Colorectal cancer before 45 years of age]

Colo-rectal cancer in young patients is a subject of interest for many reasons. Various studies are devoted to this subject but controversies regarding the stages, the evolution and the prognosis still remains. We present intermediate results, of an ongoing study, which is directed to those particular aspects of colon cancer of the patients less than 45 years of age in a region where the global incidence of the disease is one of the highest in the world. In the past five years, we have observed 602 patients with colon cancer. 23 of them (4%) were less than 45 years old. The age at diagnosis was 38 +/- 6 years. Two-thirds of the subjects were male. 13% had had predisposing conditions for colon cancer such as FAP, ulcerative colitis or Turcot syndrome; 50% had a positive familial history for cancer. Symptoms lasted for less than 3 months in two thirds of the patients. 15% had a right sided tumor, 38% were located in the sigmoid and 28.5% in the rectum. At diagnosis, the tumors were classified as follows: 32% Dukes B, 23% Dukes C and 40% were disseminated disease. Most of them were located in the rectum, but 43% of Dukes B lesions were located in ascending or transverse colon. Grading reveal moderately to poorly differentiated tumors in 3/4 of cases. 30% of patients received an adjuvant therapy. After two years, 70% of the patients were alive. None of them with Dukes A or B but one of the patients with Dukes C were dead.(ABSTRACT TRUNCATED AT 250 WORDS)     

Breast cancer in women under 35 years of age

A review was undertaken of 226 patients with primary breast carcinoma who were 35 years of age, or younger, from 1960 to 1987. Comparisons to other studies of young and older women were made for clinical, pathologic, and survival characteristics. Young patients with breast cancer share many of the same disease characteristics of tumor type, location, size, and nodal involvement as their older counterparts. Five- and 10-year survival rates were comparable for patients with stage I or stage II disease and negative axillary lymph nodes. However, patients with stage II disease and positive nodes appear to have a decreased survival compared with older patients.     

Breast cancer in advanced age

The incidence of breast carcinoma increases with advancing age. In view of the progressive aging of the population, this problem will tend to become more and more frequent. At present, patients of advanced age are often "undertreated" owing to the mistaken prejudice that older patients are unable to withstand standard multimodal therapy for this disease. In fact, there is no scientific evidence to that effect. Treatment choices should therefore be largely comparable to those adopted in younger patients. Even chemotherapy, which encounters the strongest resistance, by patients but also by doctors, should be administered when indicated. A number of studies have demonstrated that the toxic and side effects observed in elderly patients are comparable to those observed in younger age groups. In practice, particular attention needs to be paid when administering cytostatic treatment to patients over 80 years of age. Very conservative treatment (tamoxifen plus radiotherapy) may be reserved only to particularly frail elderly patients. In conclusion, the therapeutic choice should depend more on assessment of the biological age, life expectancy and patient's expectations than on the anagraphic age.     

Intelligence quotient scores at the age of 6 years in children anaesthetised before the age of 5 years

We analysed the association of independent variables with non‐verbal cognition at 6 years in children with complete data (3441 from a cohort of 9901), of whom 415 were anaesthetised before the age of 5 years. Using multivariable regression, cognition was reduced by a mean (95% CI) score for children: anaesthetised before the age of 5 years, 2.1 (0.7–3.5), p = 0.004; born prematurely, 9.8 (4.1–15.4), p = 0.001; whose mothers smoked while pregnant, 2.3 (0.8–3.8), p = 0.004; whose mothers had lower IQ scores, 0.3 (0.2–0.3) for each unit reduction in maternal IQ, p < 0.0001. The association of child IQ with exposure to anaesthetic drugs was sensitive to missing data.     

Breast carcinoma in women 35 years of age or younger.

