Awareness of heredity in colorectal cancer patients is insufficient among clinicians: a Norwegian population-based study

Objective  The assessment of family history and medical data is crucial in identifying families with Lynch syndrome (LS). Among consecutive colorectal cancer (CRC) patients, we aimed at identifying all patients with a hereditary predisposition, and to study a possible discrepancy with assessments made by the responsible clinicians.
Method  All consecutively diagnosed patients with CRC from two Norwegian hospitals were included, and information on family history was collected in a detailed interview. We assessed information in medical records, and tumours were examined for LS-associated histopathological features.
Results  Among 562 patients, there was no documentation of family history in 388 (69.0%) medical records, and in 174 (31.0%) patients, there was no clinical assessment of the information that was collected on family history. Based on detailed interviews and extended pathological examination, we found that 137 (24.4%) of the 562 patients could be classified as possible LS according to the Revised Bethesda Guidelines (RBG); and that 46 (33.6%) of these patients could be identified by family history alone.
Conclusion  Family history and relevant information in patient records can identify patients with possible LS. However, clinicians often fail to include information on hereditary factors and to assess relevant data in medical records. Familial CRC is therefore not acknowledged, and genetic counselling is not offered.     

Colonoscopy for screening and follow up of patients with a family history of colorectal cancer

Objective To determine the minimum family history of colorectal cancer (CRC), which justifies colonoscopy and to establish whether further colonic assessment is necessary after a negative screening colonoscopy. Method A retrospective review of every colonoscopy undertaken for family screening at the Royal Berkshire and Battle Hospitals, Reading between October 1996 and July 2004. Results Four hundred and thirty‐two patients (261 women) with an average age of 48 years (range 14–84) were screened. Three cancers in patients over the age of 60 years and 49 adenomas were found in 37 patients. Twenty three of 281 (8%) patients with a ‘low‐risk’ family history (one in 12 or less lifetime risk of developing CRC) had either a cancer or an adenoma. Eighteen of 151 (12%) patients with a ‘high‐risk’ family history (one in 10 or greater) had a similar positive colonoscopy. Thirteen of 15 patients who had an adenoma aged under 45 years had a high‐risk family history. Seventy‐three patients subsequently underwent two or more follow‐up colonoscopies. There were 22 adenomatous polyps found in 12 patients (16%) at the first screening, nine adenomas in seven patients in the second colonoscopy and four adenomas found in four patients in all subsequent colonoscopies. Conclusion Patients with a low‐risk family history have a similar adenoma pick‐up to that of the general population. These patients need not be screened below the age of 50 unless symptomatic. Follow up of low‐risk family history (FH) patients with a negative screening colonoscopy is unlikely to be beneficial.     

Family history? The forgotten question in high‐risk colorectal cancer patients

Aim  The aim of the study was to investigate the frequency and detail of family history recorded for patients diagnosed with potentially high-risk colorectal cancer, and to determine the proportion of these patients referred to a high-risk assessment clinic.
Method  Medical records of patients diagnosed with colorectal cancer under the age of 50 admitted to a major Sydney teaching hospital were reviewed. The proportion of records containing information about family history was calculated. Associations between recording of family history and demographic and clinical characteristics of patients were investigated. Logistic regression modelling was performed to identify significant, independent predictors of study outcomes.
Results  Of 113 patients with colorectal cancer diagnosed under the age of 50 years, 61 (54%, 95% CI: 44–63%) had an entry in their hospital medical record about family history. Family history was significantly less likely to be recorded for females, for those admitted via the Emergency Department, and for those with shorter lengths of stay. A significant family history was found in 51% of the 61 patients who had a family history recorded. Records of patients attending specialist colorectal surgeons were significantly more likely to contain information about family history than those who attended other specialists ( P  = 0.04). Only 14 patients (12%, 95% CI: 7–20%) were formally referred for further genetic assessment.
Conclusion  These results suggest that family history is still being neglected in routine clinical practice, and high-risk assessment services are underutilized, implying the need for further dissemination of guidelines with regard to the recognition and management of hereditary colorectal cancer.     

