Clinico-Pathological features in young patients with rectal cancer and the influence of clinical, histological and treatment-related factors on survival.

Deepak, Damodaran (2014) Clinico-Pathological features in young patients with rectal cancer and the influence of clinical, histological and treatment-related factors on survival. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION : Rectal cancer has in general been a disease of the middle aged and elderly, such that the most patients diagnosed with the disease are beyond 55 years of age. While only 2-10% of all rectal cancers in Western nations occur in young patients, it has been reported to occur with a much greater incidence among young patients in South East Asia. At the same time, a recent population based study in the United States has reported an increasing incidence of rectal cancer in the young adults. A number of recent epidemiologic studies have also highlighted such increase in the occurence of young-onset rectal cancer. The cut off age or age group for defining patients with young rectal cancer with respect to aggressive biology and survival statistics is not well defined. There are studies citing 35, 40, 45and 50 years as the cut off ages with conflicting data with respect to poorer survival. In spite of its rising incidence, there are only a few studies on the prognosis and clinicopathologic features young-onset rectal cancer. Furthermore, it has also been observed that the survival of younger patients with rectal cancer is poorer compared to older patients. Aims and Objectives : The following are the aims and objectives of my thesis: a ) To determine the relative distribution and the clinicopathological profile of rectal cancer across various age groups especially among the young, b) To study the influence of clinical ,histological and treatment related factors on survival, c) To determine if possible any age cutoff defining young rectal cancer which would show a survival difference over the older cohort . MATERIALS AND METHODS : A retrospective study of 552 patients, presenting to the Department of Surgical Oncology at Cancer Institute (WIA), Adyar, Chennai, India and registered in the tumour registry at the Institute between January 1998 and December 2007 was done. Only patients with histologically proven primary rectal adenocarcinoma were included, as defined as tumour involvement within 15 cm of the anal verge on digital rectal examination ⁄ colonoscopy and ⁄ or CT imaging. The tumor location was classified as follows: low rectum (0 to 6 cm from the anal verge), mid rectum (> 6 to 10 cm), and high rectum (more than 10 cm). Demographic data, presenting symptoms and their duration, pathological features of the tumour, tumour localization, histological data, pre-operative carcinoembryonic antigen (CEA) level, treatment modalities and survival data were retrospectively recorded and were analyzed. Tumor staging was as per the AJCC standards performed at the same time period as the treatment . Clinical stage was determined by preoperative imaging and endoscopy, including computer tomography (CT). Pathologic stage was based on the surgical resection specimen. CONCLUSION : If familial cancer of rectum in the young are excluded, the outcome of treatment in the young is comparable to the older population. Hence the pessimism associated with young rectal cancer patients must be shed away and they should be treated as any other patient appropriate for the stage.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinico-pathological features ; young patients ; rectal cancer ; clinical, histological ; treatment.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:48
Last Modified: 26 Jul 2017 02:48

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