Fifteen-year-old colon cancer patient with a 10-year history of ulcerative colitis

Inflammatory bowel disease (IBD) is regarded as one of the risk factors for colorectal cancer, and early detection of cancer in these patients may be difficult, especially in pediatric patients. Prognosis of pediatric colorectal cancer is known to be poor, because of delayed diagnosis and unfavorable differentiation. We report a case of a pediatric patient with a 10-year history of ulcerative colitis who was diagnosed with sigmoid colon cancer when he was 15 years old. He underwent proctocolectomy with ileal pouch anal anastomosis. Postoperative pathological examination of the tumor revealed adenocarcinoma. The pericolic tissue layer was infiltrated, but metastases were not found in either of the two lymph nodes. Children with a long history of predisposing factors such as IBD need particular attention to the possibility of colorectal cancer. Early diagnosis through regular screening with colonoscopy is one of the most important critical factors for a good prognosis.

Is rectal cancer prone to metastasize to lymph nodes than colon cancer?

The biology of colorectal cancer differs according to its location within the large intestine.A report published in a previous issue of World Journal of Gastroenterology (November 2010) evaluated the importance of tumor location as a risk factor for lymph node metastasis in colorectal cancer,and showed that rectal cancer is prone to metastasize to lymph nodes as compared with colon cancer.However,in order to conclude that the tumor location is independently associated with the occurrence of lymph node metastasis,it is necessary to consider a selection bias or other patientand tumorrelated factors carefully.

Lymph node staging in colorectal cancer:Old controversies and recent advances

Outcome prediction based on tumor stage reflected by the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC)tumor node metastasis(TNM)system is currently regarded as the strongest prognostic parameter for patients with colorectal cancer.For affected patients,the indication for adjuvant therapy is mainly guided by the presence of regional lymph node metastasis.In addition to the extent of surgical lymph node removal and the thoroughness of the pathologist in dissecting the resection specimen,several parameters that are related to the pathological work-up of the dissected nodes may affect the clinical significance of lymph node staging.These include changing definitions of lymph nodes,involved lymph nodes,and tumor deposits in different editions of the AJCC/UICC TNM system as well as the minimum number of nodes to be dissected.Methods to increase the lymph node yield in the fatty tissue include methylene blue injection and acetone compression.Outcome prediction based on the lymph node ratio,defined as the number of positive lymph nodes divided by the total number of retrieved nodes,may be superior to the absolute numbers of involved nodes.Extracapsular invasion has been identified as additional prognostic factor.Adding step sectioning and immunohistochemistry to the pathological work-up may result in higher accuracy of histological diagnosis.The clinical value of more recent technical advances,such as sentinel lymph node biopsy and molecular analysis of lymph nodes tissue still remains to be defined.

Nomograms for colorectal cancer:A systematic review

AIM: To assist in the selection of suitable nomograms for obtaining desired predictions in daily clinicalpractice.METHODS: We conducted electronic searches for journal articles on colorectal cancer(CRC)-associated nomograms using the search terms colon/rectal/colorectal/nomogram. Of 174 articles initially found, we retrieved 28 studies in which a nomogram for CRC was developed.RESULTS: We discuss the currently available CRCassociated nomograms, including those that predict the oncological prognosis, the short-term outcome of treatments, such as surgery or neoadjuvant chemoradiotherapy, and the future development of CRC. Developing nomograms always presents a dilemma. On the one hand, the desire to cover as wide a patient range as possible tends to produce nomograms that are too complex and yet have C-indexes that are not sufficiently high. Conversely, confining the target patients might impair the clinical applicability of constructed nomograms.CONCLUSION: The information provided in this review should be of use in selecting a nomogram suitable for obtaining desired predictions in daily clinical practice.

