malignancy was adenocarcinoma followed by mucinous carcinoma and neuroendocrine carcinoma. The most common anatomical site involved was rectum. Conclusion: This study concludes that colorectal carcinomas are more common in 5th and 6th decade of life with slight male preponderance. The most common malignant lesion being moderately differentiated adenocarcinomas. The most common location being rectum with highest incidence of Dukes stage B. The histopathological examination remains the gold standard for the diagnosis and further man

Background: The alteration of bowel habits, bleeding per-rectum and anemia were common features in both groups in this study, but in young patients there was a delay of 6 months between the presenting symptoms and the definitive diagnosis because the disease was not suspected and investigated in them. The most common site for the tumors in young patients was the rectum and in patients above the age of 40 years was the Sigmoid. The pathological finding showed that classification of the colorectal tumors in young patients appear moderately to poorly differentiated adenocarcinoma , this indicate a more malignant course of the disease in young patients. This study send a message to all clinicians that the incidence of colorectal cancer is increasing in young patients and therefore we should be alert when dealing with young patients presenting with abdominal pain, bleeding per-rectum and alteration of bowel habit to diagnose the disease at an early stage to undertake curative surgery . Aim of the study: To study the clinical coarse of colorectal cancer in age between (less than 40 to above 40), and the most frequent site and distribution, and the types of surgical intervention. Patients and methods: In the period between January 2012 to March 2013, 35 patients with colorectal cancer were treated at Al-Yarmouk Hospital,10 patients were below the age of 40 years ,( 5 Males and 5 Females ) with age ranging from 22-40 years , 25 patients were above the age of 40 years (12 males and13 females). Results:100% of patients less than 40 years presenting as anemia and 50% bleeding per rectum, while 88% of patients above 40 years with weakness and lethargy.30% of patients less 40years age, and 36% of patients above 40 years consider as an emergency cases, and others as elective cases. Surgical treatment involving 50% of patients less than 40 are right, left hemicolectomy and anterior resection, and in age of above 40 56% by left hemicolectomy. More common stages in young patents are C and B but in old A ,B , C. Recommendations: Researchers recommend periodic screening by a doctor to diagnose the tumor early with the need to develop educational programs on early signs of colorectal cancer.

Colorectal cancer is the third most common and second most lethal tumor globally, causing 900,000 deaths annually. In this research, a computer aided diagnosis system was designed that detects colorectal cancer, using an innovative dataset composing of both numeric (blood and urine analysis) and qualitative data (living environment of the patient, tumor position, T, N, M, Dukes classification, associated pathology, technical approach, complications, incidents, ultrasonography-dimensions as well as localization). The intelligent computer aided colorectal cancer diagnosis system was designed using different machine learning techniques, such as classification and shallow and deep neural networks. The maximum accuracy obtained from solving the binary classification problem with traditional machine learning algorithms was 77.8%. However, the regression problem solved with deep neural networks yielded with significantly better performance in terms of mean squared error minimization, reaching the value of 0.0000529.

Introduction Colorectal cancer is a major cause of illness, disability and death in the United Kingdom. The stage of disease at diagnosis has a major impact on survival rates. The aim of this study is to assess whether the survival rates of patients receiving curative treatment in our centre are comparable with national results published by Cancer Research UK, National Bowel Cancer Audit Annual Report 2016, and NCIN Colorectal Cancer Survival by Stage Data Briefing. Methods The study involved a retrospective survival analysis of consecutive patients who underwent colorectal cancer resections with curative intent performed by two surgeons between January 2009 and March 2012. Patients were identified from a prospectively collected database. Data was collected via hospital computer systems including patient notes, laboratory, pathology, and radiology systems. Exclusion criteria included all patients with advanced disease who underwent surgery with palliative intent. Results A total of 281 patients were included. The median age at operation was 71. Overall 2-year survival was 82.6% and overall 5-year survival was 69%. 2-year and 5-year survival, respectively, for Dukes A was 93.7% and 92%, Dukes B was 85.6% and 76.7%, Dukes C1 was 81.1% and 57.8%, Dukes C2 was 56.3% and 25%, and Dukes D was 61.9% and 47.6%. Conclusion Our data demonstrates that our survival rates compare favourably with current published national survival rates. Dukes C2 patients had the poorest five year survival, highlighting the significance of a positive apical node. Dukes D patients had a particularly good outcome which indicates good patient selection by the multi-disciplinary meeting (MDT) and high quality oncology and tertiary surgical support.

Aim. To study the expression of angiodrastic chemokines in colorectal tumors and correlate findings with clinicopathological parameters and survival.Methods. The proangiogenic factor VEGF, the angiogenic chemokines CXCL8 and CXCL6, and the angiostatic chemokine CXCL4 were measured by ELISA in tumor and normal tissue of 35 stage II and III patients and correlated with the histopathology markers Ki67, p53, p21, bcl2, EGFR, and MLH1 and 5-year survival. The Wilcoxon and chi-square tests were used for statistical comparisons.Results. There was a significant increase of CXCL6 (p=0.005) and VEGF (p=0.003) in cancerous tissue compared to normal. Patients with lower levels of CXCL8 and CXCL4 lived significantly longer. Patients with loss of EGFR expression had higher levels of CXCL8 while p21 loss was associated with higher levels of CXCL6. Chemokine levels were not correlated with TNM or Dukes classification. Strong expression of p53 was accompanied by decreased survival.Conclusions. (1) The angiogenic factors CXCL6 and VEGF are increased in colorectal cancer tissue with no association with the clinical stage of the disease or survival. (2) However, increased levels of tissue CXCL8 and CXCL4 are associated with poor survival. (3) Strong expression of p53 is found in patients with poor survival.

The aim of this study is to better understand the main aspects related to colorectal carcinoma diagnosed in the first 10 years of life, through a systematic review. We carried out a bibliographic search in PubMed and LILACS, focusing on identifying publications or case reports about colorectal carcinoma in the first 10 years of life. The bibliographical analysis was made in two steps. During the first phase, we excluded those articles whose titles or abstracts did not correspond with the objective settled. Publications without abstract were also included in this phase. During the second phase, we look at the articles and evaluated their content, selecting the cases with colorectal cancer under 10 years old. From 3880 publications, 132 were selected in the first phase and 84 were evaluated in the second phase. Based on these conditions, 33 articles have cases presented which 4 articles were case reviews and 29 were case reports. Duplicated cases were excluded from the analysis. Fifty-nine cases were described in English and Latin literature. There is an apparent similar proportion between the sexes, and the mean age was 8.6 years old. The main localization was the rectum and sigmoid (45.8 %). Pathologic findings showed that 86.4 % were adenocarcinoma. These tumors are frequently advanced at diagnosis. The Kaplan-Meier 60-month overall survival was 15.3 %. Dukes classification represents a factor related to survival (p = 0.03). In children, colorectal carcinoma presents distinctive characteristics, which determines poor survival.

Colorectal cancer (CRC) is a major cause of death in the western world and a leading cause of cancer-related death. It is one of the most common human malignancies with >300,000 cases both in the United States and in the European Union each year. The present study was conducted to assess differences in various variables of CRC, such as location of the tumor, differentiation, Dukes classification, 5-year survival and possible changes in these patterns during the examined period. We collected data on 2000 patients with colorectal cancer, diagnosed and treated from 1960 to 2008 in 1st Propedeutic Surgical Clinic of Aristotle’s University, Thessaloniki. Of 2000 cases reviewed, cancer was almost equal presented to both sexes, for all groups. Rectum was the most common tumor location in all analyzed groups (40.1%). The most common tumor differentiation was the moderate one (68.5%). Concerning tumor staging, Dukes’ B tumors were most common (42.5%), and the cancer-related 5-year survival was increased by the time from 42 to 71%. In the past 20 years, considerable improvements have been made in colorectal cancer therapy, and patients had received more sophisticated and multidisciplinary treatments, resulting in a better 5-year survival rate.

The aim of this study is to evaluate influence of allogeneic blood transfusion on prognosis in patients in Dukes B stage of colorectal cancer. All patients with colorectal cancer who were admitted at our Department of Surgery between January 2000 and December 2004 were analyzed. One hundred fifty-one patients who fulfilled inclusion criteria were enrolled in further evaluation. B stage according to Dukes classification and curative resection were inclusion criteria. Exclusion criteria were polyposis syndromes, nonpolyposis syndromes, inflammatory bowel disease, autoimmune disease and previous blood transfusion. Patients were divided into two groups: Group 1 received ≤3 units of allogeneic blood transfusion and group 2 received >3 units of allogeneic blood transfusion. “Cutoff” value of 3 units of blood was defined according to our results and literature data. Follow-up was 5 year. There was no statistical difference between these groups in local recurrence (χ2 = 0.009, P > 0.05) and distant metastasis (χ2 = 0.44, P > 0.05). Also, the Kaplan–Meier survival curves were calculated, and long-rank test did not show a survival difference between these two groups (log rank = 0.075, P > 0.05). Postoperative complications are significantly more frequent in Group 2 (χ2 = 4.67, P

The cellular DNA pattern in 66 colo-rectal adenocarcinomas was studied by means of flow-cytometric DNA analysis. The degree of ploidy and the proportion of cells in S-phase were related to the clinical stage according to Dukes' classification and to the histological differentiation. Multiple cell populations were found in about 60 per cent of the tumours but more frequently in advanced clinical stages. According to the DNA index the cell populations were bimodally distributed with one peak in the diploid-peridiploid region and one peak in the tri- to tetraploid region. In the second group there was a higher frequency of more advanced tumours as compared to the first. The proportion of cells in S-phase was higher in pure diploid tumour cell populations of all clinical stages as compared to normal mucosa but lower as compared to peridiploid and aneuploid cell populations with high DNA index. High as well as low S-phase values may occur in all clinical stages, but a significant higher mean value was found for Dukes' C compared to Dukes' B tumours. Distant metastases occur at all DNA indices and with various S-phase values. In conclusion, tumours of different clinical stages and histological differentiation may be subdivided according to DNA index, to the existence of single or multiple cell populations and to the proportion of cells in S-phase. The biological significance of this subdivision can only be evaluated by means of clinical follow-up.

BACKGROUND: Knowledge of the expression of the galectins in human colon carcinomas is mainly restricted to galectin-3 and, to a lesser extent, galectin-1. The current study analyzed the prognostic values contributed by galectin-1, galectin-3, galectin-4, and galectin-8 in cases of colon carcinoma. METHODS: The authors selected 55 colon carcinomas (including 10 Dukes A, 16 Dukes B, 15 Dukes C, and 14 metastatic tumors that the authors labeled "Stage D"). The immunohistochemical levels of expression of the four galectins were determined quantitatively by means of computer-assisted microscopy. RESULTS: The data from the current study indicate that the four galectins under study are associated with significant and separate prognostic values that depend on the Dukes stage of the colon tumor. In particular, the authors observed a significant prognostic value associated with galectins-1, -3, and -4 in Dukes A and B colon tumors. In addition, significant prognostic value also was associated with galectin-8 in Dukes C and D colon tumors. The prognostic values associated with the levels of expression of galectin-1 and galectin-4 in Dukes A and B tumors appear to be independent of the Dukes stage. The same feature was observed when galectin-4 and galectin-8 were analyzed in the complete series. CONCLUSIONS: The data from the current study strongly suggest that galectins-1, -3, and -4 may be involved in the early stages of human colon carcinoma development and that galectin-8 is involved in the later stages.

In the period 01.01.1991 - 12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65,2%. In the middle third, there were 28,9% and in the upper, intraperitoneal third 5,9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4,9% cased with Dukes D stage). There were 74,3% males and 23,7% females median age 59,2 years. According to Dukes classification there were 4,9% in stage A, 47,2% in stage B, 43,1% stage C, and 4,9% stage D. There were 4 (2,7%) postoperative deaths. Recurrence of the disease was registered in 44 (30,5%) patients. Local recurrence alone was found in 14 (9,7%) patients, while distant spread was registered in 30 (20,8%) patients. At present, the median follow-up is at 72,9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63,4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; sur-M\al after 60 months of follow up shows cumulative Survival of 0,35 while Dukes B has far better prognosis (0,86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0,36 after 60 months), while stage B has much better prognosis (0,84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84,9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1,00% disease free survival for cases in stage A, 0,94 for Dukes B and 0,66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p=0,005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

BACKGROUND To investigate the practical value of individual and combined testing of plasma levels of YKL-40, CEA, and CA199 for auxiliary diagnosis and detection of recurrence of colorectal cancer. METHODS ELISA and ECLIA were used to evaluate levels of YKL-40, CEA, and CA199 in 120 colorectal cancer patients (56 initial-diagnosis, 42 post-operative, and 22 recurrent cases). Forty-three patients with benign colorectal disease and 36 healthy patients were enrolled as controls. The relationship between YKL-40 and clinical indicators of tumor pathology was analyzed. The positive rate and diagnostic efficacy of single and combined YKL-40, CEA, and CA199 testing were assessed in patients with colorectal cancer. RESULTS Plasma YKL-40 in the cancer group was significantly higher than in the benign control and healthy control group, and the mean values were 145.4 ng/mL, 107.7 ng/mL, and 51.3 ng/mL (p < 0.05), respectively. With 72 ng/mL as the diagnostic threshold, the sensitivity and specificity of YKL-40 in colorectal cancer diagnosis were found to be 73.2% and 66.7%, respectively. Early-stage colorectal cancer patients showed a YKL-40 positive rate (73%) significantly higher than those of CEA and CA199 (50% and 32%, respectively; p < 0.05). When YKL-40 testing was combined with CEA or CA199, the positive rate increased to 82.1% and 80.3%, respectively. Through ROC curve analysis of the post-operative recurrent group against the non-recurrent group, the areas under the curve for YKL-40, CEA, and CA199 were found to be 0.907, 0.714, and 0.759, respectively. Based on the Dukes classification, the mean YKL-40 value for stages A/B, C, and D were 120.1 ng/mL, 131.7 ng/mL, and 226.8 ng/mL (p = 0.008), respectively. The plasma YKL-40 level gradually increased as the disease progressed. Lower degrees of tumor differentiation were correlated with higher YKL-40 levels. The mean YKL-40 values of high, medium, and low tumor differentiation groups were 96.8 ng/mL, 127.5 ng/mL, and 225.7 ng/mL (p = 0.004), respectively. CONCLUSIONS The benefits of using YKL-40 testing are higher than CEA and CA199 for the monitoring of colorectal cancer recurrence. Combined testing of both YKL-40 and CEA was found to be optimal for auxiliary diagnosis of colorectal cancer. Plasma YKL-40 was found to be suitable for auxiliary diagnosis of colorectal cancer.

