结肠癌的临床表现

早期结肠癌常无明显的临床表现,可无症状、体征或仅隐约不适、消化不良及大便隐血等。随着病变的进展,疾病干扰了机体正常生理功能,遂出现一系列症状和体征。结肠癌常见的临床表现为大便习惯的改变、便血、粘液脓血便、腹痛、腹部包块、肠梗阻及贫血等,一般与病变所在部位、患者年龄及病理类型等有关。 右半结肠癌患者由于肠腔较宽,出现稀便、腹泻症状,较少发生肠梗阻,便血也不多见,而腹部包块、腹痛、贫血、消瘦、乏力相对较多。右半结肠癌患者大便可呈果酱样或血液与大便均匀混合而不易察觉,可致长期慢性失血,患者常因贫血而就…     

结直肠癌临床表现对及时诊断的影响

目的探讨结直肠癌临床表现和诊断延误的关系。方法回顾性分析了151例经组织学证实为结直肠癌患者的临床资料,并以出现临床表现到明确诊断时间的长短分为1月,1~3月和3月3组,比较3组之间的年龄、性别、肿瘤分期、肿瘤位置和临床症状的差异。结果贫血、大便潜血阳性,腹部疼痛在结直肠癌患者中的发生率均60%;3组间年龄、大便潜血试验阳性、大便带血、腹胀、恶心、腹痛、便秘或腹泻和乏力差异有统计学意义(P0.01),性别、肿瘤位置及分期在3组间差异无统计学意义(P0.05);肿瘤位于降结肠,乙状结肠和直肠的患者更容易出现便血和便秘和(或)腹泻(P0.01),而肿瘤位于回盲部、升结肠和横结肠者更容易出现贫血(P0.01);不同肿瘤分期之间临床表现差异无统计学意义(P0.05)。结论贫血、大便潜血阳性、腹痛、便血、便秘和(或)腹泻是结直肠癌最常见的症状。粪便潜血阳性、腹痛、便秘和(或)腹泻往往与延误诊断相关,贫血与右侧结肠癌相关,大便带血、便秘和(或)腹泻与左侧结直肠癌相关。     

左右半结肠癌临床特点及生存预后的比较

目的研究左右半结肠癌临床特点及生存预后的对比。方法 2007~2010年282例根治性手术切除的结肠癌患者作为研究对象,随访其后续治疗、生存时间,对比左右半结肠癌患者的流行病学特征、临床首发症状、组织病理学及其与预后,并评价结肠癌的危险因素。结果右半结肠癌中女性多于男性;左右半结肠癌各年龄组中构成存在统计学差异,年龄越大,更容易发生右半结肠癌(P<0.05);左半结肠癌患者主要表现为血便、大便性状及排便习惯发生改变等,而右半结肠癌患者主要表现为腹部包块、腹痛、腹胀及腹泻;右侧结肠癌肿块直径≥5 cm的比例较左侧高;右侧结肠癌以低分化腺癌为主,左侧结肠癌以高分化腺癌为主(P<0.05);左侧半结肠癌5年生存率明显高于右侧(P<0.05);生存曲线Kplan-Meier法分析显示左半结肠癌累积5年生存率明显高于右侧(P<0.05);年龄、肿瘤部位、是否转移、病理分型是结肠癌预后的危险因素。结论右半结肠癌与左半结肠癌在流行病学特征、临床首发症状、组织病理学及预后方面存在明显不同,可为结肠癌的诊断、治疗及预后提供理论依据。     

大肠癌临床病理特征分析

[目的]分析大肠癌患者的临床病理特征,探讨其发病特点及临床诊断线索。[方法]回顾性分析经手术病理诊断的75例大肠癌患者的临床资料。[结果]75例中以65岁以上患者所占比例最高,腹痛、排便习惯改变及粪便性状改变是其主要的临床表现。右半结肠癌女性发病例数高于男性,左半结肠癌中男性发病例数高于女性,右半结肠癌组大便潜血阳性率及贫血发生率高于左半结肠癌组。血清CEA阳性率高于CA19-9、CA125,病理类型以中分化腺癌最多见,TNM分期以T4期最多。[结论]大肠癌老年女性发病率有增多倾向,不明原因的贫血、便潜血阳性是大肠癌报警症状,血清CEA在大肠癌的诊断中有一定的价值。     

