Colorectal cancer (CRC) is a common disease, with incidence in Brazil of 45,630 new cases per 100,000 inhabitants between 2023-2025. Risk factors for CRC can be evaluated between environmental and hereditary and their mode of presentation are classified as sporadic, inherited and familial. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. The percentage of patients with a true hereditary genetic predisposition is less than 10%, and these are related to the presence or absence of colonic polyps as an important manifestation of the disease. Non-polyposis diseases are known as hereditary non-polypomatous colorectal cancer (HNPCC) or Lynch syndrome, and polyposis diseases are familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), and hamartomatous polyposis syndromes (e.g., Peutz-Jeghers, juvenile polyposis, phosphatase and tensin homologue - PTEN, Cowden syndrome). These diseases are linked to a high risk of developing cancer. With the development of treatments in metastatic disease and the use of targeted therapies and their biomarkers, it was possible to evaluate them within clinical studies both in the primary tumor and in the correspondence of metastases.
Some studies have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality.
To evaluate the prevalence of hepatic steatosis in patients undergoing preoperative chemotherapy for metastatic colorectal cancer.
Observational retrospective cohort study in which 166 patients underwent 185 hepatectomies for metastatic colorectal cancer with or without associated preoperative chemotherapy from 2004 to 2011. The data were obtained from a review of the medical records and an analysis of the anatomopathological report on the non-tumor portion of the surgical specimen. The study sample was divided into two groups: those who were exposed and those who were unexposed to chemotherapy.
From the hepatectomies, 136 cases (73.5%) underwent preoperative chemotherapy, with most (62.5%) using a regimen of 5-fluorouracil + leucovorin. A 40% greater risk of cell damage was detected in 62% of the exposed group. The predominant histological pattern of the cell damage was steatosis, which was detected in 51% of the exposed cases. Exposure to chemotherapy increased the risk of steatosis by 2.2 fold. However, when the risk factors were controlled, only the presence of risk of hepatopathy was associated with steatosis, with a relative risk of 4 (2.7-5.9).
Patients exposed to chemotherapy have 2.2 times the risk of developing hepatic steatosis, and its occurrence is associated with the presence of predisposing factors such as diabetes mellitus and hepatopathy.
: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors.
: In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established.
Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy.
: The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent.
: Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.
: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients.
: In the second module of this consensus, management of resectable liver metastases was discussed.
: Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities.
: Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions.
: Were presented validated ressectional strategies, to be taken into account in clinical practice.
MTUYH and OGG1 genes have importance in the base excision repair systems of oxidized DNA bases. Modification of the tissue expression of these genes is related to the increased risk of developing colorectal cancer.
To evaluate the tissue expression of MUTYH and OGG1 comparing normal and neoplastic tissues of patients with sporadic colorectal cancer and to correlate it with clinical and histopathological variables.
MUTYH and OGG1 tissue expression was quantified by RT-PCR in patients with colorectal cancer and the values were compared in normal and neoplastic tissues. MUTYH and OGG1 expression was measured and normalized to the constitutive 18S gene. The level of expression of both genes was correlated with the variables: age, gender, tumor location, size of the tumor, histological type, degree of cell differentiation, invasion depth in the intestinal wall, angiolymphatic infiltration, lymph node involvement and TNM staging.
Was found downregulation of both genes in neoplastic when compared to normal tissue. There was downregulation of the MUTYH in larger tumors and in patients with angiolymphatic invasion. Tumors with more advanced TNM stages (III and IV) presented downregulation of both genes when compared to those with earlier stages (I and II).
The MUTYH and OGG1 genes present downregulation in the more advanced stages of colorectal cancer.
Among the screening tests for colorectal cancer, colonoscopy is currently considered the most sensitive and specific technique. However, computed tomography colonography (CTC), magnetic resonance imaging (MRI), and transrectal ultrasonography have gained significant ground in the clinical practice of pre-treatment, screening and, more recently, post-treatment and surgical evaluation.
To demonstrate the high accuracy of CT and MRI for pre and postoperative colorectal cancer staging.
Search and analysis of articles in Pubmed, Scielo, Capes Periodicals and American College of Radiology with headings “colorectal cancer” and “colonography”. Weew selected 30 articles that contained radiological descriptions, management or statistical data related to this type of neoplasia. The criteria for radiological diagnosis were the American College of Radiology.
The great majority of patients with this subgroup of neoplasia is submitted to surgical procedures with the objective of cure or relief, except those with clinical contraindication. CTC colonography is not the most commonly used technique for screening; however, it is widely used for treatment planning, assessment of the abdomen for local complications or presence of metastasis, and post-surgical evaluation. MRI colonography is an alternative diagnostic method to CT, recommended by the American Society of Gastrointestinal Endoscopy. Although there are still no major studies on the use of MRI for screening, the high resolution examination has now shown good results for the American Joint Committee on Cancer TNM classification.
MRI and CT represent the best means for colorectal neoplasm staging. The use of these methods as screening tools becomes beneficial to decrease complications and discomfort related to colonoscopy.
