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)

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.

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.

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 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.

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.

Ressecção da mucosa endoscópica sob imersão dágua para lesões colorretais não pediculadas. Um estudo prospectivo de braço único / Underwater endoscopic mucosal resection for non-pedunculated colorectal lesions. a prospective single-arm study

ABSTRACT BACKGROUND: Underwater endoscopic mucosal resection (UEMR) has emerged as a revolutionary method allowing resection of colorectal lesions without submucosal injection. Brazilian literature about this technique is sparse. OBJECTIVE: The aim of this study was evaluate the efficacy and safety of UEMR technique for removing non-pedunculated colorectal lesions in two Brazilian tertiary centers. METHODS: This prospective study was conducted between June 2016 and May 2017. Naïve and non-pedunculated lesions without signs of submucosal invasion were resected using UEMR technique. RESULTS: A total of 55 patients with 65 lesions were included. All lesions, except one, were successfully and completely removed by UEMR (success rate 98.5%). During UEMR, two cases of bleeding were observed (3.0%). One patient had abdominal pain on the day after resection without pneumoperitoneum. There was no perforation or delayed bleeding. CONCLUSION: This study supports the existing data indicating acceptable rates of technical success, and low incidence of adverse events with UEMR. The results of this Brazilian study were consistent with previous abroad studies.

RESUMO CONTEXTO: A ressecção endoscópica da mucosa sob imersão d'água (REMS) surgiu como um método revolucionário que permite a ressecção de lesões colorretais sem injeção submucosa. A literatura brasileira sobre essa técnica é escassa. OBJETIVO: A finalidade deste estudo foi avaliar a eficácia e segurança da técnica REMS na remoção de lesões colorretais não pediculadas em dois centros terciários brasileiros. MÉTODOS: Este estudo prospectivo foi realizado entre junho de 2016 e maio de 2017. As lesões sem tentativa de ressecção prévia, não pediculadas e sem sinais de invasão submucosa foram ressecadas pela técnica REMS. RESULTADOS: Um total de 55 pacientes com 65 lesões foram incluídos. Todas as lesões, exceto uma, foram removidas com sucesso e completamente por REMS (taxa de sucesso de 98,5%). Durante a REMS, foram observados dois casos de sangramento (3,0%). Uma paciente apresentou dor abdominal no dia seguinte à ressecção sem pneumoperitônio. Não houve perfuração ou sangramento tardio. CONCLUSÃO: Este estudo apoia os dados existentes, indicando taxas aceitáveis de sucesso técnico e baixa incidência de eventos adversos com a REMS. Os resultados deste estudo brasileiro foram consistentes com estudos internacionais prévios.

Morbidade hospitalar e mortalidade por câncer colorretal: implicações para a saúde pública no Brasil / Hospital morbidity and colorectal cancer mortality: implications for public health in brazil

ABSTRACT BACKGROUND: Colorectal cancer is a serious public health problem and one of the most common cancer worldwide. Countries around the world have shown different trends. While incidence and mortality rates for colorectal cancer are on an upward trend in developing countries, these rates have been on a downward trend in most developed countries. OBJECTIVE: To analyze the temporal trend of morbimortality by colorectal cancer in Brazil between 2002 and 2016. METHODS: Descriptive, time series research. Data were extracted from the national information systems for hospitalizations and deaths of the respective years. RESULTS: There were increasing trends in hospital morbidity and mortality from colorectal cancer in all regions of the country, with the very elderly individuals dying at a higher rate. Women (52.1%) were more affected than men, but death rates were higher for males aged 60 years or more. Regional disparities were evident, with almost 80% of deaths occurring in the South and Southeast, with the largest annual increase in the South and the lowest in the North. Regarding hospitalization, South and Southeast presented higher annual growths. CONCLUSION: These data add knowledge about the profile of public hospitalizations and deaths, reaffirming that colorectal cancer contributes to an important burden of disease and mortality in Brazil. These elements have implications for the review of colorectal cancer prevention and control strategies, as well as for public health investments.