Complexities of genetic screening and testing in hereditary colorectal cancer

It is becoming increasingly important to identify patients at risk for hereditary colorectal cancer (CRC) given the opportunity to impact medical management and reduce morbidity and mortality among patients and their family members once inherited CRC predisposition is confirmed. Methods by which patients are identified are evolving as genetic testing costs have plummeted, resulting in many more genetic screening and testing options. Opportunities and challenges with newer approaches to genetic testing and screening for hereditary CRC are reviewed along with benefits and limitations of each approach. Regardless of how methods evolve for identifying patients with hereditary cancer risk, the need for patient education, family history taking, appropriate risk counseling, and enhancing sharing across family members will remain critical for optimal patient care.     

Microsatellite instability and MLH1 hypermethylation – incidence and significance in colorectal polyps in young patients

OBJECTIVE: Microsatellite instability (MSI) is observed in most hereditary nonpolyposis colorectal cancer-related colorectal cancers (CRC). The original Bethesda criteria recommends MSI testing in patients 相似文献   

Family and personal history in colorectal cancer patients: what are we missing?

OBJECTIVE: Family and personal history of colorectal cancer and associated tumours are crucial in identifying families with hereditary nonpolyposis colorectal cancer (HNPCC). The aim of this study was to determine the adequacy of these aspects of history-taking in the management of colorectal cancer patients. PATIENTS AND METHODS: Colorectal cancer patients attending outpatient follow-up were interviewed to obtain a detailed family and personal history of cancers. The medical notes were then reviewed to identify whether these had been documented previously. RESULTS: One hundred and one patients took part. In seven, no family history had been recorded; none of these actually had a significant pedigree. In 88, the family history was not significant, a finding correctly documented in the records. Three had a high-risk family history and another three had a personal history of other possible HNPCC-related cancers. In each of these patients, the relevant findings had been documented, but no further action had been taken. CONCLUSIONS: Family history was taken in the majority of patients, but in the only three with a pedigree indicative of HNPCC, its significance was not appreciated. The potential relevance of multiple HNPCC-related cancers in the same individual was also overlooked. Improved education and referral pathways are needed to ensure that families with HNPCC have access to appropriate surveillance and genetic testing.     

COX‐2 expression is unexpectedly high in viable colorectal mucosal cells: is there life for chemoprophylaxis after VICTOR?

Introduction  Trials investigating colorectal cancer (CRC) chemoprophylaxis with cyclooxygenase-2 (COX-2) inhibitors have been discontinued because of adverse cardiovascular effects. Nevertheless, identification of patients where beneficial, chemo-prophylactic effects of COX-2 inhibitors outweigh side-effects may be possible; this study aimed to investigate whether such patient groups might exist.
Method  The COX-2 status of viable epithelial and inflammatory cells in freshly disaggregated CRC and paired normal colonic samples was assessed by three-colour flow cytometry.
Results  21/31 (67.7%) CRCs expressed COX-2, with inflammatory cells positive in 19/31 (61.3%), epithelial cells in 12/31 (38.7%), and both positive in 10/31 (32.3%). 25/30 (83.33%) normal samples expressed COX-2, with epithelial cells positive in 18/30 (60%), inflammatory cells in 15/30 (50%) and both positive in 10/30 (33.3%). Strength of expression by CRC and normal was similar. More advanced cancers had higher expression rates (COX-2 in 12/13 (92.3%) with nodal disease vs 9/17 (52.9%) node-negative; P  = 0.04).
Conclusion  Investigation of ex-vivo CRC cells by flow cytometry demonstrated COX-2 expression rates comparable to that previously reported. However, expression by paired live normal colon was significantly greater, suggesting that COX-2 may be expressed at higher rates in normal colonic cells in patients with CRC. Patients identified at resection as expressing COX-2 in normal colon may benefit from Coxib chemo-prophylaxis, thus potentially offering a refined approach to that adopted in the VICTOR trial.     

