Relationship between age and the histopathological features to chemotherapy response in colorectal cancer patients: a prospective observational study

Introduction: Chemotherapy response in early age-onset colorectal cancer patients is still controversial, and the results of chemotherapy response are unknown. Therefore, the purpose of this study is to determine the relationship between the age of colorectal cancer patients and histopathological features and chemotherapy response. Methods: This is a prospective observational study. The subjects in this study were colorectal cancer patients in the Digestive Surgery division at Tertiary Hospital in West Java from September 2021 to September 2022. Results: There were 86 subjects who underwent chemotherapy in accordance with the inclusion and exclusion criteria. Consisting of 39 patients of early age onset and 44 female patients. The most common histopathological feature in early age onset (EAO) and late age onset (LAO) was adenocarcinoma (25% and 46%, respectively). Stage III colorectal cancer affected 38 patients, while stage IV affected 48 patients. There was a significant relationship between early age onset and late age onset with histological features (p < 0.001). The patients with the highest chemotherapy response had stable diseases in EAO (17 patients) and LAO (20 patients). There was no statistically significant relationship between age, histological features, and stage of colorectal cancer and chemotherapy response (p > 0.05). The results of the ordinal logistic regression test showed no systematic relationship between chemotherapy response and age, histopathological features, gender, or cancer stage (p > 0.05). Conclusion: There was no association between age and histopathologic features with chemotherapy response and there is no difference in chemotherapy response between early and late age onset. (AU)

Cáncer colorrectal ­ diagnóstico y tratamiento: revisión bibliográfica / Colorectal cancer ­ diagnosis and treatment: literature review

Colorectal cancer (CRC) is the third most prevalent cancer worldwide. Although improvements in detection and treatment have been implemented; CRC incidence, prevalence, and mortality remain high, even in developed countries. The risk of developing this cancer is related to poor eating habits, smoking, inflammatory bowel disease, polyps, genetic factors, and aging. There are several methods for detecting colorectal cancer, including the guaiac test, stool immunochemical test, stool DNA test, sigmoidoscopy, colonoscopy, and barium enema. The stage at which the cancer is detected determines the patient's prognosis, survival, and treatment. Treatments include endoscopic and surgical local excision, preoperative radiation therapy and systemic downstage therapy, extensive surgery for locoregional and metastatic disease, local ablative therapies for metastases, and palliative, targeted chemotherapy and immunotherapy.

El cáncer colorrectal (CCR) es el tercer cáncer más prevalente a nivel mundial. A pesar de que se han implementado mejoras en la detección y el tratamiento; la incidencia, la prevalencia y la mortalidad del CCR siguen siendo altas, incluso en países desarrollados. El riesgo de desarrollar este cáncer está relacionado con malos hábitos alimentarios, tabaquismo, enfermedad inflamatoria intestinal, pólipos, factores genéticos y envejecimiento. Existen varios métodos para detectar el cáncer colorrectal, como la prueba de guayaco, la prueba inmunoquímica de heces, la prueba de ADN en heces, la sigmoidoscopia, la colonoscopia y el enema de bario. El estadio en el que se detecta el cáncer determina el pronóstico, la supervivencia y el tratamiento del paciente. Los tratamientos incluyen escisión local endoscópica y quirúrgica, radioterapia preoperatoria y terapia sistémica de reducción del estadio, cirugía extensa para enfermedad locorregional y metastásica, terapias ablativas locales para metástasis y quimioterapia paliativa, terapia dirigida e inmunoterapia.

Perfil Clínico-Epidemiológico do Câncer Colorretal na Região Oeste do Paraná, Brasil, 2016-2018 / Clinical and Epidemiological Profile of Colorectal Cancer in Paraná's Western Region, Brazil, 2016-2018 / Perfil Clínico-Epidemiológico de lo Cáncer Colorrectal en la Región Oeste de Paraná, Brasil, 2016-2018

Introdução: O câncer colorretal é a neoplasia mais frequente do trato gastrointestinal, sendo a segunda principal causa de morte por câncer no mundo. Objetivo: Traçar um perfil clínico-epidemiológico do câncer colorretal na Região Oeste do Paraná (Brasil), entre 2016 e 2018. Método: Estudo observacional analítico do tipo transversal, construído a partir da análise de resultados de exames anatomopatológicos, realizados entre 2016 a 2018. Realizaram-se análises por estatística descritiva, teste de associação qui-quadrado e U de Mann-Whitney. Adotou-se nível de significância de 5%. Resultados: A análise de 509 laudos positivos para câncer colorretal permitiu identificar o predomínio de pacientes do sexo masculino e a idade média de diagnóstico de 62 anos. A malignidade mostrou-se mais incidente na faixa etária de 61 a 70 anos (29,9%), e considerável número de casos ocorreu em pacientes abaixo de 50 anos (19,6%). Houve predomínio em cólon esquerdo e do tipo histológico adenocarcinoma infiltrativo moderadamente diferenciado. Verificou-se associação entre topografia da doença e sexo, com maior predominância do sexo feminino para tumores do cólon direito e do sexo masculino para tumores do cólon esquerdo (p=0,0081). Conclusão: A partir deste estudo, delineia-se um perfil clínico-epidemiológico do câncer colorretal na Região Oeste do Paraná, com maior incidência da doença em homens, sexagenários, além de predomínio de tumores em cólon esquerdo e do tipo adenocarcinoma infiltrativo moderadamente diferenciado. Tais achados são relevantes considerando a possibilidade de aplicação assertiva de protocolos internacionais de rastreio do câncer nessa população

