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1.
Colorectal Dis ; 18(2): 195-9, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26333198

ABSTRACT

AIM: To evaluate the impact of the national 'Be Clear on Cancer' bowel cancer reminder campaign on service and diagnosis at a single UK institution. Secondly, to evaluate the socio-economic background of patients referred before and after the reminder campaign compared with the regional demographic. METHOD: Suspected cancer 2-week wait patients in the 3 months precampaign, postcampaign and after the reminder campaign were included. Demographics, investigations and diagnosis were recorded. The postcode was used to allocate a National Readership Survey social grade. RESULTS: Three hundred and eighty-three referrals were received in the 3 months precampaign, 550 postcampaign and 470 postreminder campaign. There were significant increases in the monthly referral rates following the campaign (P < 0.001 in both the post- and postreminder periods). Significantly more patients from social grades AB and C1C2 than expected from regional demographics were referred precampaign and after the reminder campaign (P < 0.001 in each case). There were no significant differences between the proportions of patients diagnosed with colorectal cancer in the three study periods (P = 0.710). CONCLUSION: The 'Be Clear on Cancer' bowel cancer campaign has had a significant sustained impact on resources. It has failed to increase referrals among lower socio-economic grades, leading to an increase in 'worried well' referrals and no change in numbers, or the stage, of colorectal cancers diagnosed.


Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer/statistics & numerical data , Health Promotion/statistics & numerical data , Health Resources/statistics & numerical data , Social Class , Adult , Aged , Aged, 80 and over , Early Detection of Cancer/methods , England , Female , Health Promotion/methods , Health Services Needs and Demand/statistics & numerical data , Humans , Male , Middle Aged , Referral and Consultation/statistics & numerical data
2.
Colorectal Dis ; 15(4): 394-403, 2013 Apr.
Article in English | MEDLINE | ID: mdl-22958550

ABSTRACT

AIM: A literature review was performed to elucidate whether long-course preoperative radiotherapy for patients with rectal cancer affects lymph node yield, and whether this influences prognosis. METHOD: Cochrane Database, PubMed/MEDLINE, Scopus, Web of Knowledge, Embase and CINAHL databases and reference lists from published journal articles published between 1 January 1990 and 30 June 2011 were searched. Studies examining lymph node yield and prognosis were selected for review. RESULTS: One thousand and twenty-nine articles were found, of which 11 met the inclusion criteria. None was a randomized controlled trial and all were cohort studies. Four studies showed that long-course preoperative radiotherapy reduced lymph node yield; however only one demonstrated a statistically significant survival benefit in patients with higher lymph node yields. Five-year survival was 48% in patients with fewer than and 69% in those with more than 11 lymph nodes identified in the operative specimen (P = 0.04). CONCLUSION: Whilst long-course preoperative radiotherapy appears to reduce lymph node yield in patients with rectal cancer, no causal relationship between lymph node yield and survival can be established in this group of patients.


Subject(s)
Lymph Node Excision , Rectal Neoplasms/pathology , Rectal Neoplasms/radiotherapy , Humans , Neoadjuvant Therapy , Neoplasm Staging , Radiotherapy, Adjuvant , Rectal Neoplasms/surgery , Survival Rate
5.
Br J Cancer ; 90(10): 2006-12, 2004 May 17.
Article in English | MEDLINE | ID: mdl-15138486

ABSTRACT

Micro-satellite instability (MSI) is relevant in the management of colorectal cancers (CRC) and relies on analysis of gene mutations, or production of the proteins involved in DNA mismatch repair (e.g. MLH1, MSH2). p53 mutation is also relevant in MSI, but high-level CRC (MSI-H) demonstrate fewer mutations than low-level (MSI-L) or stable (MSS) cancers. Recently, the importance of gene activity (transcription) in MSI has been identified, where rather than being mutated genes have been downregulated. In this study, 67 sporadic CRC and eight samples of normal bowel were analysed for MSI status (by SSCP) and levels of MLH1, MSH2 and p53 gene transcription (by RT-PCR and scanning densitometry). Micro-satellite instability correlated with gender and site, with more MSI-H CRC in females (P<0.02) and in the right colon (P<0.04). In MSI-H, p53 transcription was markedly reduced (P<0.003). Compared to normal bowel, MLH1 transcription was elevated in all cancers (P<0.01), while MSH2 transcription was elevated only in MSI-H (P<0.04). There was a direct correlation between MLH1 and MSH2 transcription (P<0.001). Although fewer mutations are reported in MSI-H than MSI-L/MSS, these results suggest that reduced p53 transcription might account for decreased tumour suppression in MSI-H. The direct correlation between MLH1 and MSH2 transcription suggests that control of these genes might be coordinated.


Subject(s)
Colorectal Neoplasms/genetics , Colorectal Neoplasms/pathology , DNA-Binding Proteins , Genes, p53 , Genetic Predisposition to Disease , Microsatellite Repeats , Neoplasm Proteins , Proto-Oncogene Proteins , Adaptor Proteins, Signal Transducing , Adult , Aged , Aged, 80 and over , Carrier Proteins , Case-Control Studies , DNA Repair , Female , Humans , Male , Middle Aged , MutL Protein Homolog 1 , MutS Homolog 2 Protein , Nuclear Proteins , Polymerase Chain Reaction , Transcriptional Activation
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