HEREDITY,MOLECULAR GENETICS AND COLORECTAL CANCER: A REVIEW

It is estimated that the hereditary polyposis and non-polyposis colorectal cancer (CRC) syndromes, which have an autosomal dominant pattern of inheritance, represent less than 10% of the total CRC burden. Thus, more than 90% of all cases of CRC have previously been considered to arise ‘sporadically’, with no identifiable genetic link. However, recent clinical evidence now suggests that a significant proportion of CRC seen in the general population may involve an inherited genetic susceptibility. Therefore, constructing an accurate family tree on all patients with a family history of CRC is an essential part of identifying families with an increased risk for CRC who could then be offered screening. Also. molecular genetic study of colorectal adenomas and carcinomas has led to a proposed genetic model of colorectal tumorigenesis which involves interactions between oncogenes and tumour suppressor genes. This information has important potential implications for screening, determining prognosis and for providing multiple targets for altering the sequence of malignant transformation.     

Phenotypic characteristics of hereditary non-polyposis colorectal cancer by the Amsterdam criteria: an Asian perspective

Background: Hereditary non‐polyposis colorectal cancer (HNPCC) is an autosomal disease with a 68–82% lifetime risk of colorectal cancer (CRC). This study examined the phenotypic characteristics of CRC in Amsterdam criteria‐positive Asian patients from the Singapore Polyposis Registry. Methods: Hereditary non‐polyposis CRC patients, defined by the Amsterdam I and II criteria, prospectively monitored in the Singapore Polyposis Registry over a 16‐year period were reviewed. Clinical data were obtained from a computerized database and parameters, such as age of diagnosis, type and location of CRC, other associated cancers in the pedigree, cancer recurrence and survival were analysed. Results: Fifty‐two patients (31 men and 21 women) from 42 unrelated families, with a median age of 44.5 years (range 27–73 years), fulfilled either Amsterdam I or II criteria and were included in our analysis. The racial distribution was 91% (n = 47) Chinese and 9% (n = 5) Malays, with a median follow up of 44.9 months (range 2–183 months). Significantly, 69% of tumours in this Amsterdam‐defined cohort were left sided, with most being sigmoid cancers. Sixty per cent of all the tumours presented at a late stage (Dukes’ C or D). Left‐sided tumours presented with more advanced Dukes’ stage (P = 0.096) and a higher rate of metastatic disease (P = 0.08) compared with right‐sided lesions. There were, however, no significant differences in either disease‐free or overall survival between right‐sided and left‐sided tumours. Conclusion: This study emphasized the significant left‐sided predominance of CRC in Amsterdam I and II‐defined patients from our predominantly Chinese population, in contrast to those classically described in Lynch syndrome. Amsterdam criteria thus may not be suitable for diagnosing HNPCC in Asian populations and a greater emphasis should be made towards routine molecular diagnosis of mismatch repair gene defects in suspected HNPCC patients of Asian decent.     

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目的 研究遗传性非息肉病性大肠癌（ＨＮＰＣＣ）在大癌中的比例及临床病理特点。方法 收集和分析５５０例大肠癌的临床病理及随访资料，符合Ａｍｓｔｅｒｄａｍ标准或日本标准者诊断为ＨＮＰＣＣ。结果 ５５０例大肠癌中６例（１．１％）符合Ａｍｓｔｅｒｄａｍ标准，１９例（３．５％）符合日本标准。本组ＨＮＰＣＣ的临床病理特点是肿瘤发病年龄早，多位于右半结肠，粘液癌及多原发大肠癌多见，家族中肠外肿瘤增多，息肉伴随增     

Non-polyposis colorectal cancer in subjects under 55 years of age: frequency and phenotype of hereditary or familial syndromes

