Colon Cancer in Patients below Age of 50 Years: Kuwait Cancer Control Center Experience.

BACKGROUND: This study was undertaken to analyze and evaluate the clinico-pathological profile and the outcome of young patients diagnosed with colon cancer. PATIENTS AND METHODS: Patients diagnosed with adenocarcinoma of the colon at or below the age of 50 years from January 2000 to December 2007 in Kuwait were analyzed. This study retrieved 130 patients diagnosed = 50 years, representing 22% of colon cancer patients in this period, 67 females and 63 males. Patients = 40 years were 48 while those 41-50 years were 82. Median follow-up was 61 months. RESULTS: According to the TNM system, 82% patients had T3 and T4 disease, 55% had node negative disease and 15% had distant metastasis at presentation. All patients except three underwent surgery. Chemotherapy was given in 82% of patients either for adjuvant or palliative intent. The 5-year overall survival (OS) and progression free survival (PFS) were 78% and 75% respectively. Survival was significantly affected by the disease stage and grade. The OS was 96%, 83%, 6% for stage I and II, III and IV respectively (p<0.001). OS was 91% for grade 1 and 2 tumors vs. 60% for grade 3 tumors (p=0.007). Patients who presented = 40 years had relatively more grade 3 (19% vs. 7%) compared to 41-50-years age group. CONCLUSIONS: Colonic adenocarcinoma is frequently diagnosed below the age of 50 in our population. Younger age (=40 years) seems to present more with high grade tumors. Clinicians should consider full colonoscopic evaluation while investigating symptomatic young patients.

Metastatic renal cell carcinoma with undetectable renal mass presenting as lymphadenopathy.

Renal cell carcinoma has the ability to metastasize to any organ; about 16 % of affected patients present initially with metastasis. However, it is rare for this tumor to present with metastasis from an unidentified primary. The current use of immunohistochemistry and molecular genetics has enabled clinicians to reach a precise diagnosis. It has been hypothesized that the treatment protocol for metastatic renal cell carcinoma can be applied to cases with undetectable primary. In this paper, a novel case of metastatic renal cell carcinoma presenting with lymphadenopathy with no evidence of a primary renal lesion is reported from Kuwait cancer center.

Significance of Magnetic Resonance Imaging-Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation.

PURPOSE: To study the predictive and prognostic value of magnetic resonance imaging (MRI)-assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. METHODS: This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. RESULTS: In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). CONCLUSION: MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery.