혈액질환 환자에서 발생한 대장암

김도형,지성배,시윤,이윤석,강원경,오승택,이인규 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.4

Purpose: The incidence of secondary malignancies in hematologic patients is known to be higher than it is in other patients. However, the characteristics of secondary malignancy and surveillance have not yet been established for colorectal cancer in leukemic patients. Methods: From 1995 to 2007, 6,030 patients who were diagnosed with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphoid leukemia (CLL), and multiple myeloma (MM) were enrolled in this study. Among them, 9 patients were diagnosed with colorectal cancer at St. Mary’s Hospital and were analyzed retrospectively. Results: Three of the 2,570 patients with AML, 1 of the 1,158 patients with CML, 2 of the 83 patients with CLL, 2 of the 422 patients with MM, and none of the 1,797 patients with ALL were found to have colorectal cancer. There were no operative mortalities, but 2 patients refused to have surgery. The ratio of observed to expected subsequent colorectal cancer in CLL was higher than it was in the other groups, indicating that the relative risk of colorectal cancer is higher in patients with CLL. Conclusion: Compared to the Surveillance, Epidemiology and End-Result (SEER) program at the National Cancer Institute (NCI) in the United State, we have the same high relatively risk in CLL patients. Careful attention should be paid to the possibility of colorectal cancer in CLL patients. Purpose: The incidence of secondary malignancies in hematologic patients is known to be higher than it is in other patients. However, the characteristics of secondary malignancy and surveillance have not yet been established for colorectal cancer in leukemic patients. Methods: From 1995 to 2007, 6,030 patients who were diagnosed with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphoid leukemia (CLL), and multiple myeloma (MM) were enrolled in this study. Among them, 9 patients were diagnosed with colorectal cancer at St. Mary’s Hospital and were analyzed retrospectively. Results: Three of the 2,570 patients with AML, 1 of the 1,158 patients with CML, 2 of the 83 patients with CLL, 2 of the 422 patients with MM, and none of the 1,797 patients with ALL were found to have colorectal cancer. There were no operative mortalities, but 2 patients refused to have surgery. The ratio of observed to expected subsequent colorectal cancer in CLL was higher than it was in the other groups, indicating that the relative risk of colorectal cancer is higher in patients with CLL. Conclusion: Compared to the Surveillance, Epidemiology and End-Result (SEER) program at the National Cancer Institute (NCI) in the United State, we have the same high relatively risk in CLL patients. Careful attention should be paid to the possibility of colorectal cancer in CLL patients.

Clinical Usefulness of Serum CYFRA 21–1 in Patients with Colorectal Cancer

이재현 대한핵의학회 2013 핵의학 분자영상 Vol.47 No.3

Purpose Among diverse tumor markers, pretreatment evaluation and follow-up detection of recurrence in colorectal cancer are generally evaluated by serum carcinoembryonic antigen (CEA) levels. However, there have been some reports about the low accuracy and high false-positive results of CEA in colorectal cancer. We investigated the clinical utilities of CYFRA 21–1 by comparing CEA and cancer antigen 19–9(CA 19–9) in pretreatment and recurrent colorectal cancer. Methods Using a solid-phase immunoradiometric assay, serum levels of CYFRA 21–1, CEA and CA 19–9 were analyzed in 132 patients with primary colorectal cancer, 124 healthy controls,104 patients with benign colorectal disease and 19 patients with recurrent colorectal cancer. We determined three different cutoff values to evaluate the sensitivity of diagnostic performance in pretreatment and recurrent colorectal cancer. Results CYFRA 21–1 (≥ 1.13 ng/ml) had a sensitivity of 47 %, compared with 37 % for CEA (≥ 3.05 ng/ml) and 32.6 % for CA 19–9 (≥ 23.1 ng/ml) in the initial staging of primary colorectal cancer. Using different cutoff values,CYFRA 21–1 showed higher sensitivity for pretreatment colorectal cancer than CEA and CA 19–9 in adenocarcinoma and adenosquamous carcinoma of this study. A mildly significant correlative relationshipwas noted between Dukes’ stages and three tumor markers (p<0.01). The areas under the receiver operating characteristic curves of CYFRA 21–1, CEA and CA 19–9 were 0.81±0.03, 0.74±0.03 and 0.62±0.04,respectively, for discriminating colorectal cancer patients from patients with benign colorectal disease. In addition, CYFRA 21–1 was determined as the most sensitive tumor marker for evaluating recurrent colorectal cancer for all cutoff values. Conclusion This study showed that CYFRA 21–1 could be a useful and dependable tumor marker for pretreatment and recurrent colorectal cancer. Further prospective studies on its usefulness with respect to the prognosis and utility of combined tumor markers are needed.