Young age is believed to be a risk factor for hereditary or familial non-polyposis colorectal cancer. Present study analysed frequency, phenotype and familial cancer risk of 82 subjects with colorectal cancer under 55 years of age. According to age and family history, probands have been subdivided into 5 groups: Hereditary Non-Polyposis Colorectal Cancer (HNPCC) (8.2% of cases); Suspected HNPCC (7.3%); Non-specific familial aggregation of colorectal cancer (AFACC) (19.5%); Early-onset colorectal cancer (diagnosis under 35 years of age) (CCG) (6.1%); Sporadic colorectal cancer (CCS) (58.5%). Proportions of probands with multiple colonic tumours were highest in HNPCC (57.1%), but present in AFACC (12.5%) and CCG (20.0%) groups, as well. Extracolonic, in particular endometrial and ovarian cancers have been found in HNPCC and AFACC probands. Tumours of proximal colon were most frequent in HNPCC, suspected HNPCC, CCG patients. Eleven-years survival rate was higher in HNPCC probands then in CCS group. Familial cancer risk in HNPCC was 3 times as much as in CCG + CCS groups. Diagnosis of colorectal cancer under 55 years of age is associated with an high frequency of hereditary or familial cases. Genetic tests, surveillance and screening programs in these patients must be based on extensive phenotype and pedigree analyses. HNPCC is widely represented in young colorectal cancer patients and is associated with a high risk of multiple synchronous or metacronous colonic and extracolonic tumours. Total colectomy and eventual hysterectomy with bilateral oophorectomy seem therefore recommendable options in these patients.     

A study of familial non-polypotic colorectal cancer

The family history of colorectal cancer was examined in 601 patients with non-polypotic colorectal cancer. 33 (5.5 per cent) of these patients were found to have a family history. Colorectal cancer was found significantly more often in the families of those patients with the disease rather than in those with gastric cancer (5.5 per cent vs 3.0 per cent). The mean age was younger by five years in the patients with a family history than in those with no family history. The incidence of young patients, multiple cancers, and other cancers in relatives was significantly higher in the patients with a family history than in those without. No significant difference in cancer sites between the two groups was seen, however, there was a preponderance of right colon cancers in the young patients with a family history. There was one particular patient with seven affected relatives in his family. In this patient, an early age of onset, the presence of multiple cancers, including a right colon cancer, the occurrence of metachronous other cancers and the fact that one of his relatives was accidentally found to have an occult colon cancer were noteworthy. It is important to survey the family members of patients, especially the young ones, where there is a family history of colorectal cancer.     

There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study

Aim This study was designed to assess the relationship between diverticulitis and the development of colorectal cancer (CRC) and colonic adenomas. Method A retrospective study was longitudinally conducted. Patients who had been admitted to the hospital between 1990 and 2000 with diverticulitis were retrieved and the incidence of CRC and prevalence of colonic adenomas in these patients was determined. Data were collected from the electronic clinical and pathology records. The incidence of CRC and prevalence of adenomas in this patient cohort was compared with the general population. The patients were followed until 2008. Results A total of 288 patients with diverticulitis were included (167 of whom were female patients [58%]). The mean age of patients at admittance for diverticulitis was 66 years (range: 27–92). CRC was detected in five patients (1.7%) (95% CI 0.8–3.5) with a mean age of 77 years; colonic adenomas were found in 18 patients (6.3%) (95% CI 4.3–9.0) with a mean age of 62 years. The lifetime risks of developing CRC and adenomas were presumed to be 4% and 20% respectively. Expected rates for CRC and adenomas in our patients were calculated as 17 (95% CI 4.0–8.6) and 69 patients (95% CI 20.1–28.3) respectively. Conclusion This study showed a lower prevalence of CRC and colonic adenomas in patients with diverticulitis compared with the lifetime risk which means that diverticulitis is not a risk factor for development of CRC and adenomas. Long‐term colonic screening after a negative colonoscopy for diverticulitis (generally performed several weeks after recovery) does not seem to be justified.     

