A prospective case study of colonic malignancies

Karthik, A (2014) A prospective case study of colonic malignancies. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: It is the third most common cancer diagnosis in both men (behind prostate & lung) & women (behind breast & lung). Second leading cause for death after lung cancer Mean age at diagnosis is 5th decade • Sporadic colon carcinoma accounts for 70%. • Genetic colon carcinoma accounts for 23%. A more thorough understanding of the molecular basis for this disease, coupled with the development of new therapeutic approaches, has dramatically altered the way in which patients are managed. New strategies for screening and for the detection of recurrent disease have improved the survival of the patients. This study demonstrates the importance of early diagnosis and the improved prognosis and survival in patients with prompt surgical management. AIM OF THE STUDY: 1. To analyze the clinical presentation, prognosis and outcome of prompt surgical management in colonic malignancies with respect to disease free survival rate, tumor recurrence and mortality. 2. To compare the incidence of right and left sided colonic malignancies and to document their clinical and pathological differences. 3. To elucidate the importance of CEA in determining prognosis and in follow-up. METHODS: This is a prospective case study of colonic malignancies with exclusion of genetic and familial cancers, patients with concomitant malignancies and severe cardiac ailments. This study was conducted with patients admitted to Government Royapettah hospital / Kilpauk Medical College, Chennai, located in the southern part of India. The study was conducted prospectively from the day of admission in 50 patients of colon cancers in various surgical units, between June 2011 and November 2013. All cases studied were subjected to detailed clinical examination with emphasis on the family history of colon cancers and duration of the presenting complaints and the accurate chronology of symptoms complex associated with each of the colonic malignancies. Colonoscopy and CT findings were also documented. The surgeries performed for various colon cancers were also recorded with postoperative complications and its influence on the duration of stay at hospital. A detailed workup of comparison between the postoperative and preoperative CEA levels was done. RESULT ANALYSIS AND CONCLUSION: Of the 50 cases 36 patients (72%) presented with colon cancers in their fifth to sixth decade of life. The colonic malignancies were found to be more common in males (66%) when compared to females (34%). The right colon cancers presented with anemia (n=26), mass abdomen (n=22) and loss of weight (n=28). The left colon cancers presented predominantly with altered bowel symptoms either constipation or loose stools (n=25). 70% of the cases (n=35) were right-sided tumors (located in caecum, ascending colon, hepatic flexure or proximal transverse colon) whereas the left sided tumors that of splenic flexure, descending colon and sigmoid colon were seen only in 30% of cases (n=15). Of the 14 cases that showed evidence of lymph node in computerized tomography 9 were found to be poorly differentiated adenocarcinoma, 4 were moderately differentiated tumors and only one was well differentiated. It was found that all well differentiated tumors had CEA levels ranging from 15 to 25ng/ml, in the range of 5 to 15ng/ml for moderately differentiated tumors and the poorly differentiated tumors had CEA levels in the range less than 5ng/ml. Of the 50 cases of carcinoma colon, 3 cases presented as emergencies (2 cases of obstruction and 1 was colo-vesical fistula). The common complications were paralytic ileus (n=20), wound infection (n=19), respiratory infection (n=17), sepsis (n=1) and anastomotic leak (n=1) in that order of frequency. Most of the cases (n=34) studied were of stage II disease and 10 cases were of stage III disease. Thus 72% of cases were of stage II and stage I. The average duration of postoperative stay was 11 days. However average stay in patients with postoperative wound infection was 15 days. The preoperative CEA levels were on an average above 5.5ng/ml in 84% (n=42) of cases. However the values returned to value below the baseline value of 5.5ng/ml in 74%(n=37) postoperatively signifying a tumor free state. Of the 50 cases operated (47 elective surgeries and 3 emergency surgeries), 3 cases of stage III/IV disease reported with recurrence in one year and there was 1 case of death due to septicemia in the case operated as an emergency. Based on the statistical analysis of the study it was inferred that the incidence of colon cancers was common in 5th to 6th decade of life and right colon cancers where commoner than left colon cancers. Colon cancers are more common in males than females. Results with respect to the symptom complex and duration of presenting complaints were confirming to the accepted knowledge about the right and left colon cancers. The lesions were predominantly ulcero-proliferative in right colon cancers but were predominantly circumferential in left colon cancers. It is found that there is a strong correlation between the lymph nodal involvement and tumor differentiation, poorly differentiated tumor has more propensities to cause lymph node spread early hence worse prognosis. The diffentiation of tumor also has inverse correlation with respect to CEA levels; higher the levels of CEA well differentiated will be the tumor grade. The common postoperative complications were paralytic ileus, wound infection and respiratory infection and the duration of postoperative stay was not related to the tumor grade or its stage but the presence or absence of wound infection. Postoperative CEA levels measured after 2 weeks is useful in assessing the surgical outcome as a successful surgery brings the value to baseline. Recurrent tumors had elevated CEA well above their immediate postoperative levels, thus implying the importance of postoperative follow-up of all cases operated for colon cancers. Lastly the mortality associated with tumor complicating emergency surgeries is high when compared to electively planned surgeries. Early diagnosis of colon cancers can be curative as more than 90% of stage I/II tumors have longer disease free survival rate than the stage III/IV disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: colonic malignancies ; prospective case study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 06 Jul 2018 00:48
Last Modified: 06 Jul 2018 00:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/8652

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