Dukes' classification for colorectal cancer is simple and has been widely used as a valuable prognostic indicator. It has been used as an assessment of gastric cancer, but it has not been evaluated for esophageal cancer. Of 251 patients with primary squamous cell carcinoma of the thoracic esophagus between February 1981 and April 1999, 155 patients underwent esophagectomy with a curative intent. Clinicopathologic characteristics of those 155 patients were retrospectively investigated according to the Dukes', tumor node metastasis (TNM) and Japanese staging systems. Dukes' classification showed a clear correlation between tumor stage and survival. The 3-year and 5-year survival rates of 64 Dukes' A cases were excellent (97.4% and 93.7%), good for 12 Dukes' B (75% and 75%), and poor for 79 Dukes' C (50.5% and 43.4%), respectively (P0.05; Dukes' A vs B, P0.0001; Dukes' A vs C, P0.10; Dukes' B vs C). TNM stage classification also showed a good correlation between tumor stage and survival, but there were no significant differences between stage 0, I and stage IIA cases (P = 0.2678) and between stage III and stage IV cases (P = 0.8298). In the Japanese staging system, there were no significant differences among stage 0, stage 1, and stage 2 cases (P = 0.4093). Dukes' classification was significantly correlated with tumor size, Borrmann type, histological type, and vessel invasion. Subdivision of Dukes' C according to the number of positive lymph nodes (1-4 vsor = 5) showed a clearer correlation with survival rather than other subdivisions, such as the metastatic lymph node ratio (1.0 vs1.0) or the site of lymph node metastasis. Dukes' classification, which incorporates the number of positive lymph nodes, correlates well with tumor progression and provides a simple useful staging system after curative esophagectomy for esophageal cancer. Dukes' A tumor could be proposed as a criterion of early esophageal carcinoma.

The presence of serum anti-p53 antibody has been reported to be associated with survival of patients with breast cancer, ovarian cancer, and hepatocellular carcinoma. To clarify prognostic significance of p53 antibody in colorectal cancer, serum p53 antibody was measured in patients with colorectal cancer. The 89 patients included 71 with colorectal cancer and 18 with colon polyp. An enzyme-linked immunosorbent assay was used to detect p53 antibodies in serum. Clinicopathological parameters such as age, sex, degree of differentiation of cancer, location of tumor, liver metastasis, stage classification, Dukes classification, CEA, CA19-9, and immunostaining of p53 and anti-p53 antibody were evaluated as prognostic factors of colorectal cancer. p53 antibody was positive in 18 of 71 (25%) with colorectal cancer, whereas it was positive in only 1 of 18 (6%) with colon polyp. The patients with p53 antibody had higher CEA and CA19-9 levels, higher positive rates of p53 protein expression in cancer cells, and higher liver metastasis rates. The p53 antibody positivity at stage classification I–IIIb/Dukes classification A–C was significantly lower than that at stage classification IV/Dukes classification D. Overall survival in colorectal cancer patients with p53 antibody was significantly shorter than in those without p53 antibody. A Cox regression analysis showed that liver metastasis, stage classification, Dukes classification, CA19-9, and p53 antibody were significant prognostic factors in colorectal cancer. Serum anti-p53 antibody could serve as one of the prognostic factors in patients with colorectal cancer.

Background and aims. In one small study, the DCC Arg201Gly polymorphism has been observed more frequently in colorectal cancer cases compared with controls. We wondered whether these results could be replicated in a much larger study.Methodology. The DCC Arg201Gly polymorphism was genotyped in 625 unselected Caucasian colorectal cancer patients and 220 controls. Association analysis was used to search for a difference between patients and controls. Subgroup analyses were performed for site of tumour, gender, age at diagnosis, family history of colorectal cancer and modified Dukes classification.Results. The association analyses revealed no difference in Arg201Gly genotype frequency between patients and controls, neither overall nor for different subgroups according to site of tumour, gender, age at diagnosis, family history of colorectal cancer and modified Dukes classification.Conclusion. No association was observed between the Arg201Gly polymorphism of DCC and colorectal cancer risk. (C) 2004 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

The purposes of this study were to analyze the CT features of scirrhous carcinoma of the gastrointestinal (GI) tract and to assess the usefulness of CT in detecting and staging these lesions.This is a retrospective evaluation of 31 proven cases of scirrhous carcinoma (linitis plastica) of the GI tract imaged in our institution from 1986 to 1994. Twenty-two patients had primary gastric carcinoma, and nine had carcinoma of the colon (rectosigmoid in eight and right colon in one). CT examinations were reviewed and correlated with pathologic and/or surgical findings in all patients and with barium examinations in 19 cases. A modified Dukes classification was used to stage these lesions without knowledge of the pathologic and surgical results.Four gastric lesions were missed during the initial CT examination. Seventeen patients had extensive circumferential lesions, and five had focal plaquelike lesions. The wall thickness ranged from 1 to 3 cm (mean, 1.8 cm). Homogeneous enhancement was seen in 17 patients, slightly heterogeneous enhancement was seen in one, a target configuration was present in two patients, and intramural calcification was present in one patient. All colonic lesions were circumferential, homogeneously enhancing with a wall thickness ranging from 1 to 3 cm (mean, 2 cm). CT scans showed limitations in evaluating local parameters. Compared with surgical and pathologic staging, CT correctly staged 26 patients, understaged four patients, and overstaged one patient. Among the 19 patients with pathologically proven stage D lesions (61%), CT correctly staged 17 patients (89%) and had a 100% positive predictive value. One case of hepatic metastases, 13 cases of malignant ascites, and 11 cases of omental and peritoneal metastases were found.CT is an important complimentary imaging technique to detect scirrhous carcinoma. The sensitivity of detection depends on the size of the lesion and the quality of the examination. CT has limitations in staging early lesions but shows a high sensitivity (89%) in detecting Dukes stage D lesions. Accurate CT staging in these individuals (61% in this series) allows a more adequate treatment strategy and avoids unnecessary exploratory laparotomies.

