Older adults have better outcomes when they have a full

Patients over 65 with stage III colorectal cancer who completed the full 6 month course of chemotherapy were almost twice as likely to survive as those who stopped treatment early.  However, about 30% dropped out of therapy early.

Examing data for 1,600 people over 65 receiving 5FU-based chemotherapy between 1995 and 1999 and lived at least 8 months, researchers found that those who were able to complete 5 to 7 months of treatment were 40% less likely to die from any cause and 47% less likely to die of colon cancer.

Older age, being unmarried, and having other health problems all contributed to those who didn’t finish chemotherapy.

Alfred I. Neugut and his colleagues from Columbia University and New York Presbyterian Hospital reported the results of their study in the Journal of Clinical Oncology published early online on April 17, 2006. 

More than 30% of elderly patients who initiated FU-based chemotherapy for stage III colon cancer and survived for at least 8 months discontinued treatment early. Mortality rates among such patients were nearly twice as high as among patients who completed 5 to 7 months of treatment. If the association we observed between duration of treatment and survival is confirmed, additional investigation is warranted to determine whether dose-intensity, cumulative dose, or other factors related to receipt of full adjuvant treatment are responsible.

Posted by Kate Murphy on April 18th, 2006
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Barrett’s Esophagus is associated with advanced colorectal adenomas and cancer

Barrett’s esophagus is a condition in which there are pre-cancerous changes in the lining of the esophagus, the tube leading from the mouth to the stomach.  Reviewing a database of US veterans who had been diagnosed with Barrett’s esophagus (BE) and comparing them to a similar group who had not, researchers found that there was an increased risk of colon neoplasia (advanced polyps or cancer) in those with BE.

268 veterans in the study with BE were compared to 268 controls without BE.  All study participants had undergone upper GI endoscopy and colonoscopy.  Sicty percent of the BE patients had colon neoplasia while only 40% of controls had similar changes.  Advancing age and alcohol use were also associated with risk for colon neoplasia, but use of aspirin, NSAIDs, or proton-pump inhibitors were not.

The researchers, led by Peter D. Siersema MD, PhD concluded:

Veterans with BE are at an increased risk of developing colorectal neoplasia. This association is independent from the use of PPIs or aspirin/NSAIDs.

They cautioned that the study included only mostly male veterans.

The study was reported in the April 2006 issue of Gastrointestinal Endoscopy.

Posted by Kate Murphy on April 13th, 2006
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Barrett’s Esophagus is associated with advanced colorectal adenomas and cancer

Barrett’s esophagus is a condition in which there are pre-cancerous changes in the lining of the esophagus, the tube leading from the mouth to the stomach.  Reviewing a database of US veterans who had been diagnosed with Barrett’s esophagus (BE) and comparing them to a similar group who had not, researchers found that there was an increased risk of colon neoplasia (advanced polyps or cancer) in those with BE.

268 veterans in the study with BE were compared to 268 controls without BE.  All study participants had undergone upper GI endoscopy and colonoscopy.  Sicty percent of the BE patients had colon neoplasia while only 40% of controls had similar changes.  Advancing age and alcohol use were also associated with risk for colon neoplasia, but use of aspirin, NSAIDs, or proton-pump inhibitors were not.

The researchers, led by Peter D. Siersema MD, PhD concluded:

Veterans with BE are at an increased risk of developing colorectal neoplasia. This association is independent from the use of PPIs or aspirin/NSAIDs.

They cautioned that the study included only mostly male veterans.

The study was reported in the April 2006 issue of Gastrointestinal Endoscopy.

Posted by Kate Murphy on April 13th, 2006
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Mutated stem cells in the lining of the colon can predict colon cancer

Researchers at Jefferson Medical College in Philadelphia have identified a profile of 16 genes that are changed in colon cancer.  The mutated gene signature can be found in cells deep in the colon crypts, the tiny tube-like structures that line the colon.

Stem cells at the bottom of the colon crypts produce new cells that grow and divide and make their way to the to the top of the crypt as fully developed colon cells.  Mutations in the stem cells lead to mutated colon cancer cells, key to the beginnings of colorectal cancer.

Using a microarray chip to analyze microRNA (mRNA), the research team compared cell activity in the bottom of the crypt to that in the upper regions to identify stem cells and their developing daughter cells.  They also examined mRNA arrays in colon cancer tissue and compared it to normal tissue.

They found a pattern of 16 genes that characterized the stem cells at the bottom of the crypt.  This pattern was different in colon cancer tissue, and the same pattern could be found in some stem cells.  The mutated stem cells were able to predict the potential development of colorectal cancer at the very earliest point.

Their results were presented during a oral session of best late-breaking abstracts at the annual meeting of the American Association for Cancer Research in Washington D.C. on April 4, 2006.

Posted by Kate Murphy on April 13th, 2006
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Mutated mismatch repair genes increase early onset colorectal cancer

Individuals with a mutation in one of the mismatch repair genes frequently are diagnosed with colorectal cancer prior to age 45.  The body uses mismatch repair genes to stop cancer developing when an error in DNA is discovered in a dividing cell.  The genes either repair the damaged DNA, keep the cell from dividing, or cause its death.

Inherited mutated mismatch repair genes are responsible for Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC.)  People with HNPCC are at greatly increased risk for colorectal and other cancers, and they are often diagnosed in young adulthood.

Researchers at the University of Melbourne in Australia analyzed families where one individual (the proband) had been identified with a mismatch repair gene mutation (hMLH1, 4 hMSH2, 4 hMSH6, 1 hPMS2)) and who had been diagnosed younger than age 45.  Not all of the probands met the usual Amsterdam criteria for a strong family history of colorectal cancer — 11 of 17 did.

They found that the risk of colorectal cancer before age 50 for men with a mutated gene was 180 times that of a normal population.  Women had a 100–fold increased risk before age 50.  After age 50, the men’s risk returned to normal and the women’s risk was 7 times higher than the rest of the population.

Writing in Clinical Gastroenterology and Hepatology, April 2004, they concluded:

For carriers of the mutations in the mismatch repair genes that cause early onset colorectal cancer, colorectal cancer increases rapidly until age 50, and the incidence decreases to general population levels at older ages.

colorectal cancer risk Lynch Syndrome HNPCC young colorectal cancer

Posted by Kate Murphy on April 12th, 2006
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