Introduction: The colorectal cancer is the most frequent neoplasm of the gastrointestinal tract and the second cause of cancer related death. Objective: To design a clinical and epidemiological profile of the colorectal cancer at the Western Region of the Paraná State from 2016 to 2018. Method: Analytical cross-sectional observational study based on the evaluation of the results of anatomopathological exams, between 2016 and 2018, at a regional specialized center. Analyses were performed using descriptive statistics, chi-square test for association and Mann-Whitney U test. A significance level of 5% was adopted. Results: The analysis of 509 positive anatomopathological reports of colorectal cancer allowed to identify the predominance of male patients and mean age at diagnosis of 62 years. The malignancy was more incident in patients between 61 and 70 years of age (29.9%). A considerable number of cases was found in patients younger than 50 years (19.6%). The disease was predominant at the left colon, of the type moderately differentiated infiltrating adenocarcinoma according to the histological classification. Association between the tumor topography and sex was found, with predominance of females for the right colon and males for the left colon (p=0.0081). Conclusion: This study designed the colorectal cancer clinical and epidemiological profile at Paraná's Western Region. The disease affects more males, older than 60 years of age, mostly with moderately differentiated infiltrative adenocarcinoma at the left colon. These findings are relevant considering the possibility of applying international cancer screening protocols in this population.

Introducción: El cáncer colorrectal es la neoplasia más frecuente del tracto gastrointestinal y la segunda causa de muerte por cáncer a nivel mundial. Objetivo: Trazar un perfil clínico-epidemiológico del cáncer colorrectal en el Oeste de Paraná (Brasil), entre 2016 y 2018. Método: Estudio observacional analítico transversal realizado con los análisis de resultados de exámenes anatomopatológicos entre 2016 a 2018. Se realizaron análisis mediante estadísticas descriptivas, prueba de asociación chi-cuadrado y U de MannWhitney. Se adoptó nivel de significación del 5%. Resultados: Entre los 509 informes positivos para cáncer colorrectal, el 52,8% de los pacientes eran del sexo masculino y tenían promedio de edad de diagnóstico de 62 años. El cáncer fue más frecuente en el grupo de 61 a 70 años (29,9%) y un número significativo de casos se presentó en pacientes menores de 50 años (19,6%). Predominó la enfermedad de colon izquierdo y del tipo histológico de adenocarcinoma infiltrante moderadamente diferenciado. Fue encontrado asociación entre la topografía y el sexo, con mayor predominio del sexo femenino para los tumores de colon derecho y del sexo masculino para los tumores de colon izquierdo (p=0,0081). Conclusión: Se elabora un perfil clínico-epidemiológico del cáncer colorrectal en la región Oeste de Paraná, con mayor incidencia en el sexo masculino, edad de 60 años, predominio de tumores en el colon izquierdo y del tipo adenocarcinoma infiltrante moderadamente diferenciado. Estos puntos son relevantes considerando la posibilidad de aplicación asertiva de protocolos internacionales de rastreo del cáncer en esta población.

Detection rates of adenomas, advanced adenomas, and colorectal cancers among the opportunistic colonoscopy screening population: a single-center, retrospective study / 中华医学杂志(英文版)

BACKGROUND@#Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders.@*METHODS@#This was a retrospective study performed at the Institute of Health Management, Chinese People's Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test.@*RESULTS@#The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs . 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs . 9.44% [1692/17,926], 95% CI 8.94-9.79%, P  < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs . 1.85% [332], 95% CI 1.61-2.00%, P  < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs . 0.59% [105], 95% CI 0.47-0.70%, P  < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]).@*CONCLUSIONS@#The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.

Prevalence of colorectal cancer in 2020: a comparative analysis between China and the world / 中华肿瘤杂志

Objective: To demonstrate the disease burden and epidemiological characteristics of colorectal cancer in different regions by analyzing the incidence and mortality data in China and worldwide in 2020. Methods: Estimation of the incidence and mortality data of colorectal cancer were obtained from the GLOBOCAN 2020 database. The incidence, death, age standardized incidence rate (ASIR) and age standardized mortality rate (ASMR) of colorectal cancer in China and 20 regions in the world were compared. The correlation between the Human Development Index (HDI) and ASIR/ASMR was analyzed. Results: In 2020, the number of new cases of colorectal cancer in the world reached 1 931 600, and the number of deaths reached 935 200. The incidence and mortality in all regions of the world continued to rise in the age group above 50 years old. The morbidity and mortality in male were higher than those in female. East Asia ranked the highest number of incidence cases and deaths in the world, which were 740 000 and 360 100 respectively. There were significant differences in incidence and mortality among regions in the world. The highest ASIR and ASMR were observed in Northern Europe (33.61/100 000) and Eastern Europe (14.53/100 000), whereas the lowest ASIR and ASMR were both observed in South-Central Asia (5.46/100 000 and 3.16/100 000). HDI had significant exponential relationship with ASIR (r(2)=0.59, P<0.001) and ASMR (r(2)=0.38, P<0.001). There were 555 500 new cases and 286 200 death cases of colorectal cancer in China, accounting for about 30% of the world and more than 75% of East Asia. The ASIR of China was 24.07/100 000, ranking at the medium level, while the ASMR was 12.07/100 000, ranking at the high level of world. Conclusion: The incidence and mortality of colorectal cancer are highly correlated with HDI. China is one of the countries with the heaviest disease burden of colorectal cancer in the world.

Características clínico-patológicas de los pacientes asistidos en el Centro Docente Asociado de Oncología Médica en el Hospital Departamental de Soriano durante su primer año de funcionamiento / Clinical-pathological characteristics of patients assisted at the Associated Teaching Center of Medical Oncology at Soriano Departmental Hospital during its first year of operation / Características clínico-patológicas dos pacientes atendidos no Centro Docente Associado de Oncologia Médica no Hospital Departamental de Soriano durante seu primeiro ano de funcionamento

Introducción: Según el Ministerio de Salud las muertes por cáncer constituyen un cuarto del total de las defunciones registradas en Uruguay cada año. Objetivo: Conocer el perfíl epidemiológico de los pacientes diagnosticados de cáncer asistidos en el Hospital Departamental de Soriano. Material y métodos: Estudio observacional, retrospectivo y descriptivo que incluyó a los pacientes diagnosticados de cáncer asistidos en el Hospital Departamental de Soriano durante el 2022. Se mantuvo el anonimato de los pacientes en el análisis estadístico y se contó con la aprobación del Comité de Ética del Hospital de Clínicas. Resultados: Se incluyeron 113 pacientes nuevos; 53.1% fueron hombres, siendo la mediana de edad al diagnóstico de 69 años. Los 4 tumores más frecuentes para ambos sexos reunidos fueron: mama, próstata, pulmón y colo-recto; la distribución por estadio fue la siguiente: E IV 48.6% pacientes; EIII 22.5%; EII 26.5%; y EI 2.6%. En el 79.6% de las pacientes se contaba con la confirmación del diagnóstico mediante anatomía patológica. El tiempo entre el diagnóstico y el primer tratamiento oncológico fue ≤ 3 meses para el 88.2% de los pacientes. El total de los pacientes con EIV fueron contactados con la Unidad de Cuidados Paliativos. Únicamente el 15% de los casos fueron discutidos en Comité de Tumores. Conclusiones: Los datos analizados permitieron caracterizar el perfil epidemiológico del cáncer de los pacientes procedente de Soriano asistidos en el ámbito público y pueden contribuir a la implementación de políticas públicas orientadas a la prevención y por ende a la mejora en la asistencia pacientes asistidos.

Introduction: According to the Ministry of Health, cancer deaths constitute a quarter of the total deaths registered in Uruguay each year. Objective: To identify the epidemiological profile of patients diagnosed with cancer treated at the Departmental Hospital of Soriano. Materials and Methods: An observational, retrospective and descriptive study that included patients diagnosed with cancer attended at the Departmental Hospital of Soriano during 2022. The anonymity of the patients was maintained in the statistical analysis and approval was obtained from the Ethics Committee of the Hospital de Clínicas. Results: A total of 113 new patients were included; 53.1% were men, with a median age at diagnosis of 69 years old. The four most frequent tumors for both sexes were: breast, prostate, lung and colorectal; the distribution by stage was as follows: Stage IV 48.6% patients; Stage III 22.5%; Stage II 26.5%; and Stage I 2.6%. In 79.6% of the patients the diagnosis was confirmed by pathological anatomy. The time between diagnosis and first oncological treatment was ≤ 3 months for 88.2% of patients. The total number of patients with Stage IV were contacted by the Palliative Care Unit. Only 15% of the cases were discussed in the Tumor Committee. Conclusions: The data analyzed made it possible to characterize the epidemiological profile of cancer in patients from Soriano assisted in the public sector and may contribute to the implementation of public policies aimed at prevention and, therefore, at improving patient care.

Introdução: Segundo o Ministério da Saúde, as mortes por câncer constituem um quarto de todas as mortes registradas no Uruguai a cada ano. Objetivos: Conhecer o perfil epidemiológico dos pacientes diagnosticados com câncer atendidos no Hospital Departamental de Soriano. Material e Métodos: Estudo observacional, retrospectivo e descritivo que incluiu pacientes diagnosticados com câncer atendidos no Hospital Departamental de Soriano durante o ano de 2022. O anonimato dos pacientes foi mantido na análise estatística e foi aprovado pelo Comitê de Ética do Hospital de Clínicas. Resultados: foram incluídos 113 novos pacientes; 53,1% eram homens, com mediana de idade ao diagnóstico de 69 anos. Os 4 tumores mais frequentes para ambos os sexos combinados foram: mama, próstata, pulmão e colorretal; a distribuição por estágio foi a seguinte: E IV 48,6% pacientes; EIII 22,5%; EII 26,5%; EI 2,6%. Em 79,6% dos pacientes houve confirmação do diagnóstico pela patologia. O tempo entre o diagnóstico e o primeiro tratamento oncológico foi ≤ 3 meses para 88,2% dos pacientes. Todos os doentes com DIV foram contactados com a Unidade de Cuidados Paliativos. Apenas 15% dos casos foram discutidos no Comitê de Tumores. Conclusões: Os dados analisados ​​permitiram caracterizar o perfil epidemiológico do câncer em pacientes de Soriano atendidos na esfera pública e podem contribuir para a implementação de políticas públicas voltadas para a prevenção e, consequentemente, para a melhoria na assistência aos pacientes atendidos.

Colorectal cancer: comparative analysis between two series of patients separated by more than three decades

Abstract Aim This study characterizes Colorectal Cancer (CRC) incidence in the University Hospital Ramon and Cajal, Madrid, and analyzes variations over time. It establishes risk groups, aiming to discover whether diagnosis can be determined in less advanced stages of disease. Method Evolutionary epidemiological study of genetic and environmental factors contributing to the development of CRC in this district that enables the comparison of two cohorts of patients separated by 37 years: G1 (patients of current group) and G2 (patients of historical group). The main risk variables gleaned retrospectively were analyzed and the statistical association between cohorts was determined. Results The mean age of patients increased significantly from 64 to 71 along with the incidence of ascending colon cancer. G1 scored higher than G2 for: the incidence of colon cancer in men, detection of adenomatous polyps (48.1%), percentage of resectability with curative intent (80.4%), and Dukes A stage (34.1%) (p < 0.001). Conclusion Biological aspects of CRC have been compared against its profile three decades earlier. We can confirm the existence of concrete changes in the manifestation and staging at the time of diagnosis or following earlier treatment. (AU)