대장암의 발병위험요인

김동현 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.5

Colorectal cancer has been rapidly increasing in Korea during the past decades, which was known as low risk area. The age-standardized mortality rates increased from 3.0 to 14.5 in 100,000 for men and from 2.3 to 7.9 in 100,000 for women between 1983 and 2008. According to the National Cancer Registry, the age-standardized incidence rates of total colorectal cancer were increased by 7.3% and 5.5% for men and women, respectively, between 1999 and 2005, while the incidence rates of the most prevalent cancers in Korea, such as stomach, liver, and cervical cancers, have decreased during the same period. Westernized dietary and lifestyle-related factors seem to be closely related to the increased risk of colorectal cancer. Higher intakes of red and processed meat, a lack of physical activity, obesity, and alcohol drinking have been suggested to be risk factors for colorectal cancer in the numerous epidemiologic studies, while higher intakes of dietary fiber, green leafy vegetables, some micronutrients abundant in vegetables and fruits, such as folate, and calcium were reported to be protective factors. Since many of the diet and lifestyle-related factors for colorectal cancer are modifiable, it is urgently needed to set up comprehensive primary prevention program against colorectal cancer to effectively cope with the rapidly increasing cancer in Korea. Colorectal cancer has been rapidly increasing in Korea during the past decades, which was known as low risk area. The age-standardized mortality rates increased from 3.0 to 14.5 in 100,000 for men and from 2.3 to 7.9 in 100,000 for women between 1983 and 2008. According to the National Cancer Registry, the age-standardized incidence rates of total colorectal cancer were increased by 7.3% and 5.5% for men and women, respectively, between 1999 and 2005, while the incidence rates of the most prevalent cancers in Korea, such as stomach, liver, and cervical cancers, have decreased during the same period. Westernized dietary and lifestyle-related factors seem to be closely related to the increased risk of colorectal cancer. Higher intakes of red and processed meat, a lack of physical activity, obesity, and alcohol drinking have been suggested to be risk factors for colorectal cancer in the numerous epidemiologic studies, while higher intakes of dietary fiber, green leafy vegetables, some micronutrients abundant in vegetables and fruits, such as folate, and calcium were reported to be protective factors. Since many of the diet and lifestyle-related factors for colorectal cancer are modifiable, it is urgently needed to set up comprehensive primary prevention program against colorectal cancer to effectively cope with the rapidly increasing cancer in Korea.

