Characteristics of Colorectal Cancer in Elderly Patients in Comparision with Younger Patients / 대한소화기내시경학회지

BACKGROUND/AIMS: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. METHODS: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. RESULTS: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. CONCLUSIONS: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer.

Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer

PURPOSE: Endoscopic mucosal resection (EMR) for early colorectal cancer (ECC) is increasing, but in Korea, little is known about long-term results of this treatment, especially in cases of incomplete resection. In this study, we reviewed the records of patients with ECC who underwent EMR, and we analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of EMR. METHODS: From May 1995 to December 2003, 45 patients underwent EMR for ECC at Seoul National University Hospital and followed for over 10 months. Their medical records were reviewed retrospectively. RESULTS: 45 patients with average age of 62 accounted for 47 ECCs out of 164 colon mucosal lesions. En-bloc resection rate was 78.7%. Submucosal invasion was found in 10 cases (21.3%). De novo cancer rate was 12.8% and relatively high in submucosal cancer (40%). The complete resection rate was 70.2%. During the mean follow-up period of 25 months, residual tumor growth occurred in 3 out of 14 incompletely resected cases, and that was related to piecemeal resection. One of those 3 patients underwent surgical resection due to submucosal invasion, and the other two were treated endoscopically with no additional abnormal findings. No tumor recurred in completely resected cases. CONCLUSIONS: A complete en-bloc resection was a prerequisite for prevention of tumor recurrence. In cases of incomplete resection, especially those performed using piecemeal method, within 3 months after the resection and within 1 year thereafter, follow-ups are essential for the early detection of tumor regrowth, and additional endoscopic treatment can achieve complete removal of residual tumor, despite initial incomplete resection.

A case of subacute infective endocarditis with colon cancer caused by streptococcus bovis / 대한내과학회지

Streptococcus bovis, a group D non-enterococcal organism has recently received increased attention, especially for its role as a cause of infective endocarditis and associated colorectal neoplasm. Infectious endocarditis due to group D streptococci include two non-enterococcal species, S. bovis and S. equinas, which may be mistaken for enterococci in clinical laboratory. However, S. bovis is readily distinguished from the enterococci by screen with bile-esculin hydrolysis and growth in 6.5% NaCl broth. Although endocarditis caused by S. bovis or enterococci share common clinical findings, therapeutically and prognostically, S. bovis endocarditis more resembles infection with viridans group organism. Also the infection of S. bovis significantly increased the prevalence of colorectal cancer in previous report. As discussed above, the patients with S. bovis endocarditis are carried out study of colorectal cancer. We report a case of endocarditis with colon cancer caused by S. bovis in 54 year old female.