结直肠癌诊断的多因素回归分析

结直肠癌是常见的消化道恶性肿瘤,及早诊断对其治疗和预后转归有积极意义。目的:探讨各种临床特征与结直肠癌诊断的关系。方法:选取2008年9月～2009年12月至华东医院行结肠镜检查的198例结直肠癌患者,对各种临床特征与结直肠癌诊断的关系行回归分析。结果:老年、男性和便血是结直肠癌的危险因素,腹痛为诊断结肠癌的重要线索,排便习惯改变与罹患结直肠癌无关。结论:老年男性患者出现便血症状应综合病史、结肠镜等辅助检查以排除结直肠癌。     

慢性非特异性溃疡性结肠炎41例误诊分析

我院自1973年10月至1987年10月确诊慢性非特异性溃疡性结肠炎(下称溃结)88例,经纤维结肠镜(下称纤结镜)及病理活组织检查,其中误诊41例,因腹痛、腹泻粘液血便而误诊为慢性菌痢24例;因腹泻、血便、贫血、消瘦、下腹包块误诊为结肠癌11例;因腹泻粘液血便误诊为阿米巴痢疾2例;因反复发烧、腹痛、腹泻、右下腹索条状包块误     

结肠癌和直肠癌发病模式和临床特点的异同分析

目的探讨近10年来结肠癌和直肠癌发病模式及临床特点的异同,为临床早期诊断和制定筛查方案提供一定的理论依据。方法回顾性分析北京协和医院1999年1月至2008年12月1906例结肠癌和直肠癌住院患者,就其收治比、性别、年龄以及临床表现、实验室检查、诊断方法和病理分期进行分析比较。结果年龄组成方面40～60岁的直肠癌患者和70岁以上的结肠癌患者明显增多(P0.05);临床表现方面直肠癌的便血和大便习惯改变多于结肠癌,腹部包块更多见于结肠癌;结肠癌大便常规检查异常明显低于直肠癌(P0.01),而血红蛋白下降更为多见(P0.01);直肠癌行癌胚抗原(CEA)检查的人数明显低于结肠癌,其出现异常的比例也偏低;直肠指诊在直肠癌患者中的阳性率较高,结肠癌确诊主要依靠结肠镜检查;治疗方式均以手术为主,Duke D期的直肠癌患者稍多。结论直肠癌和结肠癌的患病率均呈上升趋势,结肠癌临床症状缺乏特异性,对于出现相应症状的高危人群,应注重体格检查和内镜检查相结合,以期早诊早治。     

以腹壁脓肿发病的结肠癌8例临床分析

结肠癌是我国常见的消化道恶性肿瘤;右半结肠癌多表现为消瘦、贫血、腹部肿物;左半结肠癌多表现为排便习惯改变、黏液血便、梗阻.但临床上可见到一些结肠癌以腹壁脓肿为首发表现,具有起病隐匿、易漏诊、预后较差的特点.本文对我院1984年12月～2005年8月间收治的8例以腹壁脓肿发病的结肠癌的临床资料进行分析,探讨其临床病理特点。     

老年人缺血性结肠炎的诊治

缺血性结肠炎是老年人常见的疾病,以腹痛和血便为主要症状.原因是由于结肠供血不足产生缺血性疼痛,造成肠黏膜的缺血性损伤,腹痛是其最主要的症状,常急性发作,绞痛样,疼痛持续伴阵发加重,伴随腹痛常有排便紧迫感,后出现腹泻和血便,血便量一般.因此对于出现急性腹痛、血便的老年患者要考虑缺血性结肠炎的诊断,并与结肠癌、直肠癌鉴别.     

腹胀、腹痛、大便习惯改变

病例 古XX,男,32岁。因腹胀、腹痛、大便习惯改变2年余就诊。患者于2003年2月10日开始出现腹胀及腹部隐痛。腹痛部位不同定,可忍受。大便有时干结,有时为稀便,间或便中带血。便次可达3～5次／d,或数日1次。数次在当地医院就诊,以“肠易激综合征”对症治疗,但疗效不佳。近1个月来上述症状加重,在当地医院行CT检查提示右中下腹部软组织块影,考虑为肠腔肿物。     

Clinical phenotype and prevalence of hereditary nonpolyposis colorectal cancer syndrome in Chinese population

