ABSTRACT
Recognition of the commonly encountered colorectal cancer (CRC) generally begins and takes place because of and based on symptoms and signs, due to the unsettled screening of this type of cancer. Sometimes, because of advanced stage cancer urgent surgical intervention could become necessary and, if this is the case, there is no time and possibility for searching for an eventual second tumor and perhaps the patient's status does not permit performing intraoperative investigations either. The incidence of multiple colon cancer is considered to be between 2.5 and 30% according to the literature. That is why one should exclude them even in the absence of pre- and intraoperative investigations and complaints. On the other hand, colonoscopy and perhaps irrigoscopy of seemingly healthy followed-up patients is mandatory. In the case of the presence of complaints/symptoms denoting impaired intestinal passage seen in a followed-up patient or during the adjuvant setting or metastatic/recurrent disease, treatment and even during hospice care we should evaluate the possibility of a second metachronous tumor. Moreover, if there is no urgency, the multidisciplinary team (oncoteam) should recommend the adequate treatment by balancing gain/utility and risk.
Subject(s)
Biomarkers, Tumor/analysis , Colonic Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Population Surveillance , Rectal Neoplasms/diagnosis , Adenocarcinoma/diagnosis , Biomarkers, Tumor/blood , Biopsy , Carcinoembryonic Antigen/blood , Colonic Neoplasms/epidemiology , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Colonoscopy , Contrast Media , Follow-Up Studies , Humans , Hungary/epidemiology , Magnetic Resonance Imaging , Neoplasm Staging , Neoplasms, Multiple Primary/epidemiology , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/therapy , Population Surveillance/methods , Public Health , Rectal Neoplasms/epidemiology , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Registries , Tomography, X-Ray Computed , UltrasonographyABSTRACT
The risk of venous thromboembolic events (VTE) in cancer patients is higher than in the general population. Treatment may also increase this risk in these patients. Based on the appropriate criteria (of which the most important are the current ministerial guidelines) thrombosis prophylaxis should be started (given that there is no contraindication) on these patients and be continued while they are at risk. In the event of permanent risk thrombosis prophylaxis should be given lifelong. The drug of choice is low-molecular-weight heparin (LMWH) which is safer and more effective than the oral vitamin K antagonists. Platelet aggregation inhibitors have proved unsuccessful in this patient group. The evidence so far suggests that LMWH (during VTE prophylaxis) can have a positive impact on the course of cancer and perhaps it will be registered under the indication section for cancer patients in the future.