Clinical Predictors for Recurrence after Curative Resection for Colorectal Cancer

Purpose: To identify clinical predictors of recurrence of colorectal cancer after curative surgical treatment. Methods: Retrospective follow-up-study of 925 consecutive patients treated with R0-resection for colorectal cancer Stage I, II and III from 1990 until 2000 with a mean follow-up of 60 ± 37 months. Predictors for cancer recurrence were identified in a pilot-sample of these patients, followed by analyses of the rest of the patients (test-sample), and finally with a concluding analyses of the entire patient group. Data were analyzed with Pearson Chi-square test (χ2), Cox regression analyses and log rank test. Results: Tumor stage (Stage I: HR 0.10 (0.05;0.19), Stage II: HR 0.31 (0.24;0.41)) and postoperative reoperations due to complications due to other causes than anastomotic leakage (HR 2.02 (1.21;3.36)) were significant predictors of cancer recurrence in the multivariate Cox regression model. The association between reoperations and recurrence was strongest for the patients with the best prognosis: Stage I and Stage II-cancers. Long duration of surgery, strongly associated with blood-loss and infusions of liquid and blood-products, reoperation due to anastomotic leakage as well as right colon/transversum localization were significant at a trend-level (10%). Conclusions: Tumor stage and reoperations due to postoperative complications other than anastomotic leakage are significant predictors for recurrence after curative surgery for colorectal cancer.

Crohn’s disease with infliximab treatment complicated by rapidly progressing colorectal cancer:A case report

BACKGROUND Crohn's disease(CD)causes a range of digestive symptoms including recurrent diarrhea,abdominalgia,and flatulence,and severely impacts the quality of life of patients.Infliximab,a monoclonal antibody against tumor necrosis factor alpha,has recently been promoted as a therapeutic treatment for CD,but its safety margins remain uncertain.We report a case of rapidly progressive colorectal cancer that was diagnosed in a patient with CD who had previously been treated with infliximab.CASE SUMMARY This case report refers to a 40-year-old male with a 6-year history of CD.The patient underwent transverse colostomy because of inflammatory ileus in 2017.He subsequently received infliximab treatment in 2018.Ten months later,worsening contracture of the transverse colostomy was observed.Imaging tests indicated that the patient may have developed colon cancer with extensive peritoneal implantation.At the same time,colonoscopy revealed a rectal mass and pathological examination indicated well-differentiated adenocarcinoma.Palliative ileostomy was performed to improve defecation in 2019.During the operation,a small nodular mass in the mesentery of the small intestine was identified and pathological examination of the mass revealed advanced adenocarcinoma.The patient was diagnosed with advanced colorectal cancer and administered palliative chemotherapy.He died in June 2020.CONCLUSION We stress the importance of recognizing the possible occurrence of malignance in patients with CD receiving infliximab.

Rare synchronous colorectal carcinoma with three pathological subtypes: A case report and review of the literature

BACKGROUND Synchronous colorectal carcinomas(SCRC)are two or more primary colorectal carcinomas identified simultaneously or within 6 mo of the initial presentation in a single patient.Their incidence is low and the number of pathological types of SCRC is usually no more than two.It is very unusual that the pathological findings of a patient with SCRC show more than two different pathological subtypes.Here,we report a rare case of SCRC with three pathological subtypes.CASE SUMMARY A 75-year-old woman who had no previous medical history or family history was admitted to the hospital because of intermittent hematochezia for more than a month.Colonoscopy displayed an irregularly shaped neoplasm of the rectum,a tumor-like lesion causing intestinal stenosis in the descending colon,and a polypoidal neoplasm in the ileocecum.Subsequently,she underwent total colectomy,abdominoperineal resection for rectal cancer,and ileostomy.After operation,the pathological report showed three pathological subtypes including well-differentiated adenocarcinoma of the ascending colon,moderately differen-tiated adenocarcinoma of the descending colon,and mucinous adenocarcinoma of the rectum.She is now recovering well and continues to be closely monitored during follow-up.CONCLUSION Preoperative colonoscopy examination,imaging examination,and extensive intraoperative exploration play important roles in reducing the number of missed lesions.