Surgery for neoplastic changes in ulcerative colitis – can limited resection be justified? Outcome for patients who underwent limited surgery

BACKGROUND: Patients with ulcerative colitis (UC) are at an increased risk of developing colorectal cancer (CRC). The aim of this study was to investigate the outcome for the patients who underwent limited resection of the colon and/or rectum instead of panproctocolectomy (PPC), with special attention to those with neoplastic changes. METHODS: Since 1977, all known patients with UC from our catchment area have been included in our surveillance programme. A total of 210 patients with UC have been followed up with regular colonoscopies and biopsies. Indications for surgery were severe therapy-resistant disease (TRD), high-grade dysplasia (HGD), CRC or repeated findings of low-grade dysplasia (LGD). Patient compliance was excellent. RESULTS: Fifty-one patients were operated on. In 29 of these patients, PPC was performed initially. At the end-point of the study, additionally seven patients had been radically operated on and three more patients planned to undergo such an operation. Accordingly, 22 patients had their first operation performed as a resection of either a part of or the whole colon or rectum. In this group, there were four patients diagnosed with CRC and three with dysplasia-associated lesion or mass (DALM). One of them died 6 months after surgery because of disseminated CRC, whereas the other patients were alive at the end-point of the study. One of these seven patients with CRC or DALM had at end-point been radically operated on and two patients were awaiting such a procedure (in two patients because of LGD and in one patient because of TRD). Six of the patients who had a colorectal resection performed on the indication of TRD were radically operated later on, five of them because of relapsed TRD and one patient because of LGD in the remaining rectal mucosa. Twenty-one patients gained a mean of 9.4 years with presumably better bowel function, from undergoing a limited resection instead of PPC. None of the patients who underwent a colonic and/or rectal resection died because of CRC or metachronous cancer in their remaining colon or rectum. CONCLUSION: The results of this study indicate that a limited resection of the colon and/or rectum in patients with UC, which requires surgical intervention increases the time with presumably better bowel function and may therefore be an alternative to PPC without increased risk of dying from CRC. This is dependent on the flexibility of the medical service and patient compliance.     

Early onset colorectal cancer in Canterbury,New Zealand

Background

The overall incidence of colorectal cancer is decreasing in much of the world, yet the incidence in those under 50 years of age is increasing (early onset colorectal cancer (EOCRC)). The reasons for this are unclear. This study was undertaken to describe the clinical, pathological and familial characteristics of patients with EOCRC and their oncological outcomes and compare this with previously published data on late onset colorectal cancer (LOCRC).

Methods

A retrospective review of all patients diagnosed with EOCRC in Canterbury between 2010 and 2017 was conducted. Data was collected on demographics, family history, treatment, and oncologic outcomes. Kaplan–Meier survival curves were calculated to assess overall survival based on disease stage.

Results

During the study period (2010–2017) there were 3340 colorectal cancers diagnosed in Canterbury, of which 201 (6%) were in patients under 50 years (range: 17–49). Of these, 87 (43.3%) were female and 125 (62.2%) were aged between 40 and 49 years. 28 (13.9%) were associated with hereditary conditions. Of the 201 patients, 139 (69.2%) had rectal or left-sided cancers. 142 (70.6%) patients presented with either stage 3 or 4 disease and the 5-year overall survival by stage was 79.1% and 14.4%, respectively.

Conclusion

EOCRC is increasing and usually presents as distal left sided cancers, and often at an advanced stage. They do not appear to have the common risk factors of family history or inherited pre-disposition for colorectal cancer. Planning by healthcare providers for this epidemiological change is imperative in investigating symptomatic patients under 50 and optimizing early detection and prevention.     

Is whole colonic imaging necessary for symptoms of change in bowel habit and/or rectal bleeding?