To investigate the colonic adenoma-adenocarcinoma progression sequence, DNA ploidy analysis was performed on hyperplastic polyps to adenocarcinomas. DNA ploidy data were then compared with immunocytochemical staining for proliferating cell nuclear antigen (PCNA). In hyperplastic polyps to villous adenomas, all cases were diploid except one aneuploid villous adenoma. In three adenomas, diploid in situ adenocarcinomas were present. As diploid percentages decreased from hyperplastic polyps to villous adenomas, aneuploid percentages increased. In adenocarcinomas, the Dukes classification corresponded well to DNA ploidy status: all four stage A carcinomas were diploid, whereas three cases each of stage C1 and C2 carcinomas were aneuploid or multiploid. A surprising finding was that S-phase percentage in adenocarcinomas was not parallel with PCNA-positive tumor cell numbers. It is concluded that multistep adenoma-adenocarcinoma progression was partially reflected in DNA ploidy pattern from hyperplastic polyps to villous adenomas. In adenocarcinomas, the Dukes classification paralleled well the DNA ploidy status from stage A diploid to stage D aneuploid, but was not accompanied by increasing PCNA-positive cell numbers.

Recent evidence suggests that decline of regulatory T cells (Tregs) play a critical role in the prevalence of autoimmune diseases inhibiting the maintenance of peripheral self tolerance, while its augmentation leads to insufficient antitumor response, accompanied with poor prognosis in various malignancies. Increased number of Tregs (CD4+CD25+FoxP3+) were noticed in peripheral blood mononuclear cells (PBMCs), tumor-infiltrating lymphocytes (TILs) and/or regional lymph nodes lymphocytes (LNLs) of patients with gastrointestinal tumors. The aim of our study was to investigate the correlation between the percentage of Tregs in peripheral blood of patients with colorectal carcinoma, using flow cytometric technique and tumor stages, classified as Dukes’ A, B, C or D and by stage of differentiation. Peripheral blood venous samples were obtained from 92 patients with colorectal cancer and from 30 healthy adult volunteers. Statistical analysis: Linear regression equations were generated using a least-squares method and analyzed for differences of covariance. Statistical significance was calculated by Mann Whitney U test. Our data has shown that 15% patients with colorectal cancer were classified as Dukes’ A, 41% were Dukes’ B, 35% were Dukes’ C and 9% were Dukes’ D. 54% patients with CRC were well differentiated, 11% were poorly differentiated, 20 were moderately differentiated, tage, 4% were mucinous carcinoma and rest of 11% were partly good differentiated with mucinous components. The increased percentage of Tregs in colorectal cancer patients correlates with tumor stage. These results indicate a possible involvement of regulatory T cells in disease progression. New strategies using inhibition or depletion of Tregs are necessary to elucidate the complexity of defective tumor immunity.

PURPOSE: The aim of this study was to investigate the number of new colorectal neoplasms during the first seven years after the end of rescreening in a prospective randomized screening study. METHODS: 27,700 inhabitants of Goteborg born between 1918 and 1922 (60–64 years old) who were randomly allocated to a control or a test group in 1982 were followed up. All people in the latter group were offered six fecal occult blood tests and rescreening 16 to 22 months later. RESULTS: One hundred one carcinomas were diagnosed in the screened group and 128 in the control group during the seven years of follow-up. The number of carcinomas in the test group was half that in the control group during the first two years of follow-up, but equal during the rest of the follow-up period. The distribution of carcinomas according to Dukes classification was significantly better among the participants compared with the refusers (P

Lymph node metastases are a major prognostic factor in colorectal cancer. Inadequate lymph node resection is related to shorter survival. The lymph nodes ratio (LNR) has been used as a prognostic factor in patients with colon cancer. Few studies have evaluated the impact of LNR on the 5-year survival of patients with rectal cancer. OBJECTIVE: To evaluate the impact of LNR on the survival of patients with rectal cancer not submitted to preoperative chemoradiotherapy. METHODS: Ninety patients with rectal cancer excluding colon tumors, synchronous tumors, hereditary colorectal cancer and those undergoing preoperative chemoradiation. The patients were divided into three groups according t < 0.05). RESULTS: The 5-year survival was related to the Dukes classification, TNM, number of metastatic lymph nodes and LNR. A difference was observed in 5-year survival between the different classes of LNR. Patients classified as LNR-0 had a survival rate of 85%, while classes LNR-1 and LNR-2, 73 and 19%, respectively (p=0.0001). CONCLUSIONS: The results showed that the LNR has an impact on 5-year survival of patients with rectal cancer not submitted to neoadjuvant therapy.Metástases linfonodais representam um dos principais fatores prognósticos no câncer colorretal. A ressecção linfonodal inadequada relaciona-se à menor sobrevida. A proporção entre linfonodos metastáticos (PLM) vem sendo utilizada como fator prognóstico em doentes com câncer de cólon. Poucos estudos avaliaram o impacto da PLM na sobrevida de doentes com câncer retal. OBJETIVO: Avaliar o impacto da PLM na sobrevida de doentes com câncer de reto não submetidos à quimioradioterapia pré-operatória. MÉTODOS: Foram incluídos 90 doentes com adenocarcinoma retal excluindo-se tumores de cólon, tumores sincrônicos, câncer colorretal hereditário e aqueles submetidos a tratamento radioquimioterápico pré-operatório. Os doentes foram divididos em três grupos segundo a PLM: PLM-0, sem linfonodos comprometidos; PLM-1, 1 a 20% dos linfonodos comprometidos; e PLM-2, mais de 21% dos linfonodos comprometidos. A identificação do ponto de corte da amostra selecionada foi obtida a partir da curva de características de operação do receptor (curva ROC). A sobrevida foi avaliada pelo teste de Kaplan-Meier, a diferença entre os grupos pelo teste de Cox-Mantel e a correlação entre as variáveis pelo teste de Pearson, adotando-se um nível de significância de 5% (p

Dukes’ B colorectal cancer (CRC) represents a wide spectrum of disease from early penetration through the bowel wall to aggressive and extensive tumours with extramural venous spread and involvement of the serosa, surgical margins or adjacent organs. Among Dukes’ B cancers, Petersen Index allows stratification to identify those patients whom chemotherapy may benefit. One hundred and three resected patients with CRC Dukes’ B were included prospectively in a database and considered in the present study. According to Petersen Index, a score (from 0 to 4) for each patient was calculated on the basis of peritoneal and margin involvement, venous invasion and tumour perforation. Twenty-four out of 103 tumours were located in the rectum and 79 in the colon. According to PI score 59 patients had a score of 0, 30 of 1 and 14 of ≥2. The overall R0 resection was achieved in 95.1 % of cases and the majority of patients with PI score of ≥2 were R1–2. The mean of harvested lymph nodes was 23.6 (±10.7) with no difference according to the PI score. Patients in the high-risk group had a worse 5-year survival rate (66.3 %) compared with the other group (P < 0.009). Multivariate analysis validated the PI score as a significant independent factor (P = 0.017). Both high-quality pathology and adequate harvested lymph nodes are needed for a proper staging. Even though the influence of PI score on survival is confirmed as it leads to an additional rate of colorectal cancer being considered for adjuvant therapy, we underline that a comparison with additional clinical and histological prognostic factors should be needed.

