Clinical manifestations of colorectal cancer patients from a large multicenter study in Colombia.

Colorectal cancer (CRC) is a major public health problem, and its incidence is rising in developing countries. However, studies characterizing CRC clinicopathological features in cases from developing countries are still lacking. The goal of this study was to evaluate clinicopathological and demographic features in one of the largest CRC studies in Latin America.The study involved over 1525 CRC cases recruited in a multicenter study in Colombia between 2005 and 2014 as part of ongoing genetic and epidemiological studies. We gathered clinicopathological data such as age at diagnosis, sex, body mass index, tobacco and alcohol consumption, family history of cancer, and tumor features including location, histological type, and stage. Statistical analyses were performed to test the association between age of onset, sex, and clinical manifestations.The average age at CRC diagnosis was 57.4 years, with 26.5% of cases having early-onset CRC (diagnosed by age 50 years). Most cases were women (53.2%; P = 0.009), 49.2% were overweight or obese, 49.1% were regular alcohol drinkers, 52% were smokers/former smokers, and 12.2% reported relatives with cancer. Most tumors in the study were located in the rectum (42.7%), were adenocarcinomas (91.5%), and had advanced stage (T3-T4, 79.8%). Comparisons by sex found that male cases were more likely to be obese (36.5% vs 31.1%; P = 0.001), less likely to have a family history of cancer (9.7% vs 15.3%; P = 0.016), and more likely to have advanced-stage tumors (83.9% vs 76.1%; P = 0.036). Comparisons by age of onset found that early-onset cases were more likely to be women (59.3% vs 51.0%; P = 0.005) and report a family history of cancer (17.4% vs 10.2%; P = 0.001).To our knowledge, our study is the largest report of clinicopathological characterization of Hispanic CRC cases, and we suggest that further studies are needed to understand CRC etiology in diverse Hispanic populations.

Caracterización de los hallazgos histopatológicos de tumores colorrectales en pacientes del Tolima, Colombia / Characterization of histopathological findings from colorectal tumors from patients in Tolima

En Colombia, el cáncer colorectal es reconocido como un importante problema de salud pública, con una tendencia general al incremento en ambos géneros; se ubica entre los cinco primeros lugares en relación con la mortalidad. Teniendo en cuenta los diagnósticos histopatológicos reunidos entre enero de 2000 y diciembre de 2007, se realizó un análisis descriptivo retrospectivo en 191 pacientes tolimenses con tumores colorrectales tipo adenocarcinoma; estos fueron seleccionados en cinco centros de patología de la ciudad de Ibagué, mediante pruebas descriptivas básicas empleando el método porcentual. Los datos más sobresalientes corresponden a la edad al momento del diagnóstico (promedio mayor de 60 años), localización en el recto (34,6%) y en el colon izquierdo (28,3%) y aumento de los adenomas tubulovelloso y velloso.

In Colombia, colorectal cancer is recognized as a major public health problem. Its general tendency is occur more frequently among both genders. It now ranks among the top five in terms of mortality. Using histopathological diagnoses collected from pathology laboratories in Ibagué, Tolima between January 2000 and December 2007, we conducted a retrospective analysis of 191 patients who had colorectal adenocarcinoma. The most important findings are that the average age of diagnosis was over 60 years, most common tumor locations were in the rectum (34.6%) and in the left colon (283%), and the greatest numbers of tumors were tubulovillous adenoma, or villous adenoma. Most of cases were tubular.

Poliposis adenomatosa familiar atenuada: Entidad controvertida / Attenuated familial adenomatous polyposis: Controversial entity

La poliposis adenomatosa familiar es una patología recientemente descrita y hasta cierto punto desconocida por el grupo médico, se encuentran en la literatura principalmente reportes de casos y existe controversia sobre si es una patología propiamente dicha o la podemos ubicar en la mitad de un espectro que iría de pólipos adenomatosos aislados hasta la poliposis adenomatosa familiar clásica y el cáncer. Los grupos que la consideran una entidad separada, afirman que es una variante de la poliposis adenomatosa familiar clásica, en la cual la expresión fenotípica es menor en lo referente al número de pólipos. Se ha identificado la mutación del gen APC responsable de su aparición y se ha tipificado el lugar específico del gen donde se produce, el número de pólipos es menor de 100, se ubican principalmente proximales al ángulo esplénico y el estudio histológico muestra con mayor frecuencia adenomas tubulares con displasia de bajo grado. El tratamiento puede ir desde la polipectomía hasta la colectomía total. A propósito de algunos casos manejados en nuestro servicio, la mayoría de ellos con polipectomía y seguimiento estricto, decidimos hacer una revisión de la literatura, destacando los aspectos más relevantes de su etiología, diagnóstico y tratamiento.

Attenuated Familial Adenomatous Polyposis is an entity poorly understood for medical groups, is a variant of Familial Adenomatous Polyposis, characterized by fewer colorectal polyps, begin of polyps and cancer in later age than classic variant, and predilection for proximal ubication. Colonoscopy shows multiple flat adenomas, and histopathology is characterized by tubular adenomas with displasia in high percentage. Diagnosis is difficult for abscence of specific finding or genetic proube, must be based in clinical and endoscopy findings, and treatment varies from polypectomy to total colectomy. In this review we present the history, etiology, clinical presentation, diagnosis, and treatment of this pathology, and the experience with this pathology in our sevice.