The Impact of Tumour Distance From the Anal Verge on Clinical Management and Outcomes in Patients Having a Curative Resection for Rectal Cancer.

AIM: The clinico-oncological significance of the distance of rectal cancer from the anal verge is unclear and not well reported. The aim of this study is to assess the influence of the rectal cancer distance from the anal verge on clinical management and long-term outcomes after curative resection in a specialised colorectal cancer unit. METHODS: Prospectively collected data on patients who underwent primary rectal cancer treatment at our unit between January 2005 and December 2010 were analysed. Low rectal cancer (LRC) was defined as tumour < 5 cm from the anal verge on MRI scan. Recurrent cancer, palliative resections, perforated tumours and those requiring total pelvic exenteration were excluded. RESULTS: Three hundred fifty-nine patients underwent surgery for rectal cancer (226 male/133 female). Of these, 149 (41.5%) patients had low rectal cancer (LRC). Compared to patients with mid/upper rectal cancer (M/URC), patients with low rectal cancers were significantly more likely to receive neo-adjuvant therapy (75.2 vs 38%; p < 0.001), to be associated with lower rate of restorative surgery (15.4 vs 79%; p < 0.001) and to have higher rates of pathological positive circumferential resection margin involvement (14.1 vs 7.1%; p = 0.047). There were however no significant difference in the rates of recurrent disease or survival among the two groups. CONCLUSION: Distance of rectal cancer from the anal verge does influence the use of neo-adjuvant treatment and ultimate R0 resection rate. It does not influence loco-regional or systemic recurrence rates.

The sensitivity of children to electromagnetic fields.

In today's world, technologic developments bring social and economic benefits to large sections of society; however, the health consequences of these developments can be difficult to predict and manage. With rapid advances in electromagnetic field (EMF) technologies and communications, children are increasingly exposed to EMFs at earlier and earlier ages. Consistent epidemiologic evidence of an association between childhood leukemia and exposure to extremely low frequency (ELF) magnetic fields has led to their classification by the International Agency for Research on Cancer as a "possible human carcinogen." Concerns about the potential vulnerability of children to radio frequency (RF) fields have been raised because of the potentially greater susceptibility of their developing nervous systems; in addition, their brain tissue is more conductive, RF penetration is greater relative to head size, and they will have a longer lifetime of exposure than adults. To evaluate information relevant to children's sensitivity to both ELF and RF EMFs and to identify research needs, the World Health Organization held an expert workshop in Istanbul, Turkey, in June 2004. This article is based on discussions from the workshop and provides background information on the development of the embryo, fetus, and child, with particular attention to the developing brain; an outline of childhood susceptibility to environmental toxicants and childhood diseases implicated in EMF studies; and a review of childhood exposure to EMFs. It also includes an assessment of the potential susceptibility of children to EMFs and concludes with a recommendation for additional research and the development of precautionary policies in the face of scientific uncertainty.