Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Porast incidencije raka debelog crijeva kod osoba <50 godina – populacijska studija

PURPOSE: Data on the incidence of colorectal cancer (CRC) is conflicting, and it is unknown if the incidence is constant, declining, or increasing. Proximal colon cancer is considered to be more common among older individuals, but recent data have shown that rectal cancer and distal colon cancer have been increasing in the younger population. The aim of this study was to determine the trends regarding CRC incidence and tumour location in Sweden. ----- METHODS: CRC statistics from the National Board of Health and Welfare 1995–2015 were used. CRC incidence rates by age group (<50 years, 50–79 years, ≥80 years), sex, and tumour localisation (proximal colon, distal colon, or rectum) were calculated and analysed using Poisson regression. ----- RESULTS: The age-standardised incidence of CRC increased in Sweden during the study period. This increase was significant (P<0.0001) for colon cancer during the study period for all age groups regardless of tumour localisation. The greatest increase (27–52% per decade) in the colon cancer incidence rate was seen among men and women <50 years of age. The incidence rate for rectal cancer increased for men <50 years (P<0.0001), decreased for both men and women aged ≥80 years (P<0.005), and did not change for the remaining groups. ----- CONCLUSIONS: The CRC incidence in Sweden, in particular colon cancer, is increasing regardless of tumour localisation for individuals <50 years of age. This paper supports the implementation of population-based colorectal cancer screening. A diagnostic workup should be performed in symptomatic individuals <50 years of age.SVRHA: Podaci o incidenciji kolorektalnog raka su proturiječni i nije poznato je li incidencija konstantna, opadajuća ili rastuća. Rak proksimalnog debelog crijeva smatra se češćim među starijim osobama ali nedavni podaci pokazuju da se rak stražnjeg debelog crijeva i rak distalnog debelog crijeva povećavaju u mlađoj populaciji. Svrha ovog istraživanja je bila odrediti trendove što se tiče incidencije kolorektalnog raka i lokacije tumora u Švedskoj. ----- METODE: Korišteni su statistički podaci kolorektalnog raka iz Naciolnalnog ministarstva za zdravlje i socijalnu skrb 1995-2015. Stopa incidencije kolorektalnog raka prema dobnoj skupini (<50 godina, 50-79 godina, ≥80 godina), spolu i lokaciji tumora (proksimalno debelo crijevo, distalno debelo crijevo ili stražnje debelo crijevo) su izračunati i analizirani pomoću Poissonove regresije. ----- REZULTATI: Dobna standardizirana incidencija kolorektalnog raka povećala se u Švedskoj tijekom razdoblja istraživanja. Ovaj porast bio je signifikantan (P<0.0001) za rak debelog crijeva tijekom istraživanog razdoblja za sve dobne skupine bez obzira na lokaciju tumora. Najveći porast (27-52% /desetljeće) stope incidencije raka debelog crijeva viđen je među muškarcima i ženama mlađim od 50 godina. Stopa incidencije raka stražnjeg debelog crijeva porasla je za muškarce <50 godina (P<0.0001), smanjila se i za muškarce i za žene u dobi ≥80 godina (P<0.005) i nije se promijenila za preostale skupine. ----- ZAKLJUČAK: Incidencija kolorektalnog raka u Švedskoj, posebno raka debelog crijeva, raste bez obzira na lokaciju tumora za osobe mlađe od 50 godina. Ova studija podržava uvođenje populacijski baziranog probira za kolorektalni rak. Diagnostičku obradu treba vršiti kod simptomatskih osoba mlađih od 50 godina

Porast incidencije raka debelog crijeva kod osoba <50 godina – populacijska studija

PURPOSE: Data on the incidence of colorectal cancer (CRC) is conflicting, and it is unknown if the incidence is constant, declining, or increasing. Proximal colon cancer is considered to be more common among older individuals, but recent data have shown that rectal cancer and distal colon cancer have been increasing in the younger population. The aim of this study was to determine the trends regarding CRC incidence and tumour location in Sweden. ----- METHODS: CRC statistics from the National Board of Health and Welfare 1995–2015 were used. CRC incidence rates by age group (<50 years, 50–79 years, ≥80 years), sex, and tumour localisation (proximal colon, distal colon, or rectum) were calculated and analysed using Poisson regression. ----- RESULTS: The age-standardised incidence of CRC increased in Sweden during the study period. This increase was significant (P<0.0001) for colon cancer during the study period for all age groups regardless of tumour localisation. The greatest increase (27–52% per decade) in the colon cancer incidence rate was seen among men and women <50 years of age. The incidence rate for rectal cancer increased for men <50 years (P<0.0001), decreased for both men and women aged ≥80 years (P<0.005), and did not change for the remaining groups. ----- CONCLUSIONS: The CRC incidence in Sweden, in particular colon cancer, is increasing regardless of tumour localisation for individuals <50 years of age. This paper supports the implementation of population-based colorectal cancer screening. A diagnostic workup should be performed in symptomatic individuals <50 years of age.SVRHA: Podaci o incidenciji kolorektalnog raka su proturiječni i nije poznato je li incidencija konstantna, opadajuća ili rastuća. Rak proksimalnog debelog crijeva smatra se češćim među starijim osobama ali nedavni podaci pokazuju da se rak stražnjeg debelog crijeva i rak distalnog debelog crijeva povećavaju u mlađoj populaciji. Svrha ovog istraživanja je bila odrediti trendove što se tiče incidencije kolorektalnog raka i lokacije tumora u Švedskoj. ----- METODE: Korišteni su statistički podaci kolorektalnog raka iz Naciolnalnog ministarstva za zdravlje i socijalnu skrb 1995-2015. Stopa incidencije kolorektalnog raka prema dobnoj skupini (<50 godina, 50-79 godina, ≥80 godina), spolu i lokaciji tumora (proksimalno debelo crijevo, distalno debelo crijevo ili stražnje debelo crijevo) su izračunati i analizirani pomoću Poissonove regresije. ----- REZULTATI: Dobna standardizirana incidencija kolorektalnog raka povećala se u Švedskoj tijekom razdoblja istraživanja. Ovaj porast bio je signifikantan (P<0.0001) za rak debelog crijeva tijekom istraživanog razdoblja za sve dobne skupine bez obzira na lokaciju tumora. Najveći porast (27-52% /desetljeće) stope incidencije raka debelog crijeva viđen je među muškarcima i ženama mlađim od 50 godina. Stopa incidencije raka stražnjeg debelog crijeva porasla je za muškarce <50 godina (P<0.0001), smanjila se i za muškarce i za žene u dobi ≥80 godina (P<0.005) i nije se promijenila za preostale skupine. ----- ZAKLJUČAK: Incidencija kolorektalnog raka u Švedskoj, posebno raka debelog crijeva, raste bez obzira na lokaciju tumora za osobe mlađe od 50 godina. Ova studija podržava uvođenje populacijski baziranog probira za kolorektalni rak. Diagnostičku obradu treba vršiti kod simptomatskih osoba mlađih od 50 godina

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

ImportanceThe incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.ObservationsWithin the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.Conclusions and relevanceThe clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

ImportanceThe incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.ObservationsWithin the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.Conclusions and relevanceThe clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

BackgroundImpairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (&lt;50 years) is rising, there is little data on functional outcomes in this group.MethodsThe REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, &lt;50 years of age at time of diagnosis and with documented follow-up including functional outcomes.ResultsA total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%).ConclusionA substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response

No abstract available

Impact of microsatellite status in early-onset colonic cancer

Background: The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Methods: Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. Results: A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). Conclusion: Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers