Great job sister Lil- This was very interesting and will be kept. Thank
you!
Vicci
----------
From: Lillian <firefly@islc.net>
To: mol- <mol-cancer@lists.meds.com>
Subject: [MOL] Colon Cancer Info.
Date: Wednesday, April 07, 1999 12:31 PM
UPDATE IN COLON CANCER
by: Gil Lederman, M. D.
In a National Cancer Database report trends for variety of cancers
especially the most common cancers. The data includes variations in stage
or extent of disease as well as treatments implemented and overall
survival.
>From 1985 through 1993, colon cancer data was evaluated including 36,937
patients in 1988 and 44, 812 in 1993. This is a project of the Commission
on Cancer of the American College of Surgeons and the American Cancer
Society. The goal is to evaluate cancer care outcome in America.
Colon cancer is the fourth most common malignancy in adults and the second
most common cause of cancer deaths.
Treatment was analyzed by the stage or extent of disease. While 28% of the
1988 patients had no reported clinical or pathologic stage, only 9% of the
1993 cases were so unlabeled. This suggests improvement in cancer care.
There were differences as well as similarities in patients who developed
colon cancers. When analyzed for age, area of the country, sex, incidence,
economic level or ethnic background, there were no discernible differences.
However, in patients 80 years of age or older, the stage tended to be lower
(less extensive disease) than in younger patients. Furthermore, black
Americans were diagnosed at an earlier age than white Americans - with
blacks being diagnosed on average at 66.4 years compared to 69.7 years for
white Americans.
Excluding African Americans, all other ethnic groups had similar stage of
cancer at presentation. African Americans had the highest incidence of
Stage IV disease - the most extensive amount of disease. African Americans
averaged 25.4% of Stage IV disease compared to 17.9% to 19.9% in other
ethnic groups.
There was an increased incidence of right colon cancers in 1993 compared to
1988. This is a continuation of a previous trend on the right side of the
bowel that has been long-standing.
The grade of the tumor represents the aggressiveness as observed by the
pathologist under the microscope. Sixty-four percent of Grade I - the
lowest grade or the least aggressive cancer - were Stage I or II, the
earliest stages of colon cancer. Thirty-five percent and 31% of Grade III
or IV respectively were Stage I or II. Thus, the more aggressive the tumor
under the microscope the more likely the tumor was to be a greater stage.
Also, there was a relationship between the stage of disease and the
location of the cancer. Sigmoid disease (located nearest the anus) had a
likelihood of being Stage I in 25.6% of the cases while the ascending colon
had only 19.4% of its primaries being early Stage I malignancies.
Recently published data shows that adjuvant or additional therapy after
surgery improves outcome for those with colon cancer. Those with Stage III
colon cancer are the most likely to benefit with a resultant decreased
lower recurrence rate and longer survival.
According to data presented, 43% of patients received systemic or adjuvant
chemotherapy. Chemotherapy was most commonly used in the Pacific area of
the United States and least commonly in the Northeast area. Chemotherapy
was also less likely to be used for patients older than 70 years of age
where it was given in 18.6% of patients and only in 5% of patients older
than 80 years. For patients under 50 years of age, 36.7% received
chemotherapy.
Additionally, small hospitals with less than 150 cases per year were less
likely to administer chemotherapy than larger hospitals.
Lower grade and distal site of the primary were associated with better
outcomes, thought secondary to an earlier stage of cancer. Increasing age
was noted to have a worse outcome by stage while sex and ethnic background
did not. Low income adults had a 5 to 7% worse outcome than middle or
higher income patients.
This study authored by Jessup, et al and appearing in the journal CANCER
found several important points. The first is that while patients younger
than 50 years of age have more advanced cancers. The second point was that
African Americans tend to have colon cancer at an earlier age than white
Americans so increased vigilance may be most important for this group of
high risk patients.
The authors noted that staging systems to determine the extent of disease
were better implemented in the later years. This would be a step toward
improved treatment.
Also emphasized was that the grade of the cancer is important in
determining outcome of therapy. Adjuvant therapy clearly has increased in
use being implemented in 7.2% of patients in 1985 but 22.3% in 1993. The
impact of chemotherapy on survival most likely will be felt in subsequent
years of analysis because of the short follow up rendered. The authors did
note improvement in survival in Stage III patients receiving adjuvant
therapy.
Thus, this important demographic work should produce better care for
patients and serve as a guideline for physicians caring for people with
this highly common malignancy.
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