Aim Following the introduction of a 2-week-wait (2ww) cancer pathway, many units are triaging patients with change in bowel habit (CIBH) and/or rectal bleeding (RB) straight to colonoscopy. Evidence suggests that right-sided colonic cancer does not present with these symptoms, hence imaging the left colon only is satisfactory. If this were substantiated, patients could be offered a flexible sigmoidoscopy (FS) alone. This study aimed to review presenting symptoms of patients diagnosed with a right-sided colonic malignancy and assess whether their tumours would be missed based on this practice. Method This is a retrospective analysis of patients who underwent curative resection for a proximal colonic malignancy over a 4-year period. Two-week-wait referral proforma and case notes were analysed for mode of presentation. Results Of 206 elective right hemicolectomies performed, 20/206 (9.7%) patients presented in the absence of either iron deficiency anaemia or palpable abdominal mass. Twelve patients had polyposis identified in the left colon and eight patients had no left-sided colonic pathology. One patient had a strong family history of colon cancer (two first-degree relatives) in the group absent of left-sided pathology. Conclusion Twelve patients who had left-sided polyposis and one patient with a strong family history would have undergone whole colonic imaging based on current colorectal cancer management guidelines. The remaining seven patients with right-sided cancer would have been missed if FS were the only investigation used. Patients presenting on the 2ww with symptoms of a CIBH and/or RB can be adequately investigated with a FS with a 3% chance of missing a proximal cancer.     

Krukenberg tumours of colorectal origin: Experience of a tertiary referral centre and review of the literature

Aim: Krukenberg tumours are tumours of the gastrointestinal tract that metastasize to the ovary. The condition is uncommon and accounts for 5 per cent of ovarian tumours. It is our objective to describe the outcome of patients after resection of Krukenberg tumours of colorectal origin. Patients and Methods: The present study is a retrospective review of 20 patients with resection performed for Krukenberg tumours of colorectal origin from November 1996 to April 2010 at Queen Elizabeth Hospital, Hong Kong, China. Results: The most common colonic primary site was sigmoid colon (40 per cent). Thirteen patients (65 per cent) had T4 tumours. Ten patients (50 per cent) had synchronous tumours. Seven patients (35 per cent) had bilateral ovarian involvement. Nine patients (45 per cent) had elevated serum carcinoembryonic antigen levels. The median carbohydrate antigen 125 (was 57 U/mL (range: 12–850 U/mL). Seven patients (35 per cent) developed metastases after ovarian resection. The most common sites were intra‐abdominal lymph nodes (15 per cent), bone (15 per cent) and liver (10 per cent). The overall 3‐ and 5‐year survival rates after ovarian resection were 40 per cent and 25 per cent, respectively. Right colon cancer (30 per cent right colon vs 60 per cent left colon vs 10 per cent rectum, P = 0.021) and T4 staging of the colonic primary (30 per cent T3 vs 65 per cent T4, P = 0.033) were found to be poor prognostic factors for survival. Conclusion: Although recurrence after resection of Krukenberg tumours is common, bilateral salpingo‐oophorectomy should still be considered. A more aggressive approach, such as debulking surgery or metastasectomy, is also recommended to improve the outcome of these patients.     

Lifestyle factors and colorectal cancer risk (1): systematic review and meta-analysis of associations with body mass index

Objective  Excess body weight, defined by body mass index (BMI), may increase the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we undertook a systematic review and meta-analysis of prospective observational studies to quantify colorectal cancer risk associated with increased BMI and explore for differences by gender, sub-site and study characteristics.
Method  We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. Random-effects meta-analyses and meta-regressions of study-specific incremental estimates were performed to determine the risk ratio (RR) and 95% confidence intervals (CIs) associated with a 5 kg/m² increase in BMI.
Results  We analysed 29 datasets from 28 articles, including 67 361 incident cases. Higher BMI was associated with colon (RR 1.24, 95% CIs: 1.20–1.28) and rectal (1.09, 1.05–1.14) cancers in men, and with colon cancer (1.09, 1.04–1.12) in women. Associations were stronger in men than in women for colon ( P  < 0.001) and rectal ( P  = 0.005) cancers. Associations were generally consistent across geographic populations. Study characteristics and adjustments accounted for only moderate variations of associations.
Conclusion  Increasing BMI is associated with a modest increased risk of developing colon and rectal cancers, but this modest risk may translate to large attributable proportions in high-prevalence obese populations. Inter-gender differences point to potentially important mechanistic differences, which merit further research.     