Cáncer colorrectal y anal en Sancti Spíritus en un quinquenio / Colorectal and Anal Cancer in Sancti Spíritus in a Five-Year Period

Introducción: El cáncer colorrectal y anal es una enfermedad de elevada incidencia y la oclusión intestinal es su complicación más frecuente. Objetivo: Describir la incidencia y la mortalidad de los pacientes con cáncer colorrectal y anal y oclusión intestinal mecánica por esa causa. Métodos: Se realizó un estudio descriptivo de serie de casos que incluyó a los pacientes con diagnóstico de oclusión intestinal por cáncer colorrectal en Sancti Spíritus, Cuba, desde el 1ro de enero de 2014 hasta el 31 de diciembre de 2018. Se estudiaron pacientes vivos y fallecidos. Resultados: La incidencia de cáncer colorrectal y anal tuvo la mayor tasa en el 2016 con 28,73 por 100 000 habitantes. El mayor número de pacientes ocluidos fue en 2017 con 52. Conclusiones: La incidencia de cáncer colorrectal y anal y de oclusión por esa causa se encuentra por encima de los reportes cubanos, similar a los que ocurre en países de la región. La mortalidad por oclusión está por encima de investigaciones internacionales(AU)

Introduction: Colorectal and anal cancer is a disease with high incidence and intestinal obstruction is its most frequent complication. Objective: To describe the incidence and mortality of patients with colorectal and anal cancer and mechanical intestinal occlusion due to this cause. Methods: A descriptive case series revision was carried out including patients diagnosed with intestinal occlusion due to colorectal cancer in Sancti Spíritus, Cuba, from January 1, 2014 to December 31, 2018. Living patients and deceased were studied. Results: The incidence of colorectal and anal cancer had the highest rate in 2016, that is, 28.73 per 100,000 inhabitants. The highest number of occluded patients was in 2017 with 52. Conclusions: The incidence of colorectal and anal cancer and occlusion because of this reason is above Cuban reports, similar to what occurs in countries in the region. Mortality due to occlusion is above international investigations(AU)

Una mirada al cáncer colorrectal en Chile: aproximación individualizada de las cifras para el periodo 2016-2021 / A look at colorectal cancer in Chile: Individual approximation of the figures for the period 2016-2021

Introducción: El cáncer colorrectal (CCR) es la tercera enfermedad maligna más frecuente en el mundo y suele estudiarse como un solo concepto, a pesar de las diferencias entre las neoplasias que lo conforman. Dada la falta de trabajos actualizados, se ha realizado esta revisión epidemiológica para aproximarse a su verdadera magnitud en la población chilena. Materiales y Métodos: Este estudio es de carácter observacional, descriptivo, longitudinal y retrospectivo. Analizó las tasas de mortalidad a nivel nacional y regional entre 2016-2021 por cáncer de colon, unión rectosigmoidea y recto, utilizando datos de acceso público. Los criterios de inclusión consideraron todas las defunciones por las neoplasias mencionadas registradas en el DEIS, mientras que los criterios de exclusión corresponden a aquellas que por las mismas causas no fueron registradas o sucedieron fuera del período de estudio. No se requirió consentimiento informado ni revisión por parte de un comité de ética. Resultados: Se evidencia un aumento de las defunciones por cáncer de colon, principalmente en la zona centro-sur del país, sin una predilección significativa de género. Aunque la mortalidad por otras neoplasias estudiadas ha aumentado, no ha sido en igual cuantía. Discusión: La mortalidad por cáncer de colon es superior a la de otras neoplasias estudiadas, destacando la zona centro-sur del país, sin una tendencia específica por sexo en los fallecimientos. Esto podría explicarse por fallas en los mecanismos diagnósticos o diferencias en los hábitos alimenticios. Se necesitarían estudios adicionales para confirmar estas observaciones.

Introduction: Colorectal cancer (CRC) is the third most frequent malignant disease in the world, and although it is usually studied as a single entity (rectum-colon), the differences between both neoplasms are quantitatively significant. Therefore, in view of the lack of updated studies, this epidemiological review has been carried out to approximate its real magnitude in the Chilean population. Materials and Methods: Observational, descriptive, longitudinal, and retrospective study, where mortality rates were analyzed at the national and regional level, between 2016-2021, due to colon cancer. For this, publicly accessible data was used. Therefore, informed consent or review by an ethics committee was not required. Results: During the period studied, there is evidence of a clear rising trend in mortality rates, contributed mainly by the central-southern area of the country, without significant gender predilection. The mortality rate contributed by rectum and union neoplasm isn't significant enough like the colon ones. Discussion: Through this review, the systematic growth that this pathology has experienced in national mortality and its predilection for specific geographical areas are evident. The explanation for this could range from failures in diagnostic care mechanisms to marked differences in diet habits; more studies would be needed to confirm it.