The relationship of the age at diagnosis and prognosis in breast carcinoma remains controversial. A widely held perception is that the disease has a particularly unfavorable prognosis in young women. To examine this question we have studied 166 women treated for primary operable breast carcinoma who were 35 years of age or younger at the time of diagnosis. Groups of patients treated consecutively in each of two time periods nearly a decade apart (1964-1970 and 1976-1979) have been studied. Differences between the patient groups in primary surgical treatment and postoperative adjuvant therapy were characterized in the 1970s by the increasing use of modified radical mastectomy and replacement of postoperative radiation therapy by systemic adjuvant chemotherapy. A trend to earlier stage of disease was found among patients treated in 1976 to 1979, but 5-year recurrence and survival rates were not significantly different from those of young women treated in the 1960s. Comparison of Stage II patients treated in 1964 to 1970 with postoperative radiotherapy with comparable women given adjuvant chemotherapy from 1976 to 1979 revealed no significant difference in disease-free survival in the first 3 years after surgery. It remains to be seen whether these changes in therapy will diminish the frequency of recurrences after 5 years, leading to an improvement in overall survival. When compared with historical controls from this and other institutions, the 5-year and 10-year survival rates of approximately 75% and 60%, respectively, found in this study of young women with primary operative disease were not appreciably different from those of women treated for breast cancer at a later age when the disease is more common.     

Colorectal cancer surveillance after age 65 years

BACKGROUND: It would be valuable to determine whether or not asymptomatic patients 60 to 65 years of age with normal colonoscopies should continue to undergo serial colorectal cancer surveillance examinations. METHODS: Data were obtained from retrospective review of our existing database. Additional data were obtained from patients' medical records, office charts, and pathology reports. In situ endoscopic measurements were performed using a biopsy forceps that was 7 mm when fully extended. RESULTS: Over the past 25 years, 699 asymptomatic patients between 60 and 65 years of age underwent colonoscopies which revealed no pathology. As part of their routine continuing colorectal surveillance and without any prior abnormal endoscopic findings, 56 of these patients underwent a total of 123 colonoscopies after age 65. Thirty-seven patients (66%) had surveillance colonoscopies that continued to be normal while 13 patients (23%) were diagnosed with colorectal adenomas and 6 patients (11%) were found to have hyperplastic polyps. No cancers were discovered. CONCLUSIONS: Patients over the age of 65 should continue to undergo colorectal surveillance even if prior examinations have been negative.     

40岁以下女性乳腺癌

我院１９８２年至１９９１年间手术治疗并经病理证实的原发性乳腺癌６５５例，分析比较４０岁以下的年青组乳癌与４０岁以上年长组乳癌在肿瘤发生部位，手术方式，淋巴结转移率，病理类型等五个方面，结果表明两组无明显差别。     

Breast cancer in women under 40 years of age: A series of 57 cases from Northern Ireland

BackgroundThere are few studies examining breast cancer in women under the age of 40 years, particularly in western European populations. Such tumours are reported to be more aggressive, possibly due to a different pathophysiology compared to older patients.MethodsWe performed a retrospective review of all women less than 40 years of age, diagnosed or treated with breast cancer, from June 2001 to June 2007 to assess pathophysiological factors that may influence clinical outcome and prognosis including patient demographics, clinical presentation, pre-operative investigations, surgical and pathological findings, treatment and outcome.ResultsFifty-eight women (mean age 34.9 years, range 27–39 years) were identified. One patient was excluded due to incomplete data; 98.2% (n = 56) patients presented directly to our symptomatic clinic; 89.5% (n = 51) patients had a palpable lump; 71.9% (n = 41) patients had no family history. Mammography was less sensitive than ultrasound (64.3% vs. 82.4%) while fine needle aspiration cytology was 92.5% sensitive for malignancy. Twenty-nine (50.9%) patients underwent breast-conserving surgery (BCS) of which 7 proceeded subsequently to completion mastectomy due to involved margins. Twenty-six (45.6%) patients required total mastectomy primarily while 2 (3.5%) patients were treated palliatively due to metastatic disease. The mean tumour size (nearest resection margin) was 2.13 cm (2.58 mm) for BCS and 3.95 cm (6.38 mm) for mastectomy. From a total of 55 primary resections, 85.5% (n = 47) of tumours were invasive ductal carcinoma; 57.4% (n = 31) and 40.7% (n = 22) were grade II and III tumours respectively. Lymphovascular invasion was identified in 50.9% (n = 28) while 40.0% (n = 22) were lymph node positive for metastatic disease. 76.8% (n = 43), 39.3% (n = 22) and 30.2% (n = 16) were oestrogen, progesterone and human epidermal growth factor receptor-2 positive respectively. The mean Nottingham prognostic index was 4.37 (range 2.2–8.4). Neo-adjuvant and adjuvant chemotherapy was administered to 9.3% (n = 5) and 80.0% (n = 44) of surgically treated patients respectively while 76.4% (n = 42) patients received adjuvant radiotherapy. 76.4% (n = 42) of patients were treated with tamoxifen. Four patients received Herceptin® therapy. Statistically significant univariate factors adversely associated with overall survival were time from referral to out-patient department attendance (p = 0.038), administration of neo-adjuvant treatment (p = 0.019), surgical intervention (p < 0.001), progesterone receptor positivity (p = 0.018) and tumour recurrence (p < 0.001). 86.0% (n = 49) patients were alive at mean follow-up of 52 months; 82.5% (n = 47) remain disease free.ConclusionOur study reports a low familial trait rate combined with a high proportion of hormonally active tumours less than grade III which suggests that breast cancer in this series of young women from Northern Ireland may be less aggressive and more hormonally responsive than anticipated.     