Colorectal cancer patterns of care in the Western Sydney and Wentworth Area Health Services

INTRODUCTION: Colorectal cancer is a leading cause of morbidity and mortality in Australia. Recent clinical trials show that the recurrence of colorectal cancer decreases with chemotherapy and/or radiotherapy in advanced disease. The present study aimed to document the patterns of care by the type of treatment, document the preoperative investigations and provide results to the Area Health Services. METHODS: A prospective data collection was initiated in May 1994 and ended in May 1996 in the Western Sydney and Wentworth Area Health Services of New South Wales. Deaths and recurrences were followed up until July 2002. RESULTS: There were 253 colon cancers, 107 rectal cancers and 10 patients with tumours in both the colon and rectum. Forty-one surgeons performed 299 curative procedures with 78% of them performing one to four procedures annually. One hundred and twenty-two patients had non-fatal complications and six (2%) died postoperatively. Twenty-eight per cent of rectal cancer patients underwent abdomino-perineal resection and 56% underwent low anterior resection. Forty-five per cent of rectal cancer patients and 51% of colon cancer patients who were potentially eligible received appropriate adjuvant therapy. Ninety-one per cent of patients who received chemotherapy had no or mild toxicity. By the end of follow-up period, 30% of rectal cancer patients and 24% of colon cancer patients had developed recurrence. At last follow up, 197 patients had died. Median overall survival from time of diagnosis was 73 months. Overall 5-year survival for colonic and rectal cancers was 50% and 57%, respectively. For the 299 patients who had curative procedures, the 5-year survival was 63% and 62% for colonic and rectal cancers, respectively. CONCLUSION: Colorectal cancer patients who were eligible for and received adjuvant therapy had significantly better survival. Rectal cancer patients whose tumours only required low anterior resection had a better survival than those who needed an abdomino-perineal resection. High-volume surgeons have less postoperative complications than low-volume surgeons. The high proportion of late presentations seen in colon cancer patients supports the need for screening to improve early detection.     

Metachronous colorectal cancer risk in patients with a moderate family history

Aim Lifetime risk of a metachronous colorectal cancer (mCRC) is 0.6–3% following sporadic colorectal cancer (CRC) and 15–26% in Lynch syndrome. The lifetime incidence of CRC in individuals with moderate familial risk is 8–17%. Risk of mCRC is unknown. Method A retrospective longitudinal study of the Regional Familial CRC Registry was performed. Patients who had at least one CRC were categorized as follows: moderate risk (n = 383), Lynch syndrome (n = 528) and average (population) risk (n = 409). The Kaplan–Meier estimate (1‐KM) and the cumulative incidence function were used to calculate the risk of mCRC. The 1‐KM gives the risk for individuals remaining at risk (alive) at a given time point and thus is useful for counselling. The cumulative incidence function gives the risk for the whole population. Results The 1‐KM and the cumulative incidence function demonstrated that the risk of mCRC was significantly higher in moderate‐risk patients compared with average (population)‐risk patients (1‐KM, P = 0.008; cumulative incidence function, P = 0.00097). However, the risk of mCRC was higher in patients with Lynch syndrome than in moderate‐risk or average (population)‐risk patients. The 1‐KM in moderate‐risk patients was 2.7%, 6.3% and 23.5% at 5, 10 and 20 years, respectively. In average (population)‐risk patients, the 1‐KM was 1.3%, 3.1% and 7.0% at 5, 10 and 20 years, and the cumulative incidence function was 0.3%, 0.6% and 2.4% at the same time points, respectively. Conclusion These data indicate that the risk of mCRC is significantly higher in patients with a moderate family history of CRC than in those with an average (population) risk. This justifies proactive lifelong surveillance.