Does delay in diagnosing colorectal cancer in symptomatic patients affect tumor stage and survival? A population-based observational study.

BACKGROUND: Diagnosing colorectal cancer (CRC) at an early stage improves survival. To what extent any delay affects outcome once patients are symptomatic is still unclear.Our objectives were to evaluate the association between diagnostic delay and survival in symptomatic patients with early stage CRC and late stage CRC. METHODS: Prospective population-based observational study evaluating daily clinical practice in Northern Holland. Diagnostic delay was determined through questionnaire-interviews. Dukes' stage was classified into two groups: early stage (Dukes A or B) and late stage (Dukes C or D) cancer. Patients were followed up for 3.5 years after diagnosis. RESULTS: In total, 272 patients were available for analysis. Early stage CRC was present in 136 patients while 136 patients had late stage CRC. The mean total diagnostic delay (SE) was 31 (1.5) weeks in all CRC patients. No significant difference was observed in the mean total diagnostic delay in early versus late stage CRC (p = 0.27).In early stage CRC, no difference in survival was observed between patients with total diagnostic delay shorter and longer than the median (Kaplan-Meier, log-rank p = 0.93).In late stage CRC, patients with a diagnostic delay shorter than the median had a shorter survival than patients with a diagnostic delay longer than the median (log-rank p = 0.01). In the multivariate Cox regression model with survival as dependent variable and median delay, age, open access endoscopy, number and type of symptoms as independent variables, the odd's ratio for survival in patients with long delay (>median) versus short delay (

[Diagnosis of colorectal tumours in daily clinical practice: comparison of colonoscopy and sigmoidoscopy]. / Diagnostiek van colorectale tumoren in de dagelijkse praktijk. Vergelijking van coloscopie en sigmoïdoscopie.

OBJECTIVE: To map the locations of advanced colorectal neoplasia in patients referred for colonoscopy or sigmoidoscopy and to compare the yield of advanced neoplasia and the distribution of advanced neoplasia per indication for endoscopy. DESIGN: Observational. METHOD: In a multicentre survey in North Holland, the Netherlands (n = 18 hospitals), data on all colonoscopies and sigmoidoscopies performed during a three-month period in 2005 were analyzed. The locations and the histological features of all colonic neoplasia and the indications for endoscopy were recorded. Advanced neoplasm was defined as adenoma >or=10 mm in size, an adenoma with any villous features, or high-grade dysplasia or adenocarcinoma. RESULTS: A total of 4623 patients underwent a total colonoscopy and 3004 patients underwent sigmoidoscopy. The prevalence of advanced neoplasia was 13% on colonoscopy and 6% on sigmoidoscopy. Of the advanced neoplasia found on colonoscopy, 67% were located in the distal colon and 33% in the proximal colon. Of the patients with advanced neoplasia in the proximal colon (n = 228), 51% had no abnormalities in the distal colon. The percentage of advanced neoplasia in the proximal colon varied from 23% in patients younger than 50 years to 41% in patients aged 80 years and older. Depending on the indication for endoscopy, the prevalence of advanced neoplasia in the proximal colon varied from 11-57%. CONCLUSION: Of the advanced colorectal neoplasms 33% were located in the proximal colon. With increasing age, a shift in tumour localization occurs from distal to proximal in the colon. Colonoscopy is the preferred method for the endoscopic diagnosing of colorectal neoplasia.

Colonoscopic yield of colorectal neoplasia in daily clinical practice.

AIM: To assess the prevalence and location of advanced neoplasia in patients undergoing colonoscopy, and to compare the yield per indication. METHODS: In a multicenter colonoscopy survey (n = 18 hospitals) in the Amsterdam area (Northern Holland), data of all colonoscopies performed during a three month period in 2005 were analyzed. The location and the histological features of all colonic neoplasia were recorded. The prevalence and the distribution of advanced colorectal neoplasia and differences in yield between indication clusters were evaluated. Advanced neoplasm was defined as adenoma > 10 mm in size, with > 25% villous features or with high-grade dysplasia or cancer. RESULTS: A total of 4623 eligible patients underwent a total colonoscopy. The prevalence of advanced neoplasia was 13%, with 281 (6%) adenocarcinomas and 342 (7%) advanced adenomas. Sixty-seven percent and 33% of advanced neoplasia were located in the distal and proximal colon, respectively. Of all patients with right-sided advanced neoplasia (n = 228), 51% had a normal distal colon, whereas 27% had a synchronous distal adenoma. Ten percent of all colonoscopies were performed in asymptomatic patients, 7% of whom had advanced neoplasia. In the respective procedure indication clusters, the prevalence of right-sided advanced neoplasia ranged from 11%-57%. CONCLUSION: One out of every 7-8 colonoscopies yielded an advanced colorectal neoplasm. Colonoscopy is warranted for the evaluation of both symptomatic and asymptomatic patients.

Positron emission tomography using 2-deoxy-2-[18F]-fluoro-D-glucose for response monitoring in locally advanced gastroesophageal cancer; a comparison of different analytical methods.

PURPOSE: To determine the ability of 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET) to monitor response in locally advanced gastroesophageal cancer (LAGEC). Additionally, optimal FDG-PET methods for response monitoring were selected. PROCEDURES: Sequential dynamic FDG-PET scans were performed in 13 patients with LAGEC (T2-3N0-1M0-1a) treated with neoadjuvant cisplatin and gemcitabine plus granulocyte macrophage colony stimulating growth factor at a three weekly schedule. The standard FDG-PET method, nonlinear regression (NLR), was compared with computed tomography (CT), endoscopic-ultrasound (EUS), and histopathology as well as with 21 simplified analytical FDG-PET methods. RESULTS: Five out of 12 operated tumors responded histopathologically with less than 10% residual tumorcells (42%). These had a higher decrease in FDG uptake compared with nonresponders (P=0.008). Early (after two cycles) and late (after completed induction therapy) response evaluation showed a specificity of 86% and 100%, respectively, and a sensitivity of 100%. Both FDG-PET and EUS were superior to CT. From 21 methods analyzing FDG uptake, the quantitative Patlak analysis, the simplified kinetic method (SKM), and the semiquantitative standardized uptake value corrected for bodyweight (SUV-BW) seemed to correlate best with NLR. CONCLUSIONS: FDG-PET reliably predicted response in LAGEC. FDG-PET measurements using Patlak analysis or the more clinical applicable SKM and SUV-BW were acceptable alternatives to NLR.