Clinical Characteristics of Multiple Primary Colorectal Cancers

윤주원,이승현,안병권,백승언 대한암학회 2008 Cancer Research and Treatment Vol.40 No.2

Purpose: Although multiple primary colorectal cancer has been recognized as a significant clinical entity, its clinical and pathological features and its prognosis are still controversial. The purpose of this study was to clarify clinical and pathological features of multiple primary colorectal cancer. Materials and Methods: Among 1669 patients who underwent surgery for primary colorectal cancer from January 1997 to June 2005, 26 patients (1.6%) with multiple primary colorectal cancer were identified. We reviewed clinical characteristics including diagnostic interval, lesions, operating methods, and TNM stage, and we defined the index lesion as the most advanced lesion among the synchronous lesions. For the purposes of the study, the colon and rectum were classified into three segments. The right-side colon included the appendix, cecum, ascending colon, hepatic flexure, and transverse colon, and the left-side colon included the splenic flexure, descending colon, and sigmoid colon. Results: Of the 26 patients with multiple primary colorectal cancers, nineteen patients were male and seven patients were female, with a mean age of 61.5 years. Nineteen patients had synchronous colorectal cancers and seven patients had metachronous colorectal cancers. In the metachronous cases, the mean diagnostic interval was 36.8 months. The site of the first lesion in metachronous colorectal cancers was the right colon in five cases (71.4%) and the left colon in two cases (28.6%), and the site of the second lesion was the rectum in six cases (55.5%), the right colon in three cases (33.3%), and the left colon in one case. The TNM stage of the second lesions in the metachronous colorectal cancers was stage II in four cases (57.1%), stage III in one case (14.3%), and stage IV in one case (14.3%). For the synchronous colorectal cancers, the operation methods were single-segment resection combined with endoscopic mucosal resection in five cases (26.3%), single- segment resection alone in six cases, two-segment resection in six cases, and total colectomy in two cases. Conclusion: In metachronous colorectal cancers, the secondary lesions were later-stage cancer. Therefore, careful postoperative follow-up is necessary for patients who have undergone surgery for colorectal cancers. Further study of therapeutic modalities is important for synchronous colorectal cancers.

유전성 대장암

김덕우(Duck-Woo Kim) 대한의학유전학회 2010 대한의학유전학회지 Vol.7 No.1

대장암은 우리나라에서 가장 급격하게 발생이 증가하는 암종의 하나로 유전성 대장암은 전체 대장암의 5-15%를 차지한다. 유전성 대장암은 크게 유전성 비용종증 대장암과 유전성 용종 증후군에서 발생하는 대장암으로 나눌 수 있고, 유전성 용종 증후군에는 가족성 용종증, 포이츠-예거 증후군, 유년기 용종증, MYH 연관 용종증 등이 이에 해당한다. 유전성 대장암은 원인 유전자의 배선돌연변이에 기인하므로 산발성 대장암에 비하여 암이 조기 발생하고, 동시성 및 이시성 암이 흔하며, 대장 이외의 장기에도 종양을 비롯한 질병을 일으키는 특징이 있다. 유전성 대장암은 환자뿐 아니라 가족구성원에 대한 유전자 검사, 유전 상담, 조기 진단을 위한 정기 검진이 매우 중요하며, 이러한 환자 및 가족구성원의 효율적 관리를 위한 유전성종양 등록소의 역할이 중요하다. 본 논문에서는 유전성 대장암에 해당하는 질환들의 임상적/유전적 특성, 치료, 유전자 검사 및 정기검진 프로그램에 대하여 고찰하고자 한다. Colorectal cancer is one of the most steeply increasing malignancies in Korea. Among 398,824 new patients recorded by the Korea Central Cancer Registry between 2003 and 2005, 47,915 cases involved colorectal cancers, accounting for 12.0 % of all malignancies. In 2002, total number of colorectal cancer cases had accounted for 11.2 % of all malignancies. Hereditary syndromes are the source of approximately 5% to 15% of overall colorectal cancer cases. Hereditary colorectal cancers are divided into two types: hereditary nonpolyposis colorectal cancer (HNPCC), and cancers associated with hereditary colorectal polyposis, including familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome, juvenile polyposis, and the recently reported hMutYH (MYH)-associated polyposis (MAP). Hereditary colorectal cancers have unique clinical features distinct from sporadic cancer because these are due to germline mutations of the causative genes; (ⅰ) early age-of-onset of cancer, (ⅱ) frequent association with synchronous or metachronous tumors, (ⅲ) frequent association with extracolonic manifestations. The management strategy for patients with hereditary colorectal cancer is quite different from that for sporadic cancer. Furthermore, screening, genetic counseling, and surveillance for at-risk familial member are also important. A well-organized registry can plays a central role in the surveillance and management of families affected by hereditary colorectal cancers. Here, we discuss each type of hereditary colorectal cancer, focusing on the clinical and genetic characteristics, management, genetic screening, and surveillance.

