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CRC: Diagnosis, Staging, and Patient Assessment

  • Siri Rostoft Kristjansson
  • Riccardo A. AudisioEmail author
Chapter

Abstract

Colorectal cancer often presents as an emergency with signs of obstruction, poor general conditions [1, 2]. This is associated with high mortality, increased complication rate [3], and a poor oncologic result [4]. This is particularly relevant to older patients. Every effort should be put in place to avoid the emergency setting. To achieve this, screening programs have been put in place.

Keywords

Preoperative assessment Comorbidity Operative risk Risk prediction Cancer surgery Elderly 

References

  1. 1.
    Cheynel N, Cortet M, Lepage C, Benoit L, Faivre J, Bouvier AM. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum. 2007;50(10):1568–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004;240(1):76–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Sjo O, Larsen S, Lunde O, Nesbakken A. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2008;11(7):733–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Ohman U. Prognosis in patients with obstructing colorectal carcinoma. Am J Surg. 1982;143(6):742–7.PubMedCrossRefGoogle Scholar
  5. 5.
  6. 6.
    Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750–6.PubMedCrossRefGoogle Scholar
  7. 7.
    NHS Bowel Cancer Screening Programme. www.cancerscreening.nhs.uk/bowel/. Last accessed 24 November 2012.
  8. 8.
    Anwar S, Hall C, Elder JB. Screening for colorectal cancer: present, past and future. Eur J Surg Oncol. 1998;24:477–86.PubMedCrossRefGoogle Scholar
  9. 9.
    Population screening for colorectal cancer. Drug Ther Bull. 2006;44(9):65–8.Google Scholar
  10. 10.
    Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.PubMedCrossRefGoogle Scholar
  11. 11.
    Heflin MT, et al. The impact of health status on physicians’ intentions to offer cancer screening to older women. J Gerontol A Biol Sci Med Sci. 2006;61(8):844–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Information from and about the screening programme http://www.cancerscreening.nhs.uk/bowel/programme-information.html. Last accessed 24 November 2012.
  13. 13.
    Keighley MRB. Screening for colorectal cancer in Europe. Scand J Gastroenterol. 2004;9:805–6.CrossRefGoogle Scholar
  14. 14.
    Sweet A, Lee D, Gairy K, Phiri D, Reason T, Lock K. The impact of CT colonography for colorectal cancer screening on the UK NHS: costs, healthcare resources and health outcomes. Appl Health Econ Health Policy. 2011;9(1):51–64.Google Scholar
  15. 15.
    Keeling AN, Slattery MM, Leong S, McCarthy E, Susanto M, Lee MJ, Morrin MM. Limited-preparation CT colonography in frail elderly patients: a feasibility study. AJR Am J Roentgenol. 2010 May;194(5):1279–87.PubMedCrossRefGoogle Scholar
  16. 16.
    Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008;135:1100–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006;4:343–8.Google Scholar
  18. 18.
  19. 19.
    Boyd JB, Bradford Jr B, Watne AL. Operative risk factors of colon resection in the elderly. Ann Surg. 1980;192(6):743–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet. 2000;356(9234):968–74.Google Scholar
  21. 21.
    Faiz O, Haji A, Bottle A, Clark SK, Darzi AW, Aylin P. Elective colonic surgery for cancer in the elderly: an investigation into postoperative mortality in English NHS hospitals between 1996 and 2007. Colorectal Dis. 2011;13(7):779–85.PubMedCrossRefGoogle Scholar
  22. 22.
    Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, West C, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65(2):156–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Kristjansson SR, Nesbakken A, Jordhoy MS, Skovlund E, Audisio RA, Johannessen HO, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208–17.PubMedCrossRefGoogle Scholar
  24. 24.
    Sunouchi K, Namiki K, Mori M, Shimizu T, Tadokoro M. How should patients 80 years of age or older with colorectal carcinoma be treated? Long-term and short-term outcome and postoperative cytokine levels. Dis Colon Rectum. 2000;43(2):233–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Gurevitch AJ, Davidovitch B, Kashtan H. Outcome of right colectomy for cancer in octogenarians. J Gastrointest Surg. 2009;13(1):100–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Kehlet H. Fast-track colorectal surgery. Lancet. 2008;371(9615):791–3.PubMedCrossRefGoogle Scholar
  27. 27.
    de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010;363(20):1928–37.PubMedCrossRefGoogle Scholar
  28. 28.
    Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg. 2002;195(6):768–73.PubMedCrossRefGoogle Scholar
  29. 29.
    Kristjansson SR, Jordhøy MS, Nesbakken A, Skovlund E, Bakka A, Johannessen H, et al. Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol. 2010;1(2):57–65.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Siri Rostoft Kristjansson
    • 1
  • Riccardo A. Audisio
    • 2
    Email author
  1. 1.Department of Internal MedicineDiakonhjemmet HospitalOsloNorway
  2. 2.Department of SurgerySt. Helens and Knowsley Teaching HospitalsSt Helens, MerseysideUK

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