Caracterización de adultos mayores con diagnóstico de cáncer colorrectal / Characterization of elderly with diagnosis of colorectal neoplasm

Introducción: El cáncer colorrectal es la neoplasia más frecuente de las vías digestivas en adultos mayores, así como la cuarta más diagnosticada en hombres y la tercera en mujeres. Objetivo: Caracterizar a los adultos mayores con cáncer colorrectal egresados del Hospital Provincial Clínico-Quirúrgico Docente Amalia Simoni de Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal de 145 adultos mayores egresados del Hospital Provincial Clínico-Quirúrgico Docente Amalia Simoni de Camagüey con el diagnóstico de cáncer colorrectal, desde enero de 2016 hasta igual mes de 2019, de los que se escogió una muestra de 103 de ellos, teniendo en cuenta criterios de inclusión y de exclusión. Las variables analizadas fueron: grupo de edades, antecedentes patológicos personales, formas de presentación de la enfermedad, localización del tumor y diagnóstico histológico. Resultados: Predominaron el grupo etario de 60- 69 años (41,7 %), las féminas (56,3 %), el adenoma velloso y la enfermedad inflamatoria intestinal como antecedentes patológicos personales (36,8 y 30,1 %, respectivamente), el sangrado digestivo bajo como forma de presentación (43,6 %), el lado izquierdo del colon como localización más afectada (76,7 %) y los adenocarcinomas bien diferenciados según el diagnóstico histológico (41,7 %). Conclusiones: Resulta importante la pesquisa activa para la detección temprana del cáncer colorrectal, principalmente en pacientes de 60 años y más, con antecedentes patológicos personales de adenoma velloso y enfermedad intestinal inflamatoria, que refieran sangrado digestivo bajo.

Introduction: The colorectal cancer is the most frequent neoplasia of the digestive tract in elderly, as well as the fourth more diagnosed in men and the third in women. Objective: To characterize the patients with colorectal cancer discharged from Amalia Simoni Teaching Clinical-Surgical Provincial Hospital in Camagüey. Methods: An observational, descriptive and cross-sectional study of 145 patients discharged from Amalia Simoni Teaching Clinical-Surgical Provincial Hospital in Camagüey with the diagnosis of colorectal cancer, was carried out from January, 2016 to the same month in 2019, a sample of 103 of them was chosen, taking into account inclusion and exclusion criteria. The analyzed variables were: age groups, personal pathological history, forms of presentation of the disease, localization of the tumor and histologic diagnosis. Results: There was a prevalence of the 60-69 age group (41.7 %), women (56.3 %), hairy adenoma and the intestinal inflammatory disease as personal pathological history (36.8 and 30.1 %, respectively), low digestive bleeding as form of presentation (43.6 %), the left side of the colon as more affected localization (76.7 %) and well differentiated adenocarcinomas according to the histologic diagnosis (41.7 %). Conclusions: It is important the active investigation for the early detection of the colorectal cancer, mainly in patients of 60 years and over, with personal pathological history of hairy adenoma and inflammatory intestinal disease that refer low digestive bleeding.

Neoplasia primaria sincrónica de estómago, colon y recto: reporte de un caso / Synchronous stomach, colon and rectum primary neoplasias: a case report

Presentamos el caso de un paciente masculino de 40 años de edad, con estreñimiento de un año de evolución y antecedentes de enfermedad por reflujo gastroesofágico, se realiza endoscopia digestiva alta y baja y se realiza diagnóstico sincrónico de adenocarcinoma de estómago, recto y colon descendente, realizamos tomografía por emisión de positrones con tomografía computarizada pre quirúrgico y cirugía como tratamiento primario. Mostramos una descripción del caso y una revisión de la bibliografía.

We present the case of a 40-year-old man with a one year evolution constipation and a history of GERD. An upper and lower digestive endoscopy was performed and a synchronous diagnosis of adenocarcinoma of the stomach, rectum and descending colon was established. A PET-CT pre-surgical was performed and the surgery was carried out as primary treatment. We show a description of the case and a bibliographic review.

Relación del cáncer colorrectal en el adulto mayor en la comunidad con ciencia, tecnología y sociedad / Relationship of Colorectal Cancer in Community Older Adults with Science, Technology and Society

Introducción: En Cuba, 20 por ciento de la población tiene 60 años y más, y la probabilidad de adquirir cáncer colorrectal es del cuatro al seis por ciento a lo largo de la vida, lo que constituye un problema social. Objetivo: Determinar la relación entre el cáncer colorrectal en el adulto mayor en la comunidad con ciencia, tecnología y sociedad. Métodos: Se realizó un estudio de intervención y desarrollo con la estrategia de autocuidado en adultos mayores con cáncer colorrectal en la comunidad en el Policlínico Dr. Rudesindo Antonio García del Rijo; del municipio y provincia de Sancti Spíritus, en el periodo 2007-2017. Variables: nivel de información de los médicos, estado de salud, autocuidado y el alivio del dolor en los adultos mayores con cáncer colorrectal. Se trabajó con la totalidad de la población, 116 adultos mayores con cáncer colorrectal y 37 médicos. Se utilizó estadística descriptiva de cada variable mediante tablas, con frecuencias absoluta y relativa como medida de resumen. Resultados: Se instruyó a los pacientes y se logró el alivio del dolor en un 76,72 por ciento, mejoró el autocuidado en un 50 por ciento y el estado de salud fue aceptable en un 44,82 por ciento. La sobrevida se comportó en los pacientes que estuvieron desde su diagnóstico en la estrategia de autocuidado de cinco a siete años. Conclusiones: El cáncer colorrectal en la población adulta mayor constituye un problema de ciencia, tecnología y sociedad(AU)

Introduction: In Cuba, 20 percent of the population is 60 years old and over. The probability of getting colorectal cancer throughout life is four to six percent. This is of social problem. Objective: To determine the relationship between colorectal cancer in community older adults with science, technology and society. Methods: An intervention and development study was carried out at Dr. Rudesindo Antonio García del Rijo Polyclinic from Sancti Spíritus Municipality, Sancti Spíritus Province, in the period 2007-2017, with the self-care strategy in community older adults with colorectal cancer. The variables were level of information of physicians, health status, self-care and pain relief in older adults with colorectal cancer. We worked with the entire population: 116 older adults with colorectal cancer and 37 physicians. Descriptive statistics of each variable were used through tables, using absolute and relative frequencies as summary measure. Results: The patients were instructed and pain relief was achieved in 76.72 percent, self-care improved in 50 percent and the health status was acceptable in 44.82 percent. Survival manifested in patients who were, from the time of their diagnosis, part of the self-care strategy for five to seven years. Conclusions: Colorectal cancer in the older adults' population is a problem of science, technology and society(AU)