AIM: To describe systematically the clinical characteristics and phenotype of HNPCC families and the prevalence of HNPCC in the general population of CRC patients in China. METHODS: HNPCC kindreds and CRC patients were from two sources. One was that we consecutively investigated kindreds and patients by ourselves. And the other was the published Chinese and foreign literature related to Chinese HNPCC syndrome. There were 142 HNPCC families fulfilling AC I and/or AC II including 57 families with detailed data, and 3874 general primary CRC patients in all. All statistical tests were two-sided. RESULTS: In AC I families, the number of Lynch syndrome I and II families were 25 (47.2%) and 28 (52.8%) respectively. There were 215 patients (82.4%) with CRC, 67 patients (25.7%) with extracolonic cancer and 50 patients (19.2%) with multiple primary cancers. In all CRC patients, multiple primary CRC were in 41 patients (19.1%), and the first-CRC was right-sided colorectal cancer in 143 patients (66.5%) and rectal cancer in 44 patients (20.5%). 8.8% and 19.2% of the first cancer were CRC and extracolonic cancers. Among those patients whose first cancer was CRC, 66.8% and 19.9% were right-sided colorectal cancer and rectal cancer, respectively. The similar results were found in AC II families. Normal distribution was only found in the distribution of the age of diagnosis of the first cancer in both AC I families (coefficient of skewness: u = 0.81, 0.20<0.400.5> 0.20; coefficient of kurtosis: u = 0.84, 0.20<0.40相似文献   

Rational,Design and Preliminary Results of a Cohort Study on Breast and Colorectal Cancer to Develop a Risk Assessment Model to Predict Future Cardiovascular Events. “Cardio Vascular Events in Breast and Colorectal Cancers (CIBC) Study”

Breast cancer (BC) and colorectal cancer (CRC) are among the most common cancers in Iran. We aimed to develop a risk assessment model to predict the development of cardiovascular events in these patients by performing a 5 year prospective cohort study on a newly diagnosed patients with BC or CRC before they receive any treatment. A multi-center prospective cohort study of 2700 newly diagnosed BC and CRC patients has been started in Iran since 2019 and will be continued until 2024. Demographics, socioeconomic status, life style behaviors, psychological characteristics and type of cancer treatments will be collected by standard questionnaires and blood pressure, obesity indices will be measured. Blood sampling, ECG, and echocardiography will be done in all patients at base line, 6 and 12 months, then at annual basis for five years. Incidence of heart failure, acute coronary syndrome, stroke and CVD related death are the primary outcome of this study. In this preliminary analysis, 70 patients with BC and 30 patients with CRC were enrolled in this study from April 2019 to November 2019. Mean age of BC and CRC patients was 48 ± 10.5 and 61 ± 13.2 respectively. 98.6% of patients in BC group and 60% of CRC groups were female. This study will be a platform for other cancers to develop CVD risk assessment charts that can cover other cancers. Patients who lie in the high risk category according to the newly developed risk assessment chart, should receive special management and preventive interventions.     

Colorectal cancer in HIV-infected patients: a case control study

Background Data on colorectal cancer (CRC) in HIV-positive patients are limited. The objective of this study was to investigate the incidence, presentation, and outcome of CRC in HIV patients. Materials and methods Clinical data on patients diagnosed with CRC and concurrent HIV/AIDS infection between 1994 and 2003 were retrieved from the institutional records. Each identified patient was randomly matched with two HIV-negative CRC patients based on age, sex, race, and TNM stage at cancer diagnosis. Presentation, treatment toxicities, recurrence, and overall survival rates were assessed. Data were further compared with those of the published international Surveillance Epidemiology and End Results (SEER) data. Results Out of 3,951 CRC patients, 12 HIV CRC patients (0.3%) were identified. Median age at cancer diagnosis was 41 years (29–52), revealing a 3:1 ratio between patients younger and older then 50 years, compared to a 1:33 ratio in the general population. Compared to 57% in the general population, 90% of the patients had advanced stages (III–IV) at diagnosis. The median follow-up time for both cases and controls was 30 months (6–65). HIV-positive patients had a shorter disease-free survival than the controls. No difference in overall survival was demonstrated, however survival was significantly reduced in the HIV-positive patients when only patients who were initially disease-free were compared. Adjuvant therapy was well-tolerated in all patients without chemotherapy-related deaths. Conclusion HIV-positive CRC patients tend to have an early and more aggressive presentation with less favorable outcome. Further epidemiology studies to refute or accept our observations may suggest a reduced threshold for screening for CRC in HIV-positive patients.     

Increased risk of colorectal cancer in ulcerative colitis patients diagnosed after 40 years of age.