Transcolorectal endosonography (TES) with use of both a nonoptic instrument and an echocolonoscope was performed in 91 patients with colorectal carcinomas (61 rectal and 30 colonic). Correlation of results at TES with results of histologic analysis of resected specimens according to the 1987 TNM classification demonstrated that TES allowed accurate staging of all tumors except T2 carcinomas, which were often accompanied by peritumoral inflammation or abscesses. Overall, the accuracy of staging rectal and colonic carcinomas with TES was 81% and 93%, respectively; overstaging occurred in 13% and understaging in 2%. For regional lymph nodes, the accuracy of staging with TES was 70%, the sensitivity was 94%, and the specificity was 55%. Correlations between findings at TES and the Dukes classification were as follows: for rectal carcinoma, 48% for class A, 50% for class B, and 96% for class C; for colonic carcinoma, 67% for class A, 46% for class B, and 91% for class C. Overall accuracy was 67%. With the addition of abdominal computed tomographic or ultrasonographic examinations to evaluate distant metastases, TES should become an important imaging technique for clinical TNM staging of colorectal carcinomas.

From January 1976 to June 1986, 154 patients (75 men and 79 women) who were 75 years of age or older were admitted for the surgical treatment of a colonic cancer. The mean age was 80.7 years. Patients were divided into two groups: 66 patients, between 75 and 80 years of age, were in Group I; 88 patients, 80 years of age and older, were in Group II. One hundred and forty-three patients (93%) were operated on and a resection was carried out in 125 patients (87%). The overall post-operative mortality rate was 12% (Group I: 5%; Group II: 17%; p less than 0.02). The actuarial survival rate of patients operated on was 32 +/- 8% at 3 years and 26 +/- 8% at 5 years (Group I: 37%; Group II: 17%). In both groups the survival rate was closely related to the extent of the disease according to Dukes classification. These results suggest that in the 75-80 year group age alone should no longer be considered a major risk factor for immediate surgical outcome. In patients aged 80 and older, the results are worse but it is not advanced age per se which influences mortality, rather the physiologic status of the patient.

A 37 year postoperative follow-up of a patientwith a Dukes' C2 carcinoma of the colon withno recurrence is rare. In a review of the literature, nosuch long-term survival was found.

A correlação entre diferentes padrões de expressão celular do CEA e a quantificação sérica do antígeno é assunto controvertido. OBJETIVO: O objetivo do presente estudo foi verificar se o padrão de distribuição tecidual do CEA no carcinoma colorretal, se correlaciona com seus níveis séricos. MÉTODO: Estudaram-se 24 pacientes portadores de adenocarcinoma colorretal, com média de idade de 62,6 anos. A mensuração sérica foi realizada por quimioluminescência. No estudo do padrão de distribuição tecidual empregou-se método imunoistoquímico com a técnica da estreptavidina-biotina peroxidase, utilizando anticorpos monoclonais anti-CEA. O padrão de expressão tecidual foi classificado em apical, citoplasmático e estromal, segundo a localização predominante do CEA. A intensidade da imunoexpressão foi classificada em leve, moderada e forte. Empregou-se o teste de Mann-Whitney na comparação dos níveis de CEA sérico, segundo o padrão de distribuição tecidual e o grau histológico do tumor, o teste de Kruskal-Wallis para análise de variância e o teste de Spearman para avaliação da correlação entre as variáveis estudadas, adotando-se nível de significância de 5% (pThe correlation between different cell expression patterns of CEA and the quantities of this antigen in serum is still a controversial subject. OBJECTIVE: The objective of the present study was to verify whether there is a correlation between the distribution pattern of CEA in the neoplastic tissue and CEA levels in serum. METHOD: Twenty-four patients with colorectal cancer were studied. Their mean age was 62.6 years. The measurement of CEA in serum was done by quimioluminiscence technique. To study the tissue expression pattern, the immunohistochemical method with the streptavidin-biotin peroxidase technique was utilized with the use of anti-CEA monoclonal antibodies. The tissue expression pattern was classified as apical, cytoplasmic or stromal, according to the predominant localization of the CEA distribution in the neoplastic tissue. The intensity of the immunoexpression of CEA in the neoplastic tissue was classified as slight, moderate or strong. The Mann-Whitney test was used to compare the CEA levels in serum with the tissue distribution pattern and histological tumor grade. The Kruskal-Wallis test was used to variance analysis and Spearman test was used to analyze the correlation among the studied variables. The significance level of 5% (p

Background Patients with primary colorectal cancers have a higher risk of development of second tumours synchronously or metachronously. This special group of patients raise a particular interest in their characteristics and outcome. Methods The records of 1009 patients with colorectal cancer were scrutinized. A group with multiple cancers was identified. Perioperative investigations, patterns of follow-up, pathological variables and outcome were noted. Results There were 22 patients with metachronous tumours and 39 with synchronous tumours following 'curative' operations in 20 and 28 respectively. There was no difference in Dukes classification between the two groups. Polyps were associated with metachronous lesions in ten of 22 patients and synchronous lesions in 17 of 39 patients. Five-year survival was 75 per cent for patients with metachronous tumours and only 18 per cent for those with synchronous tumours. Conclusion In this study patients with metachronous tumours seemed to do very well while those with synchronous lesions did very badly. There were no identifiable demographic or clinical characteristics to account for this. There is a need to study this group of patients and identify factors like tumour biology or host resistance which prevent spread of tumour.

AIM: To investigate the value of spiral CT pneumocolon in preoperative colorectal carcinoma. METHODS: Spiral CT pneumocolon was performed prior to surgery in 64 patients with colorectal carcinoma. Spiral CT images were compared to specimens from the resected tumor. RESULTS: Spiral CT depicted the tumor in all patients. Comparison of spiral CT and histologic results showed that the sensitivity and specificity were 95.2%, 40.9% in detection of local invasion, and 75.0%, 90.9% in detection of lymph node metastasis. Compared to the Dukes classification, the disease was correctly staged as A in 6 of 18 patients, as B in 18 of 23, as C in 10 of 15, and as D in 7 of 8. Overall, spiral CT correctly staged 64.1% of patients. CONCLUSION: Spiral CT pneumocolon may be useful in the preoperative assessment of patients with colorectal carcinoma as a means for assisting surgical planning.