Bladder cancer in patients under fifty years of age

Fifty-five cases of carcinoma of the bladder in the age group under fifty years have been reviewed. Seventy three percent of their tumors were low grade and low stage transitional cell carcinoma. Mainly, TUR was performed on these patients and their five year relative survival rate was 97.6%. The recurrence rate after TUR was 16%.     

Gastric cancer in patients above 70 years of age

Clinical records of 406 patients over 70 years of age with gastric cancer operated on during the past 22 years were analyzed. These cases amounted to 11.8% of the 3,425 patients with gastric cancer treated surgically at our hospitals during the same period. The primary tumor was confined to the upper one-third portion of the stomach in 15.8% of the cases, which was significantly higher than that usually reported. Macroscopic staging of the lesion revealed that more than two-thirds of the patients were suffering from highly advanced disease. The size of the tumor was larger than 50 mm in diameter in 50.8% of the cases. The tumor was predominantly of Borrmann II and III types. Early gastric cancer was observed in only 14.8% of the cases, which was approximately one-half of the usual rate. However, histological study revealed well-differentiated adenocarcinoma in two-thirds of the lesions, a remarkable characteristic of gastric cancer in the elderly. Resection was possible in 70.9%, and curative resection was performed in 46.8%. The over-all hospital mortality rate was 16.5%. The prognosis of curative resection cases yielded a 5-year survival rate of 51.5% and 10-year survival rate of 25.5%. These results would justify the practice of early diagnosis and aggressive surgery in every acceptable risk patient, if no contraindication exists.

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Resumen Se analizaron las historias clinicas de 406 casos de cáncer gástrico en pacientes mayores de 70 años operados en el curso de los últimos 22 años. Tales casos representaron el 11,8% del total de 3 425 de cáncer gástrico sometidos a cirugía en nuestros hospitales durante el mismo periodo.El tumor primario apareció confinado al tercio superior del estómago en 15,8% de los casos, lo cual es significativamente mayor de lo que se informa usualmente.La clasificación macroscópica del estado de la lesión reveló que más de dos tercios de los pacientes padecían de enfermedad neoplásica extremadamente avanzada. El tamaño de la lesión fue de un diámetro mayor de 50 mm, en el 50,8% de los casos, y el tumor demostró ser predominantemente de los tipos Borrmann II y III. Cáncer gástrico temprano se observó sólo en el 14,8% del total de casos, lo cual representa aproximadamente la mitad de la tasa ordinaria. Sin embargo, el estudio histológico reveló un carcinoma bien diferenciado hasta en dos tercios de la totalidad de las lesiones, una característica verdaderamente notable del cáncer gástrico en el anciano.La resección fué posible en el 70,9% y la resección curativa en el 46,8% de los casos. La tasa global de mortalidad hospitalaria fué de 16,5%. En cuanto a pronóstico, la tasa de supervivencia a cinco años para las resecciones curativas fue de 51,5% y la tasa de supervivencia a 10 años fue de 25,5%.Los anteriores resultados justifican la práctica de un diagnóstico precoz y de conducta agresiva para lograr la operación exploratoria en todo paciente de riesgo aceptable cuando no existan contraindicaciones absolutas.