BACKGROUND: The association between ulcerative colitis (UC) and colorectal cancer (CRC) is well established. Retrospective data show a 5.4% CRC incidence rate among patients with pancolitis and suggest that cancer surveillance should be provided to patients following eight to 10 years of extensive UC. AIM: To identify premalignant risk factors for UC patients and to determine whether current recommendations for cancer surveillance need reviewing. PATIENTS AND METHODS: A retrospective audit was conducted of adult patients with UC who were diagnosed with CRC between 1991 and 2002 in five hospitals in Edmonton, Alberta. RESULTS: Thirty-one cases of CRC (68% male) were identified. In this group, the mean ages at diagnosis were 44.4 years for UC patients and 60.1 years for CRC patients. For patients in whom the initial data of diagnosis of UC could be determined (n=29), the median duration of UC at the time of CRC diagnosis was 16 years. Patients diagnosed with UC after 40 years of age (n=15, mean age 64 years) progressed more rapidly to CRC than patients diagnosed before 40 years of age (n=14, mean age 23 years). The median durations of UC before development of CRC were 22 years and 10 years, respectively, for patients with a diagnosis of UC before and after 40 years of age (OR 11.5, 95% CI 2.41 to 20.16; P=0.00029). Only four patients (13%) were enrolled in an appropriate cancer-screening program. Nine of these UC patients (29%) who were older than 40 years of age developed CRC before the 10-year point. CONCLUSIONS: In the present study, patients diagnosed with UC after 40 years of age developed CRC more rapidly than those diagnosed before 40 years of age. This finding suggests that patients who are diagnosed with UC after 40 years of age should undergo CRC surveillance earlier than current recommendations.     

Cáncer colorrectal de intervalo después de colonoscopia

Introduction and aimsInterval colorectal cancer (iCRC) can occur due to missed lesions or to a newly developed lesion. The present study aimed to assess the iCRC rate and its characteristics in our population and find possible explanations.Materials and methodsA retrospective study was conducted on patients with colorectal cancer (CRC) diagnosed between January 2011 and January 2015 at our department. Demographics, endoscopic data, and tumor characteristics (location, histology, staging) were collected. We identified patients diagnosed with CCR who underwent colonoscopy at our department in the previous 10 years and presented the disease (iCRC) before the date of their next recommended exam. The cases of iCRC were characterized and compared with other CRC cases. Possible explanations for the appearance of iCRC were analyzed.ResultsA total of 266 patients presented with CRC, 61.7% were men, and mean patient age was 70.7 years. We identified 10 patients with iCRC: 6 were men, and mean patient age was 71.1 years. Mean time for iCRC diagnosis after index colonoscopy was 3.5 ± 1.84 years. Tumor was located in the right colon in 50% of the patients with iCRC and in 24.5% of the patients without iCRC (P = .091). More patients with iCRC had a family history of CRC (50%) than the patients with reference CRC (3.1%) (P = .000).ConclusionsIn our case series, 3.76% of all CRC were iCRC. There were no statistically significant differences between patients with or without iCRC, with the exception of family history of CRC.     

The Two-Week Referral System for colorectal cancer—not fit for purpose

Purpose

The UK government target expects all suspected colorectal cancer (CRC) patients to be seen within the Two-Week Referral (TWR) system made by general practitioners. These guidelines originally derived from only level 5 evidence. However, this has significant impact on the workload for colorectal surgeons. The aim of the study is to investigate the effectiveness of this colorectal service and whether the referral criteria are predictive of CRC.

Methods

A retrospective study of all patients referred under the TWR guidance in 2010 was assessed. The first 573 TWRs were piloted for analysis. Clinical information from each patient was collected regarding TWR criteria and additional colorectal symptoms or risk factors. Multiple regression analysis was performed to determine which symptoms independently correlated with CRC.

Results

One hundred twenty-six CRCs were diagnosed via all methods of referral in 2010. There were 940 patients referred under the TWR guidelines in that year, when 50 CRC patients were identified. Amongst the 573 patients, 32 CRCs were diagnosed. Multiple regression analysis revealed tenesmus to be independently associated with CRC (p?=?0.003, Pearson’s r?=?0.09185). None of the individual TWR criteria confidently predicted CRC.

Conclusion

Our preliminary results suggest that the current TWR guidelines cannot effectively predict CRC. There is an urgent need for an evidence-based approach to referral criteria for suspected CRC.     