Blood samples were obtained preoperatively from 151 consecutive patients who were operated for colorectal carcinoma; of these 132 patients underwent curatively aimed operations. Patients who lived for more than five years without any evidence of relapse were classified as survivors and those who died during follow-up were classified as non-survivors. Tumors were staged according to Dukes and tumor differentiation was classified as high, intermediate or low. Serum anti-p53 was determined in all patients and compared to CEA, CA 50 and CA 242 in serum as well as to blood hemoglobin concentration (Hb), erythrocyte sedimentation rate (ESR), serum alkaline phosphatases (ALP), in the same preoperative blood samples for comparison of power to predict mortality in colorectal cancer. Tumor differentiation and Dukes classification predicted survival and the risk to die of colorectal carcinoma as expected. CA 242 and anti-p53 titers in serum were not significantly different among groups of patients with Dukes A-D tumors, while Hb, ESR, ALP, CEA and CA 50 were significantly different with increasing levels appearing in Dukes C-D, except for Hb which decreased. Survivors had lower ESR, ALP, CEA, CA 50 and CA 242, while Hb and serum anti-p53 titers were not different among survivors and non-survivors. Survivors among Dukes A-C patients had normal Hb, ESR, ALP and CA 242 before operation, while non-survivors had increased ESR, CEA and CA 50. Levels of anti-p53 were unrelated to concentrations of all other blood and serum variables, and did not predict survival in Dukes A-D patients. Serum levels of CEA and CA 50 displayed a significantly altered distribution among survivors and non-survivors (p

Telomerase has been shown to be a marker of epithelial cancer cells. We developed a method that allows the detection of circulating carcinoma cells in the blood of cancer patients. Circulating epithelial cells are harvested from peripheral blood mononuclear cells by immunomagnetic separation using BerEP4-coated beads. A telomeric repeat amplification protocol (TRAP)-ELISA is then used to measure telomerase in harvested epithelial cells. This method is specific and sensitive as demonstrated by experiments using BerEP4-positive and negative cell lines. Whereas we never found telomerase activity in harvested epithelial cells (HEC) samples from 30/30 healthy donors, we have detected telomerase activity in HEC from 11/15 (73%) patients with stage IIIB or IV non-small cell lung cancer (NSCLC) patients and from 8/11 (72%) stage C or D (Dukes classification) colon cancer patients. This non-invasive method could be of great value as a diagnostic or prognostic marker, or for monitoring cancer progression. © 2001 Cancer Research Campaign http://www.bjcancer.com

Background: Staging of colorectal carcinoma has prognostic value and allows to take decisions about adjuvant therapy and follow up. Prognostic factors are not universally accepted and there are different staging classifications. Aim: To assess the prognostic value of clinical and pathological variables in 224 patients subjected to a curative resection of a colorectal carcinoma. Patients and methods: A retrospective analysis of 99 men and 125 women, aged 23 to 91 years old subjected to a curative resection of a colorectal carcinoma and followed up for a mean of 72 months. Results: Global survival at 60 months was 72%. Univariate analysis showed that tumor localization, vascular permeation, wall infiltration and number of involved lymph nodes had an influence on survival. A Cox regression model disclosed tumor localization (colon versus rectum), a carcinoembrionic antigen over 30 ng/ml, vascular permeation, presence of 1 to 4 involved lymph nodes, or 5 or more lymph nodes and the presence of an apical lymph node as variables with significant prognostic value. Conclusions: Our series confirms the prognostic importance of lymph node involvement. This parameter is incorporated in Jass, GITSG (both modifications of Dukes classification) and TNM staging scores. (Rev Méd Chile 2001; 129: 237-46).

Several nerve-sparing operations for advanced rectal cancer that aim to preserve genitourinary function without compromising tumor clearance have been developed in Japan. The aim of this study was to evaluate the survival and local recurrence of these procedures in Dukes B and C patients. A total of 177 patients with advanced rectal cancer underwent curative nerve-sparing surgery (NSS) over the last 11 years; 52 were Dukes B patients and 54 were Dukes C. Altogether 36 had Dukes C1 and 18 had Dukes C2 tumors, 13 with lateral lymph node metastases, designated lateral LN(+). The 5-year survival rate was 92% for Dukes B, 67% for Dukes C1, and 39% for Dukes C2 patients: 11% for Dukes C2 patients with lateral LN(+). The local recurrence rate was 6% for Dukes B, 11% for Dukes C1, and 33% for Dukes C2 patients: 20% for the lateral LN(−) group and 39% for the lateral LN(+) group. Almost all of the patients undergoing NSS could micturate spontaneously, but preservation of sexual function was not as successful. Although there is no guarantee of preserving satisfactory sexual function, our NSS is an acceptable procedure for Dukes B, C1, and C2 patients without lateral lymph node metastases.

Dukes' classification is a useful staging system in patients with colorectal cancer. The aim of this study was to present clinicopathologic characteristics and survival of patients with gastric cancer based on Dukes' classification. A total of 273 patients with gastric cancer curatively treated by radical gastrectomy and lymph node dissection (D2, D3) were studied. With the modified Dukes' classification, A includes tumors limited to the mucosa, submucosa, or muscularis propria; B includes tumors extending into the subserosa or serosa; Ca includes tumors with one to six positive lymph nodes; and Cb includes tumors with seven or more positive lymph nodes. Dukes' classification modified by the number of positive lymph nodes well correlated with the tumor size (p < 0.01), depth of wall invasion (p < 0.01), level of lymph node metastasis (p < 0.01), and degree of lymphatic permeation (p < 0.01) and venous permeation (p< 0.01). The 5-year survival rate was significantly different among Dukes' A (98%), Dukes' B (90%), Dukes' Ca (75%), and Dukes' Cb (44%) cases. The results indicate that Dukes' classification modified by the number of positive lymph nodes (Dukes' A, B, Ca, an Cb) significantly correlates with tumor progression and patient survival; and it may be a simple and useful staging system for gastric cancer.

Background . Although K-ras mutations reportedly occur in 40% to 60% of all colorectal carcinomas, the relationship between specific mutations and clinical outcome is unclear. The purpose of this study was to assess the frequency and types of K-ras mutations in 89 colorectal cancer patients, comparing groups with short-term (less than 5 years) and long-term (more than 10 years) survival. Methods . The group was divided into four cohorts by survival and modified Dukes classification (Dukes B 2 and C 2 ). DNA was extracted from formalin-fixed paraffin-embedded archival material. Mutational status was analyzed using a modification of allele-specific-polymerase chain reaction. Results . Mutations in codon 12 were found in 11.2% of tumors, and 83% of tumors had mutations in codon 13. Gly > Asp accounted for 85.2% of the mutations. Tumors with mutations in both codon 12 and codon 13 occurred significantly more frequently in the long-term (21.3%) versus the short-term (2.4%) survival group. Gly > Asp mutations in either codon were related to long-term survival, and 80% of long-term survivors with mutations in both codons had Gly > Asp mutations in both. Conclusions . Simultaneous mutation in codons 12 and 13 of the K-ras gene appears to be a positive prognostic indicator in colorectal cancer.