RESUMO CONTEXTO: O câncer colorretal é um grave problema de saúde pública e um dos tipos mais comuns de câncer no mundo. Diferentes tendências têm sido observadas nos países ao redor do mundo. Enquanto as taxas de incidência e mortalidade por câncer colorretal apresentam tendência crescente em países em desenvolvimento, essas taxas têm se mantido em tendência decrescente nos países mais desenvolvidos. OBJETIVO: Analisar a tendência temporal de morbimortalidade por câncer colorretal no Brasil, entre 2002 e 2016. MÉTODOS: Pesquisa descritiva de série temporal. Os dados foram extraídos dos sistemas nacionais de informação de Internações Hospitalares e Mortalidade, nos anos respectivos. RESULTADOS: Observou-se tendência crescente da morbidade hospitalar e mortalidade por câncer colorretal em todas as regiões do país, constatando-se que morrem mais idosos em idade avançada. As mulheres (52,1%) foram mais acometidas do que os homens, porém as taxas de óbito foram maiores para o sexo masculino a partir dos 60 anos de idade. As disparidades regionais ficaram evidentes, sendo que quase 80% das mortes ocorreram nas regiões Sul e Sudeste, com maior incremento anual na região Sul e menor na região Norte. Em relação à hospitalização, Sul e Sudeste apresentaram maior crescimento anual. CONCLUSÃO: Os dados agregam conhecimento sobre o perfil das hospitalizações públicas e mortes, reafirmando que o câncer colorretal contribui para uma importante carga de doença e mortalidade no Brasil. Esses elementos trazem implicações para a revisão das estratégias de prevenção e controle do câncer colorretal, bem como para os investimentos na saúde pública.

Situación actual del cáncer de colon en Chile: una mirada traslacional / The present situation of colorectal cancer in Chile

Colorectal (CRC) is one of the most common types of cancer worldwide. Most tumors develop from an adenoma in a period of 10 to 15 years, but some may appear without previous adenomatous lesions. Seventy-five percent of colorectal cancers are sporadic, 20% have a family component (first or second-degree relatives with CRC) and 5% have a hereditary predisposition with a Mendelian pattern. The epidemiological evolution in the recent years in Chile has a worrisome evolution and the treatment costs of advanced stages are a burden for the healthcare system. We herein highlight the main Chilean medical and scientific contributions on the pathogenesis, early diagnosis, and treatment of CRC, which lead to its better understanding, and therefore better management, based on local evidence.

Trends in colorectal cancer incidence in western Kazakhstan through the first decade of the screening implementation, 2009-2018 / Tendências na incidência do câncer colorretal no Cazaquistão ocidental durante a primeira década da implementação do rastreamento, 2009-2018

Abstract Introduction The study is aimed to outline the vector of colorectal cancer incidence in the industrial Aktobe province of western Kazakhstan through the first decade of the screening implementation, 2009-2018. Methods Rough incidence rates and annual percent changes were estimated for each age group at diagnosis, ethnicities, gender, residences, the disease stages and anatomic subsites (total N 1128) via regression analysis. Results Within 2009-2018 colorectal cancer rates increased from 14.74 to 23.19, with annual percent changes of 4.69%. The most significant growth was traced in men compared to women, up to 28.39 by 2018, with annual percent changes 6.64% vs. 2.64% (p = 0.0009). Annual percent changes in Kazakhs reached 8.7%, whereas Slavic groups showed decline in the incidence, annual percent changes −4.3% (p = 0.002). Declining in rates was also observed in urban population compared to rural one, annual percent changes −3.3% vs. 17.6%, respectively. Patients aged 60-69 made 31% of all cases and showed the largest annual percent changes 9.37% (p = 0.002). Patients at Stage II made 61% of all observations, but general trend evidenced sharp growth in the group of Stage I (annual percent changes 28.91%, p < 0.0001). Conclusion Overall, during the last decade colorectal cancer incidence increased 1.5 fold with expected further rise. However, the increment of Stage I portion by 2018 vs. advanced stages at diagnosis and the trend to decrease in rates among urban population inspire a definite assurance in potential efficiency of the screening program in long run. The next researches on colorectal cancer should include scenarios to reveal the role of disadvantaged environment in the region and consuming unhealthy ultra-processed food.

