https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(02)09290-5.pdf

Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial

https://behandelaar.pijnbijkanker.nl/sites/behandelaar.pijnbijkanker.nl/files/publicaties/van%20den%20Beuken%20et%20al.%20Prevalence%20cancer%20pain.%20Ann%20Oncol%202007.pdf

Prevalence of pain in patients with cancer: a systematic review of the past 40 years

https://www.gastrojournal.org/article/0016-5085(93)90368-M/pdf

Genetics, natural history, tumor spectrum, and pathology of hereditary nonpolyposis colorectal cancer: An updated review

https://www.gastrojournal.org/article/0016-5085(87)90563-4/pdf

Natural history of untreated colonic polyps.

The Large Bowel Cancer Project is a collaborative prospective study of 4228 patients with a histologically proven adenocarcinoma, of whom 2336 (55 per cent) survived a 'curative' resection. Follow-up information is available on 2220 patients (95 per cent). Subsequently, 309 (14 per cent) have developed a local recurrence confirmed by: biopsy (127; 41 per cent), clinical examination (77; 25 per cent), X-ray (15; 5 per cent), a raised CEA (2; 1 per cent), or some other method - e.g. CT scan or a confident unbiopsied laparotomy finding (88; 29 per cent). Statistically significant factors (chi2 test, P less than 0.05) associated with local recurrence are: Dukes' classification: A 4 per cent; B 13 per cent; C 18 per cent Tumour differentiation: Well 11 per cent; Moderate 14 per cent; Poor 21 per cent Obstruction: Absent 13 per cent; Present 21 per cent Perforation: Absent 13 per cent; Present 28 per cent Tumour mobility: Freely mobile 11 per cent; Others 21 per cent Operation performed (rectal and rectosigmoid tumours): Abdomino-perineal 12 per cent; Anterior resection 18 per cent; Surgeon (Consultant only): Range less than 5 per cent to greater than 20 per cent. Stratification of the above variables altered only the statistical significance pertaining to tumour differentiation (P less than 0.1, d.f. = 2). In particular, the differences between Consultant surgeons remained.

Local recurrence following 'curative' surgery for large bowel cancer: I. The overall picture.

A clinicopathologic staging method for colorectal carcinoma was applied prospectively to 503 patients treated by surgical resection over a period of 7 1/2 years. The method grouped separately those patients known to be incurable at the time of resection and allowed for an anatomically precise definition of the extent of tumor spread. Survival studies showed that prognosis did not significantly deteriorate with spread of tumor beyond the bowel wall unless there were demonstrable metastases, infiltration of a free serosal surface, or if local resection was incomplete. Highly significant decrements in survival occurred when lymph node metastases were demonstrable and when unresected tumor was known to be present. The staging system from which these observations were made formed an improved guide to prognosis when compared with the original Dukes' method. Patients with histologically high-grade tumors had a poorer survival rate than those with low or average tumors with the same extent of spread.

The relationship of survival to staging and grading of colorectal carcinoma: A prospective study of 503 cases

This study further assesses a previously reported clinicopathologic staging system for colorectal carcinoma. By using carefully defined anatomic criteria, various substages of tumor spread have been examined prospectively for their prognostic significance in a group of 1117 patients accessioned over 14 years and documented by the same pathologist. Spread from the muscularis propria into surrounding tissues was not associated with a significant deterioration in prognosis if the lines of resection were clear of tumor and there were no known metastases or free mesothelial surface invasion. Free mesothelial surface invasion by potentially curable tumors was associated with a significant reduction in patient survival. Patients with potentially curable tumors but with lymph node metastases had a significantly poorer probability of survival if the apical lymph node was involved. Among those with incurable tumors, there was no significant difference in survival depending on whether incurability was due to distant metastases or surgical transection of tumor. Substaging offers a means of refining the ability to predict tumor behavior.

The prognostic value of substaging colorectal carcinoma. A prospective study of 1117 cases with standardized pathology.

The clinical and pathological findings in 200 consecutive cases of colorectal carcinoma treated by surgical resection have been recorded and subjected to computer analysis. This is the initial report from a long-term prospective survey of this disease. The two most frequent presenting symptoms were altered bowel habit (51.5%) and bleeding (49.5%). Symptoms due to anaemia occurred in 16% of cases and acute obstruction in 13.5% of cases. The value of the various investigations in establishing the diagnosis is discusses. At the time of resection the disease had already reached an advanced stage in a majority of the patients. In 26% of cases it was known that complete resection of tumour tissue had not been achieved. A direct relationship between stage of spread and histological grade of malignancy was noted. The incidence of advanced stage, high histological grade and mucinous tumours was greatest in the right side of the colon. A study of early carcinomas has confirmed that many have arisen from benign epithelial neoplastic polyps. The significance of these observations is discussed.

Colorectal carcinoma: a prospect clinicopathological study.

A 39-year-old man with a lifelong history of tetany and hypocalcaemia was found to have hypomagnesaemia (0·29 mmol/l) due to renal magnesium loss. His asymptomatic 29-year-old brother had a similar disorder. Both were infertile and had severe oilgospermia but normal endocrine function. They had medullary nephrocalcinosis and glomerular filtration rate was reduced. Renal biopsy showed patchy interstitial fibrosis and some glomerular sclerosis. Electron microscopy showed thickened basement membranes in damaged glomeruli and in tubules in areas of fibrosis. Tests of renal tubule function were normal. Hypocalcaemia and tetany were corrected by oral magnesium supplements which raised the serum magnesium level to around 0.54 mmol/l.

The Congenital ‘Magnesium-Losing Kidney’

Background. Karyomegalic nephropathy, first identified in 1974, represents an increasingly recognized, but perhaps underdiagnosed condition associated with interstitial nephritis. It undoubtedly leads to end-stage renal disease requiring renal support. Methods and results. We present a series of six cases of karyomegalic nephropathy. The age at diagnosis was 9‐51 years, median 33 years. Impaired renal function, proteinuria, and haematuria were present in the majority of cases. Non-specific elevated liver enzymes were present in three cases. Two patients died soon after transplantation from overwhelming respiratory sepsis. The classical histological features of large, abnormal hyperchromatic nuclei with irregular outlines within epithelial cells were present in renal epithelial cells. Abnormality of DNA ploidy distributions compared with age- and sex-matched controls, and characterized by the presence of significant numbers of cells with high ploidy values was present in cases but not in controls. Mitotic figures were absent. Proliferation markers, Ki-67 and proliferating cell nuclear antigenucyclin were not significantly elevated in those cases examined. Human leukocyte antigen analysis did not support the clustering of A9 or B35, in the cases or their families. Conclusions. The presence of significant renal impairment, positive urine sediment, abnormal liver enzymes, and early age of onset should alert one to the presence of karyomegalic nephropathy. It represents an underdiagnosed disorder with a high degree of ploidy indicative of karyotypic abnormality.

/pdf/karyomegalic-nephropathy-an-uncommon-cause-of-progressive-zmj1pf81mi.pdf

R. C. Newland

Papers

The relationship of survival to staging and grading of colorectal carcinoma: A prospective study of 503 cases

The prognostic value of substaging colorectal carcinoma. A prospective study of 1117 cases with standardized pathology.

Colorectal carcinoma: a prospect clinicopathological study.

The Congenital ‘Magnesium-Losing Kidney’

Karyomegalic nephropathy: an uncommon cause of progressive renal failure