PURPOSE: The clinical significance and prognostic value of the histopathologic parameters used in both the Dukes and Jass classifications were evaluated to select those with an independent effect on survival after radical surgery for colorectal cancer. METHODS: The depth of local spread (limited to the bowel wall or extended beyond it), the number of metastatic lymph nodes (none, 1–4, more than 4), the character of the invasive margin (pushing or infiltrating), and the presence or absence of conspicuous peritumoral lymphocytic infiltration were assessed in 235 patients who had undergone radical resection for colorectal cancer. The influence of these variables on survival was studied by univariate and multivariate analysis. RESULTS: No significant difference in survival was found between patients with conspicuous peritumoral infiltrate and those without it; moreover, multivariate analysis failed to show any independent prognostic value for either lymphocytic infiltration or depth of local invasion. However, the character of the invasive margin and the number of metastatic lymph nodes were identified as the only variables with any independent importance on survival. Based on these data, a new prognostic model may be proposed; it uses the character of the infiltrative margin as a discriminating factor among patients within the lymph node-negative (Dukes A and B stages) and lymph node-positive (Dukes C1 and C2 subsets) groups. A good prognosis for Dukes A, B, and C1 patients was associated with pushing tumors; C1 and C2 patients with infiltrating tumors had a poor prognosis. On the whole, the new prognostic model has allowed for the placement of 59.6 percent of our patients into groups that provide a confident prognosis. The clinical outcome of Dukes A and B patients with infiltrating tumors is still uncertain. CONCLUSIONS: The character of the invasive margin is an important prognostic factor in colorectal cancer. The association of this parameter with the traditional Dukes classification may provide additional useful prognostic information and aid in the selection of those patients who could most benefit from adjuvant therapy.

A total of 448 patients with advanced lower rectal cancer who underwent curative wide lymphadenectomy with autonomic nerve preservation were reviewed with respect to surgical techniques, operative burdens, node status, survival rate, and mode of recurrence. Operative time and blood loss in patients who underwent lateral dissection were much greater than those encountered with conventional resection. According to the direction of lymphatic spread in patients with Dukes C disease, the incidence of upward spread was 94% and lateral spread 27%. The overall incidence of lateral metastasis was 14%. The overall 5-year survival was 70%. According to the Dukes classification, the 5-year survival rates were 92% for Dukes A, 79% for Dukes B, and 55% for Dukes C, whereas it was 43% in patients with lateral node metastasis. An analysis of the survival rate was carried out with regard to the number of node metastases, direction of lymphatic spread, and autonomic nerve preservation. The overall incidence of local recurrence was 9.3% and amounted to 16.0% in patients with Dukes C disease. The case of advanced lower rectal cancer was characterized by positive lymph nodes or circular lesions around the circumference (both diagnosed by endorectal ultrasonography). We recommend extended lymphadenectomy with lateral node dissection, as it preserves the autonomic nerve.

The overall cure rate of colon cancer has not improved dramatically in the last decade, remaining at approximately 60% 5-year survival. The main reason for this lack of progress is that at the moment the primary tumour is resected, a significant proportion of the patients with seemingly localised disease already has (undetectable) micrometastases, mostly in the liver. The most important prognostic indicators have been extension of the tumour into the bowel wall and the presence of lymph node metastasis, as expressed in the Dukes classification. However, in the Dukes B and C categories, these parameters are poor predictors of final outcome. For improvement of the prognosis, in addition to earlier detection, more aggressive (adjuvant) treatment of high risk patients would be a rational strategy. This requires development of new therapeutic modalities, but also reliable stratification of patients according to high risk or low risk for recurrent disease. In recent years, many attempts have been made to improve the prediction of final outcome. Parameters studied include inflammatory response to the primary tumour, tumour cell growth fraction, rumour cell differentiation, genetic abnormalities and expression of genes involved in invasion and metastasis. Although some of these newer parameters have significant predictive value, in multivariant analyses, most appear to have limited independent value. Recent studies indicate that genetic abnormalities might be important new prognostic indicators. One of the most promising findings in this area is an allelic loss of chromosome 18q, which allows division of Dukes B patients into subgroups with low risk and high risk for recurrent disease.

Metallothioneins (MTs), a set of ubiquitous low-molecular-weight proteins essential for the protection of cells against heavy metal ion toxicity, were demonstrated immunohistochemically using a monoclonal antibody (E9) against a conserved epitope of I and II isoforms in a series of 109 colorectal adenocarcinomas. In a semiquantitative analysis strong MT expression in the majority of tumour cells was observed in 34 (31%) cases, 24 (22%) tumours showed a focal MT positivity, and 51 (47%) almost completely lacked MT expression. These differences in MT expression were statistically significantly (P

PURPOSE: The aim of our study was to determine the five-year survival of patients with colorectal carcinoma whose Dukes classification had changed following fat clearance of the mesocolon or mesorectum. METHODS: One hundred three patients with colorectal carcinoma were followed up at a special clinic for at least five years after surgery. The tumors from these patients had previously been given a Dukes classification before and after fat clearance. RESULTS: Four of the five patients whose Dukes status changed from B to C as a result of fat clearance died of malignant disease during the five-year follow-up period. After fat clearance it was apparent that Dukes B patients survived, on average, 11 months longer than Dukes C patients. A significantly increased mean number of positive nodes was found after fat clearance in Dukes C cases, both in those who were alive at five years and those who died of their malignant disease. CONCLUSIONS: The fat clearance technique is a useful aid to improving the accuracy of the Dukes classification and has prognostic significance. It should be used in specimens of colorectal carcinoma, which on initial examination appear to be Dukes B cases.

BACKGROUND As a rule, mucinous colorectal adenocarcinomas tend to be at a more advanced stage at the time of discovery than their nonmucinous counterparts. This study assesses the potential value of the preoperative biopsy in the diagnosis of such mucinous adenocarcinomas. METHODS The preoperative biopsy specimens and the corresponding resection specimens of 189 patients with colorectal carcinomas were examined and compared by conventional light microscopic study. The stage of the tumor, using the modified Dukes classification of Astler and Coller, was correlated with the percentage of mucinous component (MC) in the resection specimens. The MC in the preoperative biopsy was assessed by the presence of: (1) malignant-appearing glands disrupted by the presence of abundant extruded intraluminal mucin; (2) pools of mucin in the connective stroma of the adenocarcinoma; and (3) superficial pools of mucin containing ribbons or clusters of neoplastic epithelial cells. RESULTS The presence of a significant (more than 25%) MC in the resection specimen correlated well with an advanced stage of the tumor; 82% of tumors with more than 25% MC were at the B2 or higher stage, compared with 64% of tumors with less than 25% MC (P < 0.05). Finding MC in the preoperative biopsy correlated well with a similar finding in the resection specimen and with a B2 or higher stage of the tumor in such specimens; 83% of MC-positive biopsy specimens exhibited more than 25% MC in the corresponding resection specimen, whereas only 10% of MC-negative biopsy specimens were associated with a surgical specimen containing more than 25% MC (P < 0.001). Similarly, 83% of such MC-positive biopsy specimens revealed a carcinoma at the B2 or higher stage upon resection, compared with 63% of the MC-negative biopsy specimens (P < 0.02). CONCLUSIONS Colorectal adenocarcinomas showing MC in the preoperative biopsy are significantly more likely to reveal a high mucin content and to be at an advanced stage at resection. Thus, such preoperative findings should be recorded and made available on a prospective basis to the treating physicians.

