What do we know and where do we go?
Early-onset colorectal cancer
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Ass.Prof. Ayman Fahad Ali
Dalia Alhosain M.D.
Outline
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Global trends of early onset�colorectal cancer (EO-CRC):
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Global trends of colorectal cancer (CRC):
Colorectal cancer (CRC) is a worldwide problem, with an annual incidence of approx. 1 million cases and an annual mortality of more than 500,000.
An alarming increase in EO-CRC defined as diagnosis in patients younger
than 50 years of age. It appears to represent a unique disease process.
roughly 10% of all new CRC diagnoses.
Damascus University Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality
Alassad and Almouassat hospitals for 36 cancers.CA Cancer J Clin 2018;68:394-424
Global trends of colorectal cancer (CRC):
Steady decline in incidence of later-onset CRC(LO-CRC), which is attributed primarily to screening and management.
In 2030, it is estimated that 25% of rectal cancers and 10-12% of colon
cancers will be diagnosed in persons younger than 50 years of age.
Damascus University Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020Alassad and Almouassat hospitals CA Cancer J Clin 2020;70:145-64.
�EO-CRC characteristics:�
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
EO-CRC characteristics:�
Over 86 percent are symptomatic at diagnosis. Hematochezia (38%),
abdominal or pelvic pain and bloating (in 33%), and change in bowel habits
(in 20%)
EO-CRC pt. have had a longer duration of Sx at presentation and
a longer delay in the time to diagnosis (7 to 9 mo.).
Damascus University Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020Alassad and Almouassat hospitals CA Cancer J Clin 2020;70:145-64.
EO-CRC characteristics:
More than 70% detected in rectum and distal colon.
More frequent of poorly differentiated cancers, and higher risk of
lymph nodes metastases.
Damascus University Surveillance, Epidemiology, and End Results (SEER) Program. Alassad and Almouassat hospitals SEER research data, Nov 2019 sub (1975–2017).
Our Study:�Early Onset Colorectal Cancer In Damascus University Hospitals�(on progress)
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
A case – control study, is being conducted in Alassad and Almouassat hospitals
since 1 Jan 2022.
Inclusion criteria: ≥ 1 high risk symptom for CRC:
Hematochezia, altered bowel habits, abdominal or pelvic pain with bloating,
weight loss, iron deficiency anemia.
Excluding criteria: those <45 y who meet Rome 4 criteria for irritable bowel syndrome.
Those known to have hereditary colorectal cancer syndromes.
Those who refuse enrollment.
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Case group: symptomatic patients diagnosed with colon or rectal cancer by
colonoscopy at all ages.
Control group: symptomatic patients with no colon or rectal cancer by
colonoscopy at all ages.
Then comparing demographic variables, clinical presentation, endoscopic features.
Goal: introducing alarming Sx of EO-CRC, looking for correlations between previous variables, and highlighting the importance of clinical suspicion and early diagnosis.
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Study plan:
120 Patients
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
50 patients
<50 year
70 patients
≥50 year
Clinical presentation | |
Hematochezia | 25 pt. |
Hematochezia + constipation | 20 pt. |
Hematochezia + abdominal pain | 15 pt. |
Anemia + constipation | 20 pt. |
Anemia + Weight loss | 10 pt. |
46 patients have CRC (38.3%)
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
36 patients have LO-CRC (30%)
10 patients have EO-CRC (8%)
50 symptomatic patients
<50 year of age
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Control:
40 have no CRC
Normal endoscopy,
polyps, hemorrhoids, solitary rectal ulcer, proctitis
Case:
10 patients have EO-CRC
EO-CRC:
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
4 patients (40%)
6 patients (60%)
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Most received symptomatic Tx for variable durations before having the right Dx
or seeking medical assistance.
More than 75% attribute their symptoms to common benign conditions.
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Physical examination was unremarkable.
Digital rectal examination revealed a palpable mass in 3 of 10 patients
(30%) with EO-CRC.
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Endoscopic:
Rectal cancer in 5 of 10 (50%)
Left colon cancer in 3 of 10 (30%)
Right colon cancer in 2 of 10 (20%)
Pathological:
All were adenocarcinoma
4 of 10 poorly differentiated AC.
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Endoscopic and Pathological findings:
Management:
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Surgery
Emergency surgery 2 patients
Elective surgery 3 patients
Neoadjuvant therapy
On progress treatment
2 patients
Treatment failed.
managed with Abdominopelvic resection.
3 patients
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
60% of cases that underwent surgery, the tumor had invaded through muscularis
propria with metastases to adjacent lymph nodes.
We found advanced local disease.
Conclusion:
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Conclusion:
The incidence of EO-CRC is projected to steadily increase for more than
double by 2030.
An awareness of the unique features of EO-CRC on the part of general public and health care providers is crucial to reduce time from Sx to Dx.
Identification of high risk patients, to implement individualized screening
approaches.
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022
Thank you for listening
Damascus University
Alassad and Almouassat hospitals
16 Sep 2022