结直肠癌合并糖尿病患者组织中EMT相关蛋白的表达

目的观察结直肠癌合并糖尿病患者组织中促进上皮间质转换(EMT)进展的相关蛋白的表达。方法收集直肠癌及合并糖尿病患者的肿瘤组织及非肿瘤组织,分为对照组和肿瘤组;根据是否合并糖尿病,又分为伴及不伴糖尿病组。用免疫组化检测晚期糖基化终末产物(AGE)及其相应受体(RAGE)、上皮标志物钙黏连蛋白E(E-cad)、β-连环蛋白(β-catenin)、波形蛋白(vimentin);蛋白质印迹法检测各组中不同分化程度下相关蛋白的表达。结果 RAGE、AGE、E-cad和vimentin主要染色于细胞膜上,β-catenin主要染色于胞质内,且两个肿瘤组染色较对照组更深(P<0.01);与对照组相比,不伴糖尿病组及伴糖尿病中各蛋白表达均增高,E-cad表达降低(P<0.01);在同一分化状态下,伴糖尿病组中各蛋白表达水平较不伴糖尿病组高,E-cad较之降低(P<0.01)。结论结直肠癌合并糖尿病患者组织中相关蛋白β-catenin和vimentin表达上调,E-cad表达下降,从而促进EMT进展,对结直肠癌发生发展起重要促进作用。

两种腹腔镜手术方案在乙状结肠癌患者中的疗效对比

目的对比传统腹腔镜乙状结肠癌根治术与腹部无切口经直肠取出标本腹腔镜手术的近期疗效。方法以2015年1月-2016年12月于该院拟实施腹腔镜辅助乙状结肠癌根治手术的患者中选出34例实施腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术的患者作为腹部无切口组。以1∶2的配对方式选择同期内年龄、性别一致,体质指数(BMI)相近的实施腹腔镜辅助乙状结肠癌根治手术的患者68例作为对照组。对比两种腹腔镜手术方案的手术时间、手术出血量、术后排气时间、术后疼痛评分、手术并发症、术后住院时间、附加镇痛处理情况、肠管切除长度、近远端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期。结果腹部无切口组乙状结肠癌患者的手术时间、手术出血量明显高于对照组,腹部无切口组乙状结肠癌患者的术后排气时间、术后清醒时疼痛评分、术后第1天的疼痛评分明显低于对照组,差异有统计学意义(P<0.05);两组乙状结肠癌患者的肠管切除长度、远近端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期差异无统计学意义(P>0.05)。腹部无切口组随访5~8个月,平均6个月;对照组随访6~9个月,平均7个月,均未发现肿瘤局部复发及远处转移。结论相比于传统腹腔镜手术,腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术可以明显降低患者的疼痛程度,缩短术后排气时间,肿瘤根治效果相近。

同时性大肠多原发癌的诊治(附34例报告)

目的提高同时性大肠多原发癌的诊断正确率。方法对2677例大肠癌病人进行术前钡灌肠、纤维结肠镜检查及术中纤维结肠镜检查。结果发现34例同时性多原发性大肠癌,占同期大肠癌病人的1.3%。同时性多原发性大肠癌常因临床医生不够重视而漏诊。结论大肠癌病人术前应常规行钡灌肠及纤维结肠镜检查,术前未作纤维结肠镜检查的病人术中应加做结肠镜检查,以减少同时性多原发癌的漏诊。术中应常规解剖标本检查,从而决定手术切除范围。

术中动脉灌注美蓝标记淋巴结的临床应用

在9例结直肠癌根治术中,经动脉灌注美蓝标记区域性淋巴结。病灶及有关淋巴结染色后呈鲜艳水蓝色,为肠系膜上下血管周围的淋巴结清除提供了清晰的标记,也增加了切除标本上可挑出的淋巴结数目。本方法简便,有助于为结直肠癌临床分期提供系统的病理资料,较准确地反映了疾病发展的实际阶段。