There were 108 cases of hepatic metastases from various primaries during 8 year period. Among the 26 resectable cases 24 (92.4%) were colorectal in origin. The 5 year survival following hepatic resection was 44.4%. Among 4 long -term survivors all had solitary metastatic tumors. There was no significant difference in the survivability between synchronous and metachronous or between solitary and multiple hepatic metastasis. Long term survival was not influenced by lymph node involvement or lymphatic or venous invasion and Dukes classification.

In order to develop an experimentally derived molecular signature closely associated with survival of colorectal cancer (CRC) patients from mouse tumor models, we isolated single cell-derived progenies (SCPs) from SW480 CRC cell line and compared their metastatic potential in an orthotopic implantation model of murine CRC. We compared the differences in the gene expression profiles of a high metastatic variant SCP51, a low metastatic variant SCP58 and their parent SW480/EGFP. We found that 143 genes were commonly differentially expressed between SCP51 and SCP58 cells, SCP58 and SW480/EGFP. Using Gene-annotation enrichment analysis of DAVID, 80 genes were found in top ten clusters of the analysis. Thirty-two genes of above the 80-gene set were found to be involved in metastasis by Genclip, a text mining program. We selected five genes (LYN, SDCBP, MAP4K4, DKK1 and MID1) for immunohistochemical analysis in a cohort of 181 CRC patients. Results showed those LYN, SDCBP, MAP4K4, MID1 and five-gene signatures were significantly correlated with overall survival in patients with CRC. We also found that LYN, MAP4K4 and MID1 but not SDCBP and DKK1 expression was closely correlated with lymph node metastasis and Dukes classification in patients with CRC. Our five-gene signature was closerly associated with survival of CRC patients and could be used as a potential prognostic factor for CRC. Citation Information: Cancer Res 2009;69(23 Suppl):C25.

Rectal cancer has a hypoechoic apearance on the sonogram, and, as it invades deeper through the rectal wall, the normal sonographic anatomy is disrupted. The accuracy of endosonography for diagnosing rectal cancers is given for some authors in Table 6.1. By comparing the changes caused by a tumour with the normal sonogram the depth of tumour invasion can be assessed. So that this invasion can be reported in a standardised way it has been compared to histopathological staging methods. The Dukes classification has the disadvantage that a Dukes B cancer may also be a tumour invading the mesorectum early or one with wide local invasion.

Computed tomography (CT) was used to study 42 patients with rectal carcinoma. Water was used as a contrast medium for studying the local extent of tumor in all patients. Scans were read prospectively without knowledge of the histologic staging and then compared with pathologic specimens. CT depicted the tumor in all patients. Comparison of CT and histologic results (following the Dukes classification) showed that disease was correctly staged as A in three of four patients, as B in eight of 12, as C in 15 of 17, and as D in nine of nine. Overall, carcinoma was correctly staged with CT in 35 of 42 patients (diagnostic accuracy, 83.3%). The accuracy in the assessment of local invasion was 97.6% (41 of 42). In the detection of lymph node involvement, the accuracy was 78.6% (sensitivity, 88%; specificity, 64.7%). CT is recommended in the preoperative staging of rectal carcinoma and as an aid in choosing the appropriate therapy. The use of water enema and complete distention of the rectum are reliable techniques for improving the accuracy of CT in the assessment of local invasion by cancer.

Twenty-eight patients with colon carcinoma (excluding the recto-sigmoid region) underwent preoperative staging with computed tomography (CT). The CT had a sensitivity and a specificity of 60 and 67% for detection of extramural invasion, 75% sensitivity and specificity for lymph node metastases and a sensitivity of 87% and specificity of 95% for liver metastases. Compared with the modified Dukes classification, CT correctly staged 50% of the patients with Dukes A lesions; 40% with Dukes B; 75% with Dukes C and 85% with Dukes D lesions. The data presented in this study showed that CT has limitations in the sensitivity and accuracy of staging local colonic carcinoma. However, we recommend its use for patients who are clinically suspected of having extensive disease.

Clinicopathological Differences of Colorectal Cancer in Three Age Groups of a Japanese Population Takeshi Nakajima, Takahisa Matsuda, Yutaka Saito, Daizo Saito, Masahiro Moriya Background & Aim: The Incidence of colorectal cancer is increasing in Japan. Colorectal cancer in young patients is unusual and little is known about the clinical differences between young and elder patients. A better understanding of the characteristics of colorectal cancer with respect to age would be useful. The aim of this study was to investigate the clinicopathological differences between aged groups. Material & Methods: A total of 4843 patients with advanced colorectal cancer were reviewed over about 40 year period in our hospital. (FAP, anal, appendix, endocrine cancers were excluded.) We classified the subjects into three groups: young patients (#40 years), middle-aged patients (41-74 years), older patients ($75 years) Results: The number of young patients was 277 (6%),middleaged patients 4061 (84%), older patients 505 (10%). There was no apparent difference in male: female ratio (1.3 vs 1.5 vs 1.4). The location of the tumor, histopathological finding,Dukes classification, family history of colorectal cancer, recurrence rate, mortality rate due to colorectal cancer are shown in table 1 Conclusion:Young patients hadmore poorly differentiated tumors andweremore advanced disease. However the recurrence rate andmortality of young patients are same as middle aged patients. Family history of colorectal cancer would be risk factor. The frequency of rectosigmoid disease decreased with age, therefore we recommended colonoscopy for screening even in the older patients.

Proper classification of colorectal cancer has been critical in determining prognosis and possible therapy. The Dukes classification has generally been the one most widely used. However, modifications by Dukes himself, as well as by others, have created considerable confusion. This paper attempts to review, in critical detail, the origins for each of the proposed systems and to compare them.

279 patients with a rectal cancer and 120 patients with a colonic cancer proven histologically on operative specimens were seen at the Aichi Cancer Center Hospital between Dec. 1964 and Dec. 1972. To promote an earlier diagnosis, the presenting symptoms and signs in relation to the Dukes' classification and the site of the cancer were studied.399 patients were classified into 103 patients of Dukes'A, 90 of Dukes'B and 206 of Dukes'C. Rectal bleeding was much more common in patients with cancer of the rectum and the sigmoid colon in the Dukes'A. Altered bowel habit and abdominal mass noticed by patients were relatively late symptoms. Although patients with a right-sided lesion and cancer of the transverse colon were more likely to present with abdominal pain in the Dukes'A, bleeding from the large bowel, i.e. not only over bleeding but also positive occult blood (more than + + by Benzidine method) and/or anemia (less than 350×104mm3. in R.B.C. and⁄or 70% Sahli in Hb) was confirmed in the vast majority of patients.It is, therefore, concluded that testing occult blood in the stools plays an important role in early detection of cancer of the large bowel.