Perceptions of Malaysian Colorectal Cancer Patients Regarding Dietary Intake: A Qualitative Exploration

Yusof, Afzaninawati Suria,Isa, Zaleha Md.,Shah, Shamsul Azhar Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.2

Background: Changes in dietary practices are known to be associated with changes in the health and disease pattern of a population. This study aimed to qualitatively explore the perception of colorectal cancer patients regarding causes of colorectal cancer and the influence of diet. Materials and Methods: Twelve respondents from three major ethnicities in Malaysia were selected from the quantitative study on dietary pattern and colorectal cancer carried out earlier in this study. In-depth interviews (IDI), conducted from April until June 2012, were mainly in the Malay language with additional use of English and continued until the saturation point was reached. All interviews were autorecorded so that verbatim transcriptions could be created. Results: Causes of colorectal cancer were categorized into internal and external factors. The majority of respondents agreed that there is an association between Western foods and colorectal cancer. Malaysian traditional diet was not related to colorectal cancer as less preservative agents were used. Malaysian diet preparation consisting of taste of cooking (spicy, salty and sour foods) plus type of cooking (fry, grilled and smoked) were considered causes of colorectal cancer. All respondents changed their dietary pattern to healthy food after being diagnosed with colorectal cancer. Advice from doctors regarding suitable food for colorectal cancer was useful in this regard. Conclusions: Eating outside, use of food flavoring ingredients and preservative agents were considered to be the main factors causing colorectal cancer. All respondents admitted that they changed to a healthy diet after being diagnosed with colorectal cancer.

다발성 원발성 대장 직장암의 임상 병리학적 특성

김용진,김남규,이강영,손승국,민진식 대한대장항문학회 2002 Annals of Coloproctolgy Vol.18 No.5

최근 10년간 고신대학교 복음병원 일반외과에서 치험한 대장 및 직장암의 추세 변화

이승현,안병권,백승언 고신대학교(의대) 고신대학교 의과대학 학술지 2002 고신대학교 의과대학 학술지 Vol.17 No.1

Background : In western countries, colorectal cancers are one of the most common malignant tumors. In Korea, colorectal cancers are the fourth common malignancy following gastric cancer, hapatoma, and lung cancer. It's incidence and importance has been rising over the past 10 years. We reviewed colorectal cancer patients to study the changing pattern in the last decade. Methods : We reviewed 1453 patients with primary colorectal cancers who were operated at Gospel Hospital, School of Medicine, Kosin University between 1991 and 2000, retrospectively. The colorectal patients were divided into two groups. First group was the patients who were operated in the first half of the decade, between 1991 to 1995. The second group was the patients who were operated in the second half of the decade, between 1996 to 2000. We compared the two groups according to sex, age, location, tumor size, preoperative serum carcinoembryonic antigen (CEA), and stages of the patients. Results : We operated the 1453 colorectal cancer patients in the last decade. Males were accounted for 734 of the cases, and females were accounted for 719 of the cases (sex ratio was 1:1). The Peak age incidence was 7th decade (30.4%). Of the tumor location, colon cancer cases totalled 598 (48.7%), rectal cancer cases totalled 630 (51.3%). Of the rectal cancer operation, the number of the low anterior resection were 337 (67.0%), the abdominoperineal resection were 166 (33.0%). The incidence of stage 1,2,3 and 4 were 10.9%, 35.4%, 36.2% and 16.3%, respectively. In comparison of the 2 group, the number of the patients who were operated in the first half of the decade were 519, in the second half of the decade were 934 (1:1.8). The sex ratio was 1:1 and peak age incidence was 6th decade in the first half of the decade. In the second half of the decade, sex ration was 1:1 and peak age incidence was 7th decade. The number of colon cancers were 194 (49.7%), rectal cancers were 196 (50.3%) in the first half of the decade. In the second half of the decade, the number of the colon cancer were 404 (48.2%), rectal cancers were 434 (51.8%). Of the rectal cancer operation comparing low anterior resection and abdominoperineal resection, the incidence of the lower anterior resection was 56.8% (83/146) in the first half of the decade, 71.1% (254/357) in the second half of the decade. In the preoperative serum CEA level, 177 cases (37.2%) were more than 5ng/ml in the first half of the decade, 254 cases (43.5%) in the second half of the decade. The incidence of stage 1,2,3 and 4 were 8.8%, 34.2%, 36.2% and 19.8% in the first half of the decade, 12.3%, 36.1%, 36.1% and 14.2% in the second half of the decade. Conclusion : During the second half of the decade, there was a significant increase of the incidence of the total number, the older patients, the higher CEA level in colorectal cancers. And the incidence of low anterior resection was increased in rectal cancer operations. The incidence of stage 1,2 was slightly increased in the second half of the decade, but not significant. There was no difference of the distributions according to age, sex, tumor location, size.

