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Background: About half of the patients diagnosed with colon cancer are 70 years or older. Standard treatment for stage III colon cancer is major surgical resection followed by adjuvant chemotherapy (ACT). Norwegian guidelines recommend initiation of ACT within 6 weeks after resection., Objective: This study investigated socioeconomic and geographic variation in the recommended provision of ACT to elderly patients with stage III colon cancer in Norway., Methods: This population-based retrospective cohort study included patients aged 70 years or older diagnosed with stage III colon cancer between 2011 and 2021 who underwent major surgical resection. Individual data were obtained from national registries. Multilevel logistic regression analysis was used to model variation in provision of ACT., Results: Of 4 501 included patients, 603 (13%) and 1 182 (26%) received ACT within 6 and 8 weeks after resection, respectively. The provision of ACT decreased with increasing age and frailty. Odds of ACT within 6 weeks decreased for patients with low socioeconomic status (SES) compared to high SES (odds ratio (OR) 0.67 (95% confidence interval (CI) 0.50-0.91)), and decreased for patients living alone compared to those living with a cohabitant (OR 0.72 (95% CI 0.58-0.91)). Geographic variation was found between hospital referral areas (OR 0.41-2.58)., Conclusions: Our study found that ACT provision to elderly stage III colon cancer patients is associated with SES and geography, indicating variation in guidelines adherence. Further research is needed to explore the impact of ACT timing among elderly patients with stage III colon cancer in Norway., Competing Interests: Declarations. Ethics approval and consent to participate: This study is based on secondary use of clinical and administrative register data. According to the Regional Committees for Medical and Health Research Ethics (REK), the study was not in the substantive scope of the Health Research Act and approval was not required (REK reference 2017/1391/REK nord). Exemption from the duty of confidentiality was granted by REK for data from the CRN, The Norwegian Colorectal Cancer Registry and NPR, by the Norwegian Health Directorate for KUHR-data and by the SSB for SSB-data. The data controller has carried out a data protection impact assessment (DPIA). The data protection officer was consulted and has concluded that the data processing was in accordance with the regulations. Data were received after applications to the CRN, the Norwegian Institute of Public Health, the Norwegian Health Directorate, and the SSB. Public access to this type of data is closed. According to Norwegian law, further ethical approval or obtaining informed consent was not required for this study. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s).)

Purpose: Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (CRC). However, aspirin as primary prevention is debated because of the risk of hemorrhagic adverse effects. Aspirin as secondary prevention may be more justified from a risk-benefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CRC-specific survival (CSS) and overall survival (OS)., Materials and Methods: An observational, population-based, retrospective cohort study was conducted by linking patients diagnosed with CRC from 2004 through 2011 (Cancer Registry of Norway) with data on their aspirin use (The Norwegian Prescription Database). These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS., Results: A total of 23,162 patients diagnosed with CRC were included, 6,102 of whom were exposed to aspirin after the diagnosis of CRC (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific. In multivariable analysis, aspirin exposure after the diagnosis of CRC was independently associated with improved CSS (hazard ratio [HR], 0.85; 95% CI, 0.79 to 0.92) and OS (HR, 0.95; 95% CI, 0.90 to 1.01)., Conclusion: Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS., (© 2016 by American Society of Clinical Oncology.)

Background: The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010., Material and Methods: A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993-2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1)., Results: Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993-1997 to 63.4% in 2007-2010 (p < 0.001). Among the 10 796 patients with stage I-III disease who underwent tumour resection, from 1993-1997 to 2007-2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993-1997 to 5.0% in 2007-2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001)., Conclusion: Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.

Objective: The most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites., Methods: Retrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites., Results: Data for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%;  isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001)., Conclusion: Our study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The surgical management of rectal cancer has changed substantially over the past decade. There are limited data on the long-term outcome of implementing systematic management strategies., Methods: Survival of a national cohort of patients treated surgically for colonic and rectal cancer over a 10-year interval was analysed. All 31 158 patients in Norway diagnosed with adenocarcinoma of the colon and rectum between 1994 and 2003 were identified from the Cancer Registry of Norway and the Norwegian Rectal Cancer Registry. Changes in 5-year relative survival were compared by age, stage and tumour location during the early and late years., Results: The study population included 19 053 patients who had a curative resection. The relative 5-year survival rate significantly improved for both colonic cancer (73·8 versus 78·0 per cent; P < 0·001) and rectal cancer (72·1 versus 79·6 per cent; P < 0·001). The 5-year relative survival was significantly better for rectal than colonic cancer during the late period (P = 0·030). Improved 5-year relative survival was related to better outcomes in patients with positive lymph nodes (67·2 and 62·1 per cent for rectal and colonic cancer respectively; each P < 0·001 versus early period), but not for the subgroup aged over 75 years with lymph node-positive colonic cancer., Conclusion: In this national cohort, survival after curative surgery for colorectal cancer increased significantly after implementation of national management strategies. Improvements were most evident for rectal cancer and in lymph node-positive disease; they were less substantial for colonic cancer and elderly patients (over 75 years). Strategic treatment changes may be warranted for the latter group., (Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Complete and accurate histopathology reports are fundamental in providing quality cancer care. The Cancer Registry of Norway and the Norwegian Society of Pathology have previously developed a national electronic template for histopathology reporting on colorectal carcinoma resection specimens. The present study was undertaken to investigate (1) whether quality routines in Norwegian pathology laboratories might affect completeness of such histopathology reports and (2) whether the national electronic template improves completeness of histopathology reports compared with other modes of reporting. A questionnaire on quality routines was sent to the 21 pathology laboratories in Norway. All histopathology reports on colorectal cancer submitted to the Cancer Registry for a 3-month period in the autumn of 2007 were then evaluated on the mode of reporting and the presence of 11 key parameters. Of the 20 laboratories that handled resection specimens, 16 had written guidelines on histopathology reporting. Of these, 4 used the national electronic template, 5 used checklists, 3 used locally developed electronic templates, whereas the remaining 4 had neither obligatory checklists nor templates. Of the 650 histopathology reports submitted to the Cancer Registry in the 3-month period, the national template had been used in 170 cases (26.2%), checklists/locally developed templates in 112 cases (17.2%), and free text in 368 cases (56.6%). Quality routines in the pathology laboratories clearly governed reporting practice and the completeness of the histopathology reports. Use of the national electronic template significantly improved (P < .05) the presence of the 11 key parameters compared with reporting by checklists, locally developed electronic templates, or free text., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to describe management and outcome in patients with locally recurrent rectal cancer based on data from the Norwegian Colorectal Cancer Registry., Methods: This was a prospective national cohort study of 577 patients with local recurrence after major resection (R0/R1) for rectal cancer between November 1993 and December 2001 (initial cohort of 4504 patients)., Results: Of the 577 patients, 185 (32.1 per cent) had curative resections (R0/R1), 203 (35.2 per cent) had palliative radiotherapy with or without palliative surgery and chemotherapy, and 189 (32.8 per cent) received no treatment at all or only palliative surgery or chemotherapy. The overall 5-year survival rate was 14.9 per cent. Ninety-seven patients had an R0 resection, and 88 had an R1 resection, with 5-year overall survival of 55 and 20 per cent respectively. This outcome reflected surgical treatment in 33 different hospitals. Some 274 patients (47.5 per cent) had metastases. The 5-year survival rate after R0 resection was 62 per cent in patients without metastases., Conclusion: Obtaining an R0 resection is the most important prognostic factor in treating recurrent rectal cancer.

Background: The incidence of colorectal cancer has increased rapidly in both sexes during the last 50 years, and the disease is today the most frequent form of cancer diagnosed in Norway. This paper provides an overview of the incidence, mortality and survival of colorectal cancer in Norway; it discusses known and assumed causality and the prospects for prevention, screening and treatment., Material and Methods: Colorectal cancers diagnosed in Norway were obtained from the Cancer Registry of Norway by location (colon and rectum) and 5-year age group for each year in the period 1953-2005. Data obtained from the NORDCAN, GLOBOCAN and EUROCARE databases were used to compare incidence, mortality and survival in Norway with corresponding data from the Nordic and European countries., Results: Age-adjusted rates have doubled since the 1960s. Norway used to have a lower risk of colorectal cancer than its Northern European neighbours, but now has the highest rate in the Nordic countries and one of the highest in Europe., Interpretation: The rates for colorectal cancer appear to be stabilising, especially among the younger generations.

Temporal heterogeneity in blood perfusion is a common phenomenon in tumors, but data characterizing the nature of the blood flow fluctuations are sparse. This study investigated the occurrence of blood flow fluctuations in A-07 melanoma xenografts by using gadopentetate dimeglumine (Gd-DTPA)-based dynamic contrast-enhanced MRI (DCE-MRI). Each tumor was subjected to two DCE-MRI acquisitions separated by 1 hour. The data were processed by Kety analysis and resulted in two E.F images (E is the initial extraction fraction of Gd-DTPA and F is the perfusion) and two lambda images (lambda is the partition coefficient of Gd-DTPA) for each tumor. The E . F images were used to determine the changes in blood perfusion arising in the time between the two imaging sequences. The lambda images were used to control the reproducibility of the experimental procedure. The study showed that DCE-MRI with subsequent Kety analysis is a useful method for detection of blood flow fluctuations in A-07 tumors, and strongly suggested that the peripheral regions of A-07 tumors are more exposed to temporal changes in blood perfusion than are the central regions., (Copyright (c) 2007 Wiley-Liss, Inc.)