Resumo Introdução O objetivo do estudo é delinear o vetor da incidência do câncer colorretal na província industrial de Aktobe, no oeste do Cazaquistão, durante a primeira década da implementação do rastreamento, 2009‒2018. Métodos Taxas de incidência brutas e alterações percentuais anuais foram estimadas para cada faixa etária ao diagnóstico, etnias, sexo, residências, estágios da doença e localizações anatômicas (N total de 1.128) através da análise de regressão. Resultados Entre 2009‒2018, as taxas de câncer colorretal aumentaram de 14,74 para 23,19, com alteração percentual anual de 4,69%. O crescimento mais significativo foi evidenciado em homens em comparação com as mulheres, até 28,39 em 2018, com alterações percentuais anuais de 6,64% contra 2,64% (p = 0,0009). Alterações percentuais anuais nos cazaques atingiu 8,7%, enquanto os grupos eslavos mostraram declínio na incidência, alterações percentuais anuais -4,3% (p = 0.002). O declínio nas taxas também foi observado na população urbana em comparação com a rural, alterações percentuais anuais -3,3% vs. 17,6%, respectivamente. Pacientes com idade entre 60‒69 anos eram 31% de todos os casos e apresentaram as maiores alterações percentuais anuais 9,37% (p = 0,002). Os pacientes no Estágio II eram 61% de todas as observações, mas a tendência geral evidenciou crescimento acentuado no grupo do Estágio I (alterações percentuais anuais 28.91%; p < 0,0001). Conclusão No geral, durante a última década, a incidência de câncer colorretal aumentou 1,5 vezes com expectativa de maior aumento. No entanto, o incremento da porção do Estágio I em 2018 em comparação com os estágios avançados no momento do diagnóstico e a tendência de diminuição nas taxas entre a população urbana inspira uma garantia definitiva de eficiência potencial do programa de rastreamento em longo prazo. As próximas pesquisas sobre o câncer colorretal devem incluir cenários para revelar o papel do ambiente desfavorecido na região e o consumo de alimentos ultraprocessados não saudáveis.

Investigación traslacional en microbioma (InTraMic): un área de interés común y creciente en el IMTIB, Hospital Italiano e Instituto Universitario / Translational research in microbiome (InTraMic): an area of common and growing interest at IMTIB, Hospital Italiano and Instituto Universitario

Se estima que aproximadamente 100 trillones de microorganismos (incluidos bacterias, virus y hongos) residen en el intestino humano adulto y que el total del material genético del microbioma es 100 veces superior al del genoma humano. Esta comunidad, conocida como microbioma se adquiere al momento del nacimiento a través de la flora comensal de la piel, vagina y heces de la madre y se mantiene relativamente estable a partir de los dos años desempeñando un papel crítico tanto en el estado de salud como en la enfermedad. El desarrollo de nuevas tecnologías, como los secuenciadores de próxima generación (NGS), permiten actualmente realizar un estudio mucho más preciso de ella que en décadas pasadas cuando se limitaba a su cultivo. Si bien esto ha llevado a un crecimiento exponencial en las publicaciones, los datos sobre las poblaciones Latinoamérica son casi inexistentes. La investigación traslacional en microbioma (InTraMic) es una de las líneas que se desarrollan en el Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB). Esta se inició en 2018 con la línea de cáncer colorrectal (CCR) en una colaboración con el Colorectal Cancer Research Group del Leeds Institute of Medical Research en el proyecto Large bowel microbiome disease network: Creation of a proof of principle exemplar in colorectal cancer across three continents. A fines de 2019 se cumplió el objetivo de comprobar la factibilidad de la recolección, envío y análisis de muestras de MBF en 5 continentes, incluyendo muestras provenientes de la Argentina, Chile, India y Vietnam. Luego de haber participado de capacitaciones en Inglaterra, se ha cumplido con el objetivo de la etapa piloto, logrando efectivizar la recolección, envío y análisis metagenómico a partir de la secuenciación de la región V4 del ARNr 16S. En 2019, la línea de enfermedad de hígado graso no alcohólico se sumó a la InTraMic iniciando una caracterización piloto en el marco de una colaboración con el laboratorio Novartis. Los resultados de ese estudio, así como el de cáncer colorrectal, están siendo enviados a publicación. En 2020, con la incorporación de la línea de trasplante alogénico de células progenitoras hematopoyéticas, fue presentado un proyecto para un subsidio del CONICET que ha superado la primera etapa de evaluación. En el presente artículo se brinda una actualización sobre la caracterización taxonómica de microbioma y se describen las líneas de investigación en curso. (AU)