Clinical Characteristics of Colorectal Cancer Patients With a Second Primary Cancer

이진우,김종우,김남근 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.1

Purpose: The incidence of colorectal cancer is increasing due to a westernized dietary lifestyle, and improvements in treatment and diagnostic tools have resulted in more patients being confirmed of having multiple primary cancers. However, studies regarding multiple primary cancers are insufficient. In this study, the clinical aspects of patients with primary multiple cancers, including colorectal cancers, were investigated, and the results were compared to those of patients with primary colorectal cancer only. Methods: Seven hundred eighteen patients who received surgery for colorectal cancer between March 2003 and September 2012 in CHA Medical Center were enrolled. A retrograde cohort was done for comparison of the two groups: those with and those without multiple primary cancer. The analysis was done according to sex, age, tumor location, tumor size, metastatic regional lymph-node number, vascular/lymphatic microinvasion, staging, tumor markers, microsatellite instability, and C/T subgroup of polymorphism in methylenetetrahydrofolate reductase. Results: Of the 718 subjects, 33 (4.6%) had multiple primary cancers: 12 (36.4%) synchronous and 21 (63.6%) metachronous. The malignancy most frequently accompanying colorectal cancer was gastric cancer, followed by thyroid, prostate, and esophageal malignancies in that order. In the comparison between groups, mean age, tumor location, and microsatellite instability showed statistically significant differences; others parameters did not. Conclusion: The incidence of multiple primary cancers, including colorectal cancer, is increasing. Therefore, defining the characteristics of patients with multiple primary cancers is crucial, and those characteristics need to be acknowledged in the follow-up of colorectal cancer patients.

Primate-specific miR-944 activates p53-dependent tumor suppression in human colorectal cancers

Kim, Yoon-Jin,Lee, Jeong Hwa,Jin, Soll,Kim, Jung Hoon,Kim, Sang Hoon Elsevier 2019 Cancer letters Vol.440 No.-

<P><B>Abstract</B></P> <P>As cancers with a high incidence rate, colorectal cancers are a main cause of cancer-related death. MicroRNAs are often deregulated in cancers. The primate-specific miR-944, located in a p63 intron, is known to be highly expressed in patients exhibiting low colorectal cancer recurrence rates. However, the biological functions of miR-944 in colorectal cancers remain unclear. In this study, we found that miR-944 was downregulated in colorectal cancer tissues, and inhibited cancer cell growth in a xenograft mouse model. The overexpression of miR-944 caused G1 phase arrest and increased p53 expression in cancer cells. p53 stability was enhanced by miR-944s targeting E3 ligases COP1 and MDM2. Overexpression of COP1 and MDM2 restored cell growth inhibition caused by miR-944. Taken together, our results suggest that miR-944 acts as a potential tumor suppressor in colorectal cancers through the ubiquitin-proteasome system.</P> <P><B>Highlights</B></P> <P> <UL> <LI> miR-944 was downregulated in colorectal cancer tissues. </LI> <LI> The overexpression of miR-944 caused G1 phase arrest in cancer cells. </LI> <LI> miR-944 stimulated p53-mediated signaling by increasing p53 stability. </LI> <LI> COP1 and MDM2 are functional targets of miR-944 mediating its anti-proliferative effect in colorectal cancers. </LI> </UL> </P>