The Challenge of Metastatic Colorectal Cancer

Colorectal cancer (CRC) is a very common disease with a high rate of mortality around the world, representing the second most frequent cause of cancer-related death. As the majority of patients are diagnosed with advanced cancer with a subsequent low five-year survival rate (10%), it is imperative to develop new strategies to treat this challenging patient population. Traditionally, patients received successive lines of chemotherapy and discontinued the treatment or switched to a different one in the event of disease progression. But despite the therapeutic advances achieved with combination chemotherapy regimens, particularly FOLFOX and FOLFIRI, considerable research has been necessary to further optimize chemotherapy for patients with metastatic colorectal cancer (mCRC). However, progress has been achieved over recent years. The most relevant relates to the approval of several new effective therapeutic drugs, such as monoclonal antibodies, which have greatly improved the outcomes for metastatic disease. The last agent approved has been panitumumab, which has been designed to target the epidermal growth factor receptor molecular pathway involved in the appearance and spread of cancer

Pilot Study of a Clinical Pathway Implementation in Rectal Cancer

Background Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs. Methods We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway. Results We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good. Conclusions Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients

Evaluación de dos estrategias de seguimiento del cáncer de colon desde el punto de vista del coste-efectividad

Este trabajo tiene como objetivo la evaluación comparativa desde el punto de vista del coste-efectividad de dos estrategias de seguimiento del Cáncer de Colon llevadas a cabo en el Servicio de Oncología del Hospital Clínico Universitario de Valladolid. Para ello se realizó un estudio retrospectivo de dos grupos de pacientes intervenidos quirúrgicamente en el periodo 2000-2001 sometidos a dos estrategias de seguimiento diferenciadas de acuerdo a la periodicidad: Grupo 1 o estándar y grupo 2 o minimalista. Se consideró la perspectiva hospitalaria para el análisis de los costes y de la efectividad. Los resultados obtenidos muestran que la modalidad de seguimiento más coste-efectiva es la minimalista. Estos resultados se mantienen relativamente estables tras la aplicación del análisis de sensibilidad excepto al aplicar la variación de costes con eliminación de los costes innecesarios que favorece a la estrategia estándar. De acuerdo a los resultados obtenidos sería interesante la realización de un análisis prospectivo para extraer conclusiones definitivas.Departamento de Anatomía y Radiologí

Life after Breast Cancer: Dealing with Lymphoedema

Background In recent years, breast cancer (BC) mortality rates have declined, reflecting advances in early detection. Prevention and management of treatment sequelae that could impair function or quality of life have increased in relevance. Lymphoedema after BC treatment is one of these sequelae. It is caused by an acquired interruption or damage to the axillary lymphatic system and it is characterized by an abnormal accumulation of fluids and other substances in the tissue. Purpose We observed a group of patients with incidents of BC aiming to estimate the lymphoedema incidence, degree, time course, symptoms and treatment they received. Methods and Results We evaluated 127 women. Median age was 58 years. 66% were postmenopausal. The median number of axillary nodes was 9. Over the first five years of follow-up we were informed about hand/arm swelling, thickness or tiredness by 37% of this group. The median of axillary nodes affected by metastatic cells in our patients with lymphoedema was 6. The symptoms they referred to us as the most relevant were heaviness (33%), tiredness (27%), jewelry or clothing too tight (25%), swelling and indentations (9%) and difficulty writing (6%). Several of them had psychological problems. Conclusion We know of the relevance of lymphoedema in BC patients but its natural history and most effective therapies are poorly understood. Self-reported symptoms are relevant to promptly start therapy

Gastric cancer: predictors of recurrence when lymph-node dissection is inadequate