Carcinoma colorrectal en niños y adolescentes / Colorectal carcinoma in children and adolescent

Si bien el carcinoma colorrectal (CCR) es la tercera enfermedad oncológica más frecuente en adultos, solo el 1-4 % ocurre en menores de 25-30 años. Su presentación suele confundirse con otras patologías, lo cual lleva a significativas demoras diagnósticas. Dada su baja incidencia, pocos pediatras se enfrentarán con algún caso a lo largo de su carrera. Sin embargo, existen en la niñez múltiples síndromes hereditarios que predisponen al CCR. El objetivo de esta revisión es brindar una actualización sobre los síndromes predisponentes al CCR. Se revisarán las indicaciones de tamizaje, dado que el diagnóstico precoz en estadios localizados es el principal factor pronóstico. Además, se fortalecerán las herramientas de consejería genética para el paciente y su familia. A su vez, se discutirán las manifestaciones clínicas e histológicas y los factores pronósticos propios del CCR en la población pediátrica. Si bien las guías de tratamiento se extrapolan de la experiencia en adultos, se resumirán los lineamientos terapéuticos.

Although colorectal carcinoma (CRC) is the third most common type of cancer in adults, only 1-4 % of cases are reported in individuals younger than 25-30 years. Its presentation is usually confused with other diseases, leading to significant delays in diagnosis. Given its low incidence, few pediatricians will see a case throughout their practice. However, multiple hereditary syndromes during childhood predispose to CRC.The objective of this review is to provide an update on syndromes predisposing to CRC. Screening indications will be reviewed because an early diagnosis during localized stages is the main prognostic factor. In addition, patient and family genetic counseling tools will be enhanced. In turn, the clinical and histological manifestations and prognostic factors typical of CRC in the pediatric population will be discussed. Although treatment guidelines are extrapolated from the adult experience, therapy guidelines will be summarized here.

Helicobacter pylori and colorectal neoplasms: a concise review / Helicobacter pylori e neoplasias colorretais: revisão concisa

ABSTRACT Helicobacter pylori is the main etiological agent of all malignant tumors caused by an infectious disease. It is a major, at times dominant, factor in the pathogenesis of a large spectrum of diseases such as acute and chronic gastritis, gastric and duodenal ulcers, gastric carcinoma, and lymphoma. Epidemiological and experimental studies suggest that H. pylori chronic infection may be related to different extragastric diseases, including colorectal neoplasms. This concise review aims to explore the association of H. pylori infection with colorectal cancer and adenoma, including the recent epidemiological findings, the diagnostic methods employed to detect H. pylori and virulent factors, and the potentially involved mechanisms. Furthermore, is attempted to establish the current data integration for causal inference using the Bradford-Hill causality criteria. The weak, although global, strength of the epidemiological positive association between H. pylori infection and colonic neoplasms associated to new mechanisms postulated to explain this interaction, including intestinal dysbiosis, should stimulate future studies. Prospective confirmatory studies to establish the role of H. pylori eradication in the process of carcinogenic transformation of the colonic epithelium may define its eventual role in the treatment and prevention of colonic neoplasms.

RESUMO Helicobacter pylori é o principal agente etiológico dos tumores malignos causados por doenças infecciosas. Constitui fator importante, às vezes dominante, na patogênese de um amplo espectro de doenças como gastrite aguda e crônica, úlceras gástricas e duodenais, carcinoma gástrico e linfoma. Estudos epidemiológicos e experimentais sugerem que a infecção crônica por H. pylori pode estar relacionada a diferentes doenças extragástricas, incluindo neoplasias colorretais. Esta concisa revisão tem como objetivo explorar a associação da infecção por H. pylori com câncer colorretal e adenoma, incluindo os recentes achados epidemiológicos, os métodos de diagnóstico empregados para detectar H. pylori e seus fatores de virulência com os mecanismos potencialmente envolvidos nesta relação. Além disso, procura-se estabelecer a integração dos dados atuais na busca de inferência causal com o emprego dos critérios de causalidade de Bradford-Hill. A associação epidemiológica positiva entre infecção por H. pylori e neoplasias do cólon embora classificada como fraca - porém global - do ponto de vista epidemiológico, quando associada a mecanismos recentemente postulados para explicar essa interação, incluindo disbiose intestinal, deverá estimular a realização de investigações futuras. Estudos prospectivos confirmatórios para estabelecer o papel da erradicação do H. pylori no processo de transformação carcinogênica do epitélio do cólon são aguardados para definir seu eventual papel no tratamento e prevenção de neoplasias do cólon.

Fatores sociodemográficos e clínicos associados ao tempo para o início do tratamento de câncer de cólon e reto no Brasil, 2006-2015 / Sociodemographic and clinical factors associated with time to treatment for colorectal cancer in Brazil, 2006-2015 / Factores sociodemográficos y clínicos relacionados con el tiempo para el inicio del tratamiento de cáncer de colon y recto en Brasil, 2006-2015

O câncer de cólon e reto apresenta alta incidência mundialmente, porém a letalidade da doença é maior em países em desenvolvimento. O objetivo deste estudo é analisar fatores sociodemográficos e clínicos associados ao atraso para o início de tratamento de câncer de cólon e reto em hospitais no Brasil. Trata-se de estudo retrospectivo com dados dos registros hospitalares de câncer no Brasil de 2006 a 2015. O desfecho analisado é o tempo para início do tratamento de câncer de cólon e reto e possíveis associações entre variáveis sociodemográficas e referentes a fatores clínicos. Observaram-se disparidades no tempo para início do tratamento de acordo com estratos sociodemográficos e regiões geográficas. Há maior chance de atraso para o início do tratamento de câncer de cólon em pacientes com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,50; IC95%: 1,21-1,84) e parda (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1.50; IC95%: 1,19-1,90) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,25; IC95%: 1,14-1,38). Em pacientes com câncer de reto, há maior chance de atraso para o início do tratamento entre os casos com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,44; IC95%: 1,20-1,72) e parda (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,35; IC95%: 1,25-1,47). Como conclusão, maior atenção deve ser destinada a reduzir o tempo para iniciar o tratamento nas regiões desfavorecidas e nos estratos identificados com barreiras de acesso ao tratamento em tempo oportuno.

Colorectal cancer presents high incidence worldwide, but case-fatality is higher in developing countries. The study's objective was to analyze sociodemographic and clinical factors associated with delay in the initiation of treatment for colorectal cancer in hospitals in Brazil. This is a retrospective study of data from hospital cancer registries in Brazil from 2006 to 2015. The target variable is time to initiation of treatment for colorectal cancer and possible associations between sociodemographic variables and clinical factors. The analysis revealed disparities in time to treatment according to sociodemographic strata and geographic regions. Higher odds of treatment delay were associated with age over 50 years, black race/color (OR = 1.50; 95%CI: 1.21-1.84) and brown race/color (OR = 1.28; 95%CI: 1.17-1.42), illiteracy or low schooling (OR = 1.50; 95%CI: 1.19-1.90), and treatment in a city far from the patient's residence (OR = 1.25; 95%CI: 1.14-1.38). For rectal cancer, higher odds of treatment delay were associated with age over 50 years, black (OR = 1.44; 95%CI: 1.20-1.72) or brown race/color (OR = 1.29; 95%CI: 1.19-1.39), illiteracy or low schooling (OR = 1.71; 95%CI: 1.40-2.09), and treatment in a city far from the patient's residence (OR = 1.35; 95%CI: 1.25-1.47). In conclusion, greater attention should be given to reducing the time to initiation of treatment in underprivileged regions and in social strata identified with barriers to timely treatment access.

El cáncer de colon y recto presenta una alta incidencia mundialmente, pese a que la letalidad de la enfermedad es mayor en países en desarrollo. El objetivo de este estudio fue analizar los factores sociodemográficos y clínicos, asociados al retraso para el inicio del tratamiento de cáncer de colon y recto en hospitales en Brasil. Se trata de un estudio retrospectivo con datos de registros hospitalarios de cáncer en Brasil de 2006 a 2015. El resultado analizado es el tiempo para el inicio del tratamiento de cáncer de colon y recto, así como las posibles asociaciones entre variables sociodemográficas y las relacionadas con factores clínicos. Se observó disparidades en el tiempo para el inicio del tratamiento, según estratos sociodemográficas y regiones geográficas. Existe una mayor oportunidad de retraso para el inicio del tratamiento de cáncer de colon en pacientes con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,50; IC95%: 1,21-1,84) y mulata/mestiza (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1,50; IC95%: 1,19-1,90) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,25; IC95%: 1,14-1,38). En pacientes con cáncer de recto existe una mayor oportunidad de atraso para el inicio del tratamiento entre los casos con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,44; IC95%: 1,20-1,72) y mulata/mestiza (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,35; IC95%: 1,25-1,47). Como conclusión, se debe prestar mayor atención a la reducción del tiempo para comenzar el tratamiento en las regiones desfavorecidas y en estratos identificados con barreras de acceso al tratamiento en el tiempo adecuado.

Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000-2019 / 中华医学杂志(英文版)

BACKGROUND@#Globally, colorectal cancer (CRC) imposes a substantial burden on healthcare systems and confers considerable medical expenditures. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.@*METHODS@#We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index (HDI). Trends of age-standardized rates of incidence and mortality in 60 countries (2000-2019) were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019. The association between exposure to country-level lifestyle, metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.@*RESULTS@#CRC incidence and mortality varied greatly in the 60 selected countries, and much higher incidence and mortality were observed in countries with higher HDIs, and vice versa. From 2000 to 2019, significant increases of incidence and mortality were observed for 33 countries (average annual percent changes [AAPCs], 0.24-3.82) and 18 countries (AAPCs, 0.41-2.22), respectively. A stronger increase in incidence was observed among males (AAPCs, 0.36-4.54) and individuals <50 years (AAPCs, 0.56-3.86). Notably, 15 countries showed significant decreases in both incidence (AAPCs, -0.24 to -2.19) and mortality (AAPCs, -0.84 to -2.74). A significant increase of incidence among individuals <50 years was observed in 30 countries (AAPCs, 0.28-3.62). Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking, higher level of cholesterol level, higher level of unemployment, and a poorer healthcare system.@*CONCLUSIONS@#Some high-HDI countries showed decreasing trends in CRC incidence and mortality, whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends, especially in males and populations ≥50 years, which require targeted preventive health programs.