快速康复在结直肠癌外科应用的临床观察

快速康复外科（Fast track surgery）是指在术前、术中及术后应用各种已证实有效的方法以减少手术应激及并发症，加速患者术后康复，使患者术后数周的机体功能下降过程缩短为数天，很快就可康复出院的方法。近年来，我科对结直肠癌患者引进快速康复外科的理念，在临床实践中取得一定的效果和经验。现将临床观察报告如下。

双歧杆菌调理和改善肠道相关疾病作用的研究进展

双歧杆菌(Bifidobacterium)作为人体肠道中具有代表性的一大类益生菌,因其具有营养、抗菌、免疫调节、抗癌及抗肿瘤等多种生理功能,一直是研究者们的热门研究内容。肠道相关的疾病主要包括:炎症性肠病(IBD)、肠易激综合征(IBS)、腹泻、结肠癌、直肠癌等,目前这些肠道相关性疾病的发生、发展机理不是很清楚,而传统的药物治疗效果并不令人满意,且副作用大。本文主要就双歧杆菌的生理功能及双歧杆菌制剂在调理和改善肠道相关疾病的国内外研究进展进行综述。

青年人结直肠癌38例临床分析

目的:探讨青年人结直肠癌的临床及病理特点。方法:回顾分析我院1996年～2006年10年间行手术治疗,并经病理检查确诊的青年人结直肠癌患者38例(占同期收治结直肠癌的14.39%)的临床资料。结果:青年人结直肠癌组织病理学类型以低分化腺癌(21%)、粘液腺癌(28.9%)为多,73.7%的病例Dukes临床分期为C期和D期。结论:提高对青年人结直肠癌的认识,做到早诊断、早治疗是提高疗效的关键。

香菇多糖联合化疗治疗老年结直肠癌患者的临床疗效及安全性研究

目的:探讨香菇多糖联合化疗方案治疗老年结直肠癌患者的临床疗效、耐受性及安全性。方法:将2012年1月-2014年1月本院肿瘤科收治的结直肠癌老年患者按纳入、排除标准实际纳入128例,按随机数字表法分为两组,治疗组63例采用含氟尿嘧啶类化疗方案的同时给予香菇多糖,对照组65例仅给予含氟尿嘧啶类化疗方案。化疗过程中比较两组的毒副反应、T细胞亚群和NK细胞、生活质量及治疗疗效差异。结果:(1)化疗后,联合香菇多糖治疗组的CD4+/CD8+、CD4+、CD3+、NK细胞较治疗前明显升高(P<0.05),对照组治疗后CD4+/CD8+、CD4+、CD3+、NK细胞较治疗前有所下降。(2)治疗组较对照组生活质量明显改善(P<0.05)。(3)两组的疾病控制率比较差异无统计学意义(P>0.05)。(4)两组均未发生IV度不良反应及治疗相关性死亡,不良反应以血液学毒性、消化道反应、神经毒性为主,联合香菇多糖治疗组不良反应发生率低于对照组。结论:在老年结直肠癌患者中,香菇多糖联合化疗可以缓解化疗毒副反应、改善免疫功能、提高患者的化疗耐受性,提高生活质量,值得临床推广应用。

无痛肠镜单人操作132例临床分析

[目的]探讨无痛结肠镜单人操作方法。[方法]采用丙泊酚注射液静脉麻醉,行无痛结肠镜单人操作单人操作技术。[结果]132例肠镜检查中,有127例插至回盲部,21例进入末段回肠,所有病例均无穿孔、出血等并发症发生,插至回盲部成功率96.21%。[结论]在麻醉睡眠情况下进行结肠镜单人操作,受检病人始终处于放松状态,易于接受,并省时省力,值得临床进一步推广。

全肠外营养对老年大肠癌病人术后的治疗作用(附42例临床分析)