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Résumé Les dossiers cliniques de 406 cas de cancer gastrique opérés au cours des 22 dernières années chez des malades âgés de plus de 70 ans ont été étudiés. Ces cas représentent 11,8% des 3 425 cancers gastriques qui ont été opérés dans les formations hospitalières des auteurs au cours de la même période.La tumeur siégeait au niveau du tiers supérieur de l'estomac dans 15,8% des cas, ce taux étant supérieur au taux habituel.L'étude macroscopique de la tumeur a montré que deux tiers des malades présentaient des lésions très importantes. Le diamètre de la tumeur dépassait 50 mm dans 50,8% des cas et répondait le plus souvent au type II et au type III de la classification de Borrmann. Le cancer dit précoce ne fut observé que dans 14,8% des cas seulement, ce qui répond approximativement à la moité du taux habituel. L'étude histologique, pour sa part, a montré que dans les deux tiers des cas l'adénocancer était de type indifférencié, fait caractéristique du cancer du sujet âgé.La résection fut possible dans 70,9% des cas et une exérèse à but curatif fut réalisée dans 46,8% des cas. La mortalité postopératoire fut de 16,5 pour cent. L'exérèse à but curatif s'est soldée par un taux de survie à 5 ans de 51,5% et un taux de survie à 10 ans de 25,5%.Ces résultats plaident en faveur d'un diagnostic précoce du cancer et d'une attitude thérapeutique entreprenante qui implique de pratiquer une laparotomie systématique en l'absence de contre-indication d'ordre général dès que le cancer de l'estomac est diagnostiqué.Au cours des dernières années la fréquence du cancer gastrique a augmenté parallèlement à la durée de la vie. Il convient dès maintenant de définir les caractères spécifiques qui sont susceptibles de permettre le diagnostic précoce du cancer gastrique du sujet âgé.

     

Renal replacement therapy for end-stage renal failure before 2 years of age.

This report concerns 296 children (67% males and 33% females) from 24 countries who started renal replacement therapy (RRT) for end-stage renal failure between 1969 and 1988. Children under 2 years of age represented 3.6%, 4.4%, and 8.9% of all children under 15 years of age who started RRT in 1978-1982, 1983-1985, and 1986-1988 respectively. During the first 2 years of life, the most frequent causes of end-stage renal failure were renal hypoplasia and dysplasia (24%), and haemolytic-uraemic syndrome (17%). During 1986-1988 the initial therapy for ESRF was continuous ambulatory peritoneal dialysis (CAPD) in 60%, haemodialysis 25%, intermittent peritoneal dialysis 8%, and 7% were transplanted without prior dialysis. Between 1978 and 1988, 139 of these children were grafted; 53 received a graft (39 cadaveric, 10 living donor, 4 donor uncertain) below, and 86 (71 cadaveric, 14 living donor, 1 donor uncertain) above 2 years of age. One-year graft survival was 54% in the 53 children grafted below 2 years of age and 65% in the 86 grafted above 2 years of age. Only two of the 24 living donor grafts were lost during the first year after grafting. These results compare favourably with the 67% 1-year graft survival of all 278 children aged 2 to less than 6 years at grafting in 1978-1988 on the Registry's file. The 3-year survival of all children aged less than 2 years at start of RRT was 65% in 1978-1982 and rose to 78% in 1986-1988. Twenty-three percent of all deaths were caused by infections.(ABSTRACT TRUNCATED AT 250 WORDS)