Can factors that influence nodal dissemination in patients with colorectal cancer be identified? Own experience.

INTRODUCTION: As one of the most common causes of cancer deaths in Poland, colorectal cancer, remains a mystery when factors affecting local and distant lymph node metastasis are concerned. AIM: In this study the authors have analysed possible correlations between the number of regional (and distant) lymph nodes affected by cancer, location and stage of the primary tumour, levels of oncological markers CA19-9 and CEA, and the patients age, sex, body mass index (BMI), and other clinical symptoms. MATERIAL AND METHODS: A special questionnaire was created for this study, and a group of 100 men and women was selected. All patients in the study group had undergone surgery due to colorectal cancer. RESULTS: There were no statistically significant relationships between age, and number and location of metastases (p > 0.05). Primary tumour assessment did not show a statistically significant relationship with the presence of metastases to regional lymph nodes (p > 0.05). There was also no statistically significant correlation between tumour localisation and lymph node metastases (p > 0.05) or between tumour size, BMI, occurrence of physical symptoms, and involvement of distant lymph nodes (p > 0.05). The highest CEA was observed in a patient with nine regional lymph node metastases (612.46 ng/ml) and the lowest in one with metastases to two regional nodes (0.2 U/ml). CEA value above 5 ng/ml was found in 35.74% of patients with regional lymph node metastases. A statistically significant relationship was reported (p < 0.05). CONCLUSIONS: The location of the primary tumour, and its pathological stage and size does not seem to have a direct correlation with the occurrence of regional lymph node metastases. Metastasis to distant lymph nodes seems to be a consequence of metastases in regional nodes. Elevated CEA tumour marker values are significantly related to metastases in regional lymph nodes. The elevation of CA 19-9 and CEA tumour markers significantly correlates with the presence of metastasis to distant lymph nodes. The location of the primary tumour determines the formation of metastases in distant lymph nodes.

Stomach cancer in young people - a diagnostic and therapeutic problem.

INTRODUCTION: According to statistics, gastric cancer remains one of the most common causes of death due to neoplastic disease in the world's population. It is a common conception that this type of cancer mostly affects people in their fifth or sixth decade of life. So, when it comes to young people, for example in their twenties or early thirties, who present to a doctor with symptoms suggesting a cancer of the gastrointestinal tract, these are quite often ignored because of their young age. AIM: In this study we at The Second Department of General and Gastroenterological Surgery of the Medical University of Bialystok, Poland decided to enlighten the problem of stomach cancer in people under 40 years old as a cause of death and complications most likely because of an incorrect diagnosis at the beginning of therapy. MATERIAL AND METHODS: Major analysis involved 350 cases of gastrointestinal tumours treated surgically, of which 14 cases (7 men and 7 women) were patients aged 18-39 years diagnosed with different stages of gastric cancer. RESULTS: Statistical analysis has shown that gastric cancer in women occurred much earlier than in men, and the average survival time was 16 months after the surgery. CONCLUSIONS: Because of the false suggestion that gastric cancer affects mostly older people, there is a risk of ignoring the symptoms in young people and finding advanced neoplastic lesions at the time of diagnosis, which has a negative effect on long-term treatment results.

Own experiences of endoscopic self-expandable stent placement for malignant colorectal ileus.

INTRODUCTION: Acute low neoplasm ileus requires emergency surgery. Nowadays there are increased numbers of patients with comorbidities, which causes higher risk of intra- and postoperative complications. AIM: To evaluate the clinical usefulness of endoscopic self-expandable stent placement for malignant colorectal ileus. MATERIAL AND METHODS: Twenty-one patients (8 women and 13 men), mean age 66.7 years, with low neoplasm obstruction, underwent endoscopic stenting of the stricture. This procedure was performed as a bridge to the surgery especially for high-risk patients. Eight of them had coagulation system impairment, 5 severe metabolic disorders, 4 circulatory insufficiency, 3 severe malnutrition and 1 patient undiagnosed synchronic rectal tumor. In 10 patients cancer was located in the sigmoid colon, in 7 in the rectum, in 2 in the ascending colon, and the transverse and ascending colon was involved in another 2 patients. RESULTS: All 21 patients (100%) underwent endoscopic stenting successfully. There were no complications after stent placement. The authors underline that placement of expandable metallic stents for patients with malignant colon obstruction with acute ileus is a safe and effective method. It gives an opportunity for quick balance of fluid, electrolyte, and the coagulation system and improvement of efficiency of the circulatory and respiratory system. CONCLUSIONS: Endoscopic treatment of ileus helps precisely estimate tumor advancement and gives the possibility of a single stage radical surgical procedure.