It is estimated that approximately 100 trillion microorganisms (including bacteria, viruses, and fungi) reside in the adult human intestine, and that the total genetic material of the microbiome is 100 times greater than that of the human genome. This community, known as the microbiome, is acquired at birth through the commensal flora of the mother's skin, vagina, and feces and remains relatively stable after two years, playing a critical role in both the state of health and in disease. The development of new technologies, such as next-generation sequencers (NGS), currently allow for a much more precise study of it than in past decades when it was limited to cultivation. Although this has led to exponential growth in publications, data on Latin American populations is almost non-existent. Translational research in microbiome (InTraMic) is one of the lines developed at the Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB). This started in 2018 with the Colorectal Cancer Line (CRC) in a collaboration with the Colorectal Cancer Research Group of the Leeds Institute of Medical Research in the project "Large bowel microbiome disease network: Creation of a proof of principle exemplar in colorectal cancer across three continents". At the end of 2019, the objective of verifying the feasibility of collecting, sending and analyzing MBF samples on 5 continents, including samples from Argentina, Chile, India and Vietnam, was met. After having participated in training in England, the objective of the pilot stage has been met, achieving the collection, delivery and metagenomic analysis from the sequencing of the V4 region of the 16S rRNA. In 2019, the non-alcoholic fatty liver disease line joined InTraMic, initiating a pilot characterization in the framework of a collaboration with the Novartis laboratory. The results of that study, as well as that of colorectal cancer, are being published. In 2020, with the incorporation of the allogeneic hematopoietic stem cell transplantation line, a project was presented for a grant from the CONICET that has passed the first stage of evaluation. This article provides an update on the taxonomic characterization of the microbiome and describes the lines of ongoing research. (AU)

Are obesity and adenoma development associated as colorectal cancer precursors? / Obesidade e desenvolvimento de adenoma estão associados como precursores do câncer colorretal?

ABSTRACT Background: One of the most important concerns on health is the increased rates of obesity in population and the speed in which this number is increasing. This number translates a serious public health problem, since it also increases the risk of several other diseases associated with obesity resulting in significant morbidity and mortality. Among them, it seems to be connected to several neoplasms, such as colorectal carcinoma. Aim: To evaluate the impact of obesity as a risk factor for colorectal carcinoma through the detection of adenoma, and to discuss the mechanisms that could establish a link between obesity and neoplasm. Methods: Patients who underwent colonoscopy were included. Personal and anthropometric data, clinical history, and results of the tests were analyzed in order to verify the correlation of BMI and the presence of adenomatous polyps. Results: A total of 142 patients were studied, which a mean age of 62 years. Of the patients, 74 (52.1%) were men and 68 (47.9%) were. Obesity was identified in 16.2% of the patients. Polyps were found in 61 (42.9%), mostly smaller than 1 cm. Obese individuals were 1.56 times more likely to present colorectal adenoma than patients with normal weight. Conclusion: This study, although showing the greater presence of colorectal adenomas in obese individuals, did not show a significant difference in the occurrence of pre-malignant lesions.

RESUMO Racional: Uma das grandes preocupações no âmbito da saúde é o crescente índice de obesidade na população e a velocidade com que esse número vem aumentando. Ele constitui grave problema de saúde pública, uma vez que aumenta também o risco de inúmeras doenças associadas à obesidade e que resultam em morbimortalidade significativa, como o câncer colorretal. Objetivo: Avaliar o impacto da obesidade como fator de risco para câncer colorretal, através da detecção de adenomas colorretais, e discutir os mecanismos que podem estabelecer uma ligação entre esta neoplasia e a obesidade. Métodos: Foram incluídos pacientes submetidos à colonoscopia. Dados pessoais e antropométricos, antecedentes clínicos e laudos dos exames foram analisados, a fim de verificar a correlação do IMC e a presença de pólipos adenomatosos. Resultados: Foram estudados 142 pacientes, 74 (52,1%) homens e 68 (47,9%) mulheres, com média de 62 anos. A obesidade foi identificada em 16,2% dos pacientes. Pólipos foram encontrados em 61 (42,9%), sendo em sua maioria menores do que 1 cm. Obesos tiveram probabilidade 1,56 vez maior de apresentar adenoma colorretal que pacientes com peso normal. Conclusão: Este estudo, apesar de mostrar a maior presença de adenomas colorretais em indivíduos obesos, não mostrou diferença estatisticamente significativa na ocorrência de lesões pré-malignas.