目的 :研究老年大肠癌病人行根治术后进行全肠外营养支持 ,对术后恢复、胃肠道功能恢复、创口愈合及免疫功能的影响。 方法 :对 42例 6 5岁以上的大肠癌病人随机分为实验组 (TPN组 )和对照组 (非 TPN组 )。实验组采用全营养混合液 (TNA)经颈内静脉输注 ,从术后第 1天起每天输注 ,连续 8～ 9天 ,每天提供非蛋白热量 83.7～12 5 .5 k J(2 0～ 30 kcal) /(kg· d) ,氮 0 .12～ 0 .16 g/(kg· d) ,脂肪占总热量约 2 0 %～ 30 % ;对照组术后常规给予葡萄糖与电解质溶液 ,逐步过渡到口服饮食。观察术后胃肠功能的恢复和创口愈合情况 ,检测术前第 1天、术后第 1天及第 8天血清白蛋白、前白蛋白、免疫球蛋白 (Ig G、Ig A、Ig M)及 T细胞亚群的变化。 结果 :实验组胃肠功能恢复时间和创口愈合情况均优于对照组 ,前白蛋白、Ig G与 Ig A水平、CD3+与 CD4+细胞百分率均较对照组显著升高(P<0 .0 1)。 结论 :全肠外营养对术后老年大肠癌病人具有提高机体营养状况、促进胃肠道功能尽早恢复以及创口更好愈合 。

DR-70^(TM)检测在消化系统肿瘤中的应用

目的评价 DR- 70 TM在消化系肿瘤筛查中的价值。方法应用 EL ISA对 135例确诊为食道癌、胃癌、肠癌或肝癌的患者和 16 6例年龄相当的健康者进行了对照检测。结果以 5 .3mg/ L 为临界值 ,食道癌阳性率为92 .9%,胃癌阳性率为 92 .9%,肠癌阳性率为 83.3%,肝癌阳性率为 83.8%,合计总阳性率为 85 .8%;与健康对照组结果比较 ,P<0 .0 0 1,差异呈高度显著性。结论 DR- 70

住院大肠癌术后病人癌因性疲乏与希望水平的相关性研究

[目的]探讨住院大肠癌术后病人癌因性疲乏与希望水平的关系。[方法]采用癌因性疲乏量表和Herth希望量表对110例住院大肠癌术后病人进行调查,并分析其相关性。[结果]住院大肠癌术后病人总疲乏发生率为100.00%,其中躯体疲乏和情感疲乏发生率均为98.18%,认知疲乏发生率为97.27%。其中躯体疲乏得分最高(1 4.1 7分±3.75分),情感疲乏得分次之(5.92分±2.38分),认知疲乏得分最低(4.76分±2.61分)。住院大肠癌术后病人希望水平总得分为31.47分±3.81分。住院大肠癌术后病人癌因性疲乏各个维度均与总体希望水平呈负相关(P<0.05)。[结论]住院大肠癌术后病人普遍存在癌因性疲乏,提高病人的希望水平对减轻其疲乏症状有正向促进作用。

结直肠癌并发急性肠梗阻18例的诊治体会

目的:探讨结直肠癌并发急性肠梗阻的外科诊治策略及手术方式。方法:回顾分析2002年1月-2010年12月收治的18例结直肠癌致急性肠梗阻病例的临床资料。结果:本组18例均行手术治疗。7例右半结肠癌均行Ⅰ期切除吻合术;左半结肠癌9例,行Ⅰ期切除吻合术4例,3例行Hamann手术,肿瘤无法切除行单纯性结肠造口术2例;直肠癌2例,分别行Ⅰ期切除吻合术及Hartmann手术。治愈15例,病死3例;术后发生并发症7例。结论:结直肠癌并发急性肠梗阻经积极术前准备和治疗合并症后应尽快手术,正确合理的选择手术方式以及加强围手术期处理,对于减少手术并发症和提高治愈率至关重要。