<p>Abstract</p> <p>Background</p> <p>The TNM classification (sixth edition) requires at least 15 lymph nodes to be examined to allow an accurate staging. However, in our environment, only 20% of patients have the recommended minimum of 15 nodes removed.</p> <p>Purpose</p> <p>To evaluate clinicopathological predictors of recurrence in patients with gastric cancer undergoing radical resection with an inadequate number of lymph nodes examined.</p> <p>Methods</p> <p>101 patients were included in this retrospective cohort. We evaluated age, gender, tumoral location, Borrmann type, Lauren histotype, type of gastrectomy, grade, invasion depth of tumor, lymph node involvement, ratio between metastatic and total number of excised lymph nodes keeping 20% as the cutoff value (LNR) and adjuvant treatment. The association between these variables and recurrence was investigated by using univariate methods and multivariate logistic regression analysis.</p> <p>Results</p> <p>Median (range) age was 63 years (44-85). 63% males, 37% females. Median follow-up time for the whole patients population was 36 months (10-104). Median number of lymph nodes retrieved was 6 (0-14). Recurrence: 50 of 101 cases (49,6%); 41 hematogeneus dissemination, 9 locoregional recurrences. The following factors were found to be correlated with the recurrence risk: tumoral location, invasion depth of tumor, lymph node involvement and LNR. A multivariate analysis revealed that depth of invasion [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.03-7.58, P = 0.04] and LNR (OR 2.34, 95% CI 1.05-5.21, P = 0.03) were independent risk factors for recurrences of gastric cancer. Median time to recurrence: 16 months (2-50). 82% of recurrences occurred within the first two years after surgical treatment. The estimated cumulative risk of recurrence at five years: 61% in the whole patients population, with serosal invasion and LNR > and < 20% was 82% and 44%, without serosal invasion 73% and 39% respectively.</p> <p>Conclusion</p> <p>Invasion depth of tumor and LNR were independent predictors of recurrence in gastric cancer after potentially curative resection with an inadequate number of lymph nodes examined.</p

Distinctive accumulation patterns of trace elements in sediments of bedrock rivers (Miño river, NW Iberian Peninsula)

Sediment compositions and enrichment patterns are investigated in an urban reach of a bedrock river, the Miño River passing through Ourense City, Spain. This study focuses on the trace element distribution in different fractions to gain insights into trace element enrichment. To assess enrichment, a context-specific approach was employed, based on the mean, the standard deviation of the estimated background, and the empirical rule, avoiding the pitfalls of general and arbitrary thresholds. Notably, the <0.063 mm and <2 mm fractions showed differential accumulation patterns. Both fractions serve to detect enrichments that can be indicative of contamination, but they measure different things, the maturity of sediments and postdepositional processes being key factors in understanding the sediment composition and enrichments. These findings also highlight the role of rock cavities, particularly those hosting permanent deposits, as traps for trace elements and their potential significance in assessing environmental enrichment. This work contributes to understanding sediment compositions and enrichment dynamics in bedrock rivers. It also underscores the significance of considering site-specific approaches for enrichment assessment and the necessity for further research to unravel the mechanisms driving differential accumulation within distinct depositional environments.Universidade de Vigo | Ref. INOU15-02Deputación de Ourense | Ref. INOU15-02Xunta de Galicia | Ref. ED481D-2023/00

Parkinsonism secondary to metastatic lesions within the central nervous system: a case report

<p>Abstract</p> <p>Introduction</p> <p>Colorectal cancer is one of the most common human diseases worldwide, and metastases are detected in approximately 20% of patients at diagnosis. Brain metastases occur in only 4% of cases, however, and usually present with hemiparesis or other motor or sensory symptoms. There have been only a few reports of parkinsonism secondary to a brain tumor-related mass effect.</p> <p>Case presentation</p> <p>We present an unusual case of parkinsonism secondary to multiple brain metastases. A 57-year-old Caucasian man had recently been diagnosed with primary carcinoma of the colon and had multiple metastases in the lungs and liver. He subsequently developed bilateral symmetrical parkinsonism, and multiple brain tumors were detected by computed tomography scanning. The condition of our patient deteriorated rapidly, and he became akinetic and dependent for all activities of daily living. He was followed up and treated at home by our palliative care unit team and died two weeks after the onset of his neurologic symptoms.</p> <p>Conclusion</p> <p>Although primary and secondary brain tumors are uncommon causes of parkinsonism, their clinical presentation may resemble that of idiopathic Parkinson's disease. An awareness of this rare differential diagnosis is therefore important in ensuring early diagnosis and treatment, thus improving prognosis and quality of life. A rapid progression in neurologic symptoms was observed in our patient, and clinicians should be alert to this atypical presentation of secondary parkinsonism.</p