Time trends in colorectal cancer incidence in four regions of Latin America: 1983-2012 / Tendências temporais na incidência do câncer colorretal em quatro regiões da América Latina: 1983-2012 / Tendencias temporales en la incidencia del cáncer colorrectal en cuatro regiones latinoamericanas: 1983-2012

Abstract: This study aimed to assess time trends in colorectal cancer incidence from 1983 to 2012 in Latin America. This was an ecological time-series study whose population consisted of individuals aged 20 years or older diagnosed with colorectal cancer. Data from population-based cancer registries in Cali (Colombia), Costa Rica, Goiânia (Brazil), and Quito (Ecuador), were used for rates estimation, while time trends estimations were proceeded by the Joinpoint Regression Program. The study showed an increase in colorectal cancer incidence in men and women in Cali (2.8% and 3.2%, respectively), Costa Rica (3.1% and 2.1%, respectively), and Quito (2.6% and 1.2%, respectively), whereas in Goiânia, only women showed an increase in colorectal cancer rates (3.3%). For colon cancer, we observed an increasing trend in incidence rates in men and women in Cali (3.1% and 2.9%, respectively), Costa Rica (3.9% and 2.8%, respectively), and Quito (2.9% and 1.8%). For rectal cancer, we observed an increasing trend in incidence in men and women in Cali (2.5% and 2.6%, respectively), Costa Rica (2.2% and 1%, respectively), and Goiânia (5.5% and 4.6%, respectively), while in Quito only men showed an upward trend (2.8%). The study found increases in colorectal cancer, colon cancer, and rectal cancer in four Latin America regions. This findings reflect lifestyle, such as dietary changes, following the economic opening, and the prevalence variations of colorectal cancer risk factors by sex and between the four studied regions. Finally, the different strategies adopted by regions for colorectal cancer diagnosis and screening seem to influence the observed variation between anatomical sites.

Resumo: O estudo teve como objetivo avaliar as tendências temporais na incidência do câncer colorretal entre 1983 e 2012 na América Latina. Este é um estudo ecológico de séries temporais com uma população de indivíduos com 20 anos ou mais, diagnosticados com câncer colorretal. Foram usados os dados dos registros de câncer de base populacional de Cáli (Colômbia), Costa Rica, Goiânia (Brasil) e Quito (Equador) para estimar taxas, enquanto as estimativas das tendências temporais foram realizadas com o software Joinpoint Regression Program. O estudo mostrou um aumento na incidência do câncer colorretal em homens e mulheres em Cáli (2,8% e 3,2%, respectivamente), Costa Rica (3,1% e 2,1%, respectivamente) e Quito (2,6% e 1,2%, respectivamente). Em Goiânia, somente as mulheres mostraram um aumento na incidência do câncer colorretal (3,3%). Para o câncer de cólon, houve uma tendência crescente na incidência em homens e mulheres em Cali (3,1% e 2,9%, respectivamente), Costa Rica (3,9% e 2,8%, respectivamente) e Quito (2,9% e 1,8%). Para o câncer retal, houve uma tendência crescente na incidência em homens e mulheres em Cali (2,5% e 2,6%, respectivamente), Costa Rica (2,2% e 1%, respectivamente) e Goiânia (5,5% e 4,6%, respectivamente), enquanto em Quito somente os homens mostraram tendência crescente (2,8%). O estudo encontrou aumentos no câncer colorretal, câncer de cólon e câncer retal em quatro regiões latino-americanas. Os achados refletem mudanças no estilo de vida, como mudanças de dieta, após a abertura econômica, e variações na prevalência de fatores de risco para câncer colorretal de acordo com gênero e entre as quatro regiões estudadas. Finalmente, as diferentes estratégias adotadas pelas regiões para o diagnóstico e triagem do câncer colorretal parecem influenciar a variação observada entre os sítios anatômicos.

Resumen: El objetivo fue evaluar las tendencias temporales en la incidencia del cáncer colorrectal, de 1983 a 2012, en Latinoamérica. Se trata de un estudio ecológico de series temporales, cuya población consistió en individuos con 20 años de edad, diagnosticados con cáncer colorrectal. Para las tasas de estimación se utilizaron los datos provenientes de los registros de cáncer de base poblacional en: Cali (Colombia), Costa Rica, Goiânia (Brasil), y Quito (Ecuador), mientras que las estimaciones en las tendencias temporales se obtuvieron mediante el software Joinpoint Regression Program. El estudio mostró un incremento en la incidencia de cáncer colorrectal en hombres y mujeres en Cali (2.8% y 3.2%, respectivamente), Costa Rica (3.1% y 2.1%, respectivamente), y Quito (2.6% y 1.2%, respectivamente). En Goiânia, solo las mujeres mostraron un incremento en las tasas de cáncer colorrectal (3.3%). Para el cáncer de colon, hubo una tendencia creciente en las tasas de incidencia en hombres y mujeres en Cali (3.1% y 2.9%, respectivamente), Costa Rica (3.9% y 2.8%, respectivamente), y Quito (2.9% y 1.8%). En el caso del cáner rectal, hubo una tendencia creciente en la incidencia en hombres y mujeres en Cali (2.5% y 2.6%, respectivamente), Costa Rica (2.2% y 1%, respectivamente), y Goiânia (5.5% y 4.6%, respectivamentre), mientras en Quito solo los hombres mostraron una tendencia creciente (2.8%). El estudio encontró incrementos en cáncer colorrectal, cáncer de colon, y cáncer rectal en cuatro regiones de Latinoamérica. Los resultados reflejan un estilo de vida con cambios en la dieta, que siguió a la apertura económica, así como variaciones en la prevalencia de los factores de riesgo de cancer colorrectal por sexos y entre las cuatro regiones estudiadas. Finalmente, las diferentes estrategias adoptadas por las regiones para el diagnóstico del cáncer colorrectal y su pruebas de cribado parece que influencian la variación observada entre los sitios anatómicos donde surge.

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

Abstract Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.