结直肠癌的临床病理特征及其与血清25羟基维生素D相关性的分析

背景:近年结直肠癌(CRC)的发病率和死亡率呈上升趋势,熟悉临床病理特征有助于提高CRC诊断水平。目的:总结CRC的临床病理特征并分析其与血清25羟基维生素D[25(OH)D]的相关性。方法:回顾性分析249例经结肠镜活检或术后病理证实的CRC患者的临床资料,以ELISA法检测血清25(OH)D水平,并分析其与CRC临床病理特征的相关性。结果:CRC好发于60岁的老年人(69.5%),男女之比为1.33∶1;直肠为最常见的发病部位(40.4%),便血为最常见的症状(41.0%),肿瘤大体类型以溃疡浸润型(54.9%)为主,病理类型主要为管状腺癌(75.1%)。与非老年组相比,老年组直肠癌发生率明显降低,右半结肠癌发生率明显上升,浸润型CRC少见,Ⅱ期CRC明显升高,排便习惯和性状改变更常见,细胞中分化率明显升高,差异均有统计学意义(P0.05)。老年、右半结肠和分期较晚的CRC患者血清25(OH)D水平明显降低(P0.05)。结论:老年CRC的发病部位、肿瘤类型、临床分期、临床表现和分化程度与非老年患者均有明显差异。血清25(OH)D水平可能与CRC患者年龄、发病部位、临床分期有关     

Identification of patients at-risk for Lynch syndrome in a hospital-based colorectal surgery clinic

AIM:To determine the prevalence of a family history suggestive of Lynch syndrome (LS) among patients with colorectal cancer (CRC) followed in a coloproctology outpatient clinic in Southern Brazil.METHODS:A consecutive sample of patients with CRC were interviewed regarding personal and family histories of cancer.Clinical data and pathology features of the tumor were obtained from chart review.RESULTS:Of the 212 CRC patients recruited,61 (29%) reported a family history of CRC,45 (21.2%) were diagnosed under a...     

Temporal trend in relative risk of second primary colorectal cancer

BACKGROUND: Patients with colorectal cancer (CRC) are at a higher risk for developing a second primary. Factors (such as survival rate, rate of receipt of surveillance procedures, and the overall incidence of CRC) with potential impact on the risk for second primary CRC have changed over the last three decades. Thus, it is likely that the risk for second primary CRC also has changed over the years. OBJECTIVES: We used the Surveillance, Epidemiology, and End Results public-use database to assess whether the relative risk of second primary CRC has changed in patients with initial primary CRC. METHODS: The temporal trend in the standardized incidence ratio (SIR) for a second primary CRC was estimated. Also, the clinical features of the second primary CRC were compared in two subgroups based on the year of diagnosis of the first primary CRC: Group A (1973-1977) and Group B (1988-1992). RESULTS: During the period of 1973 to 2002, 216,751 patients developed a primary CRC and over a follow-up period of 1,250,687 person-years, 5,595 of these patients developed a second primary CRC, with an SIR of 1.36 (95% CI 1.32-1.39). In a Cox regression model, the period of diagnosis of the first primary CRC was an independent risk factor for a subsequent primary CRC, with a relative hazard of second colon cancer in Group B compared with Group A being 1.18 (95% CI 1.06-1.31), after controlling for age at diagnosis, site, stage of first primary, gender, and race. CONCLUSION: The relative risk of the second primary CRC has increased since early 1990s. These subsequent cancers are being diagnosed at an earlier stage. Increased surveillance may be one of the factors contributing to this temporal difference.     

Incidence of Second Primary Malignancies Following Colorectal Cancer: A Distinct Pattern of Occurrence Between Colon and Rectal Cancers and Association of Co-Morbidity with Second Primary Malignancies in a Population-Based Cohort of 98,876 Patients in Taiwan

The purpose of this study is to determine the features of second primary malignancies (SPMs) among patients with prior colorectal cancer (CRC) using a nationwide population-based dataset.Patients with CRC newly diagnosed between 1996 and 2011, and >1 year of follow-up were recruited from the Taiwan National Health Insurance database. Standardized incidence ratios (SIRs) of SPMs in patients with CRC were calculated.During the 16-year study period, 4259 SPMs developed among 98,876 CRC patients. The median duration of follow-up was 4.03 years. The SIR for all SPMs was 1.13 (95% confidence interval = 1.10–1.17). Compared with the general population, a higher incidence of thyroid, prostate, ovarian, and hematologic malignancies developed among patients with colon cancer, whereas the risk for bone and soft tissue cancers increased among patients with rectal cancer. The risk for breast, bladder, kidney, lung, and uterine cancers was significantly higher in patients with colon and rectal cancers than the general population. The risk for liver and biliary tract cancers declined in patients with rectal cancer. Based on multivariate analysis among patients with CRC, age ≥70 years, men, chronic obstructive pulmonary disease (COPD), cirrhosis, and dyslipidemia were independent predictors of an SPM.In conclusion, patients with CRC were at increased risk for a second cancer. The pattern of SPMs was distinct between patients with colon and rectal cancer. Age, men, COPD, cirrhosis, and dyslipidemia were independent risk factors for SPMs. Surveillance and education should be provided for survivors with respect to risk for SPMs.