Colorectal cancer (CRC) is one of the most common types of cancer in the world. Over time, intestinal epithelial cells undergo mutations that may lead to proliferative advantage and the emergence of cancer. Mutations in the beta-catenin pathway are amongst those described in the development of CRC.
To verify the existence of a relation between the presence of Wnt3, beta-catenin and CDX2 in colorectal cancer samples and clinical outcomes such as disease progression or death.
Wnt3a, beta-catenin and CDX2 immunohistochemistry was performed on CRC tissue microarray samples (n=122), and analysis regarding the relation between biomarker expression and disease progression or death was performed.
No significant difference was found between the presence or absence of CDX2, beta-catenin or Wnt3a expression and clinical stage, tumor grade, disease progression or death.
CDX2, beta-catenin and Wnt3a are not useful to predict prognosis in patients with CRC.
As the coronavirus disease 2019 (COVID-19) pandemic spreads throughout the world, new clinical manifestations are being reported. In addition to the respiratory manifestations, acute renal failure3, hypercoagulability9, vomiting and diarrhea5 have been described.
The Cancer Institute of the São Paulo State (ICESP) has already performed over 8500 surgeries for colorectal cancer in the last 10 years. It is one of the hospitals associated with the University of São Paulo School of Medicine, which has already admitted over 3000 patients with moderate or severe COVID-19 for in-hospital treatment. We present a case of intestinal perforation caused by microcirculatory thrombosis in the colon in a patient undergoing surgery for colorectal cancer.
A 92-year-old male patient with a diagnosis of rectal adenocarcinoma sought emergency care in April 2020 due to intestinal subocclusion. He had a personal history of hypertension and nondialysis chronic kidney disease. Chest and abdomen CT scans showed no pulmonary changes; multiple liver metastases, the largest one measuring 3.0 cm and distension of the colon and small intestine. He underwent exploratory laparotomy, and a tumor was found in the upper rectum, causing bowel obstruction. A rectosigmoidectomy was performed with blind-ending closure of the rectal stump and terminal colostomy.
During the postoperative (PO) period, the patient received food and had intestinal transit until the 3rd PO day, when he started to present coughing and fever. Laboratory testing showed increased C-reactive protein (CRP), as shown in Figure 1. Chest CT scan revealed consolidation in the right lung base. Assessment by the infectious disease team indicated a clinical and radiological profile compatible with bacterial pneumonia. Antibiotic therapy with piperacillin-tazobactam was initiated and maintained for five days with good response, after which the patient started receiving levofloxacin. He was discharged on the 8th PO day, with clinical improvement, decreased CRP levels, good acceptance of food and a functioning colostomy.
After two days, on the 10th PO day, he returned to the emergency room complaining of diffuse abdominal pain, oliguria and coughing. Abdominal examination showed a nonfunctioning colostomy and abdominal pain upon palpation, without signs of peritonitis. In the laboratory analysis, the patient had leukocytosis of 19,000 cells/mm³, with 92% neutrophils and a CRP level of 110 mg/l (normal range <5.0 mg/l) in addition to renal dysfunction with an increase in creatinine levels from 1.58 mg/dl to 3.7 mg/dl and an increase in urea from 56 mg/dl to 110 mg/dl. A CT scan of the abdomen showed pneumoperitoneum without free fluid collections and with diffuse distension of small bowel loops. Exploratory laparotomy was indicated and showed punctiform perforation of the descending colon at 5 cm from the colostomy, with fecal peritonitis blocked by small bowel loops. The perforated descending colon segment located at 5 cm from the colostomy was resected, followed by exhaustive washing of the cavity, terminal colostomy and introduction of antibiotic therapy with meropenem.
Due to the concomitant pulmonary manifestations, the patient was referred to the ICU intubated with vasoactive drugs, a nasogastric tube, antibiotic therapy and parenteral nutrition. He maintained high nasogastric tube output. Starting on the 1st PO day, he received anticoagulant therapy for the prophylaxis of thromboembolic events. He was extubated on the 3rd PO day and discharged from the ICU. On the 5th PO day, worsening of the respiratory condition was observed, with discomfort, decreased oxygen saturation and increased CRP. The chest CT scan, Figure 2, showed multiple bilateral ground-glass opacities. A D-dimer level of 3225 ng/ml and DHL of 638 U/l were observed. A nasopharyngeal and oropharyngeal swab was collected to screen for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the decrease in oxygen saturation even with 100% oxygen supplementation by mask, the patient was again admitted to the ICU, immediately subjected to orotracheal intubation, and kept on mechanical ventilation and in isolation.
Regarding the clinical evolution, the swab was positive, with worsening of general conditions: adynamic ileus, acute renal failure with creatinine reaching 5.0 mg/dl, need for high doses of vasoactive drugs and antibiotic therapy with meropenem, vancomycin and anidulafungin. The patient was extubated on the 28th PO day after improvement of the respiratory condition. He was discharged from the ICU on the 30th PO day but progressed to a coma vigil, according to the neurologist. Death occurred on the 36th PO day.
An anatomopathological assessment of the surgical specimen revealed thrombotic changes in the microcirculation of the perforated descending colon (Figure 3).
Inhibitors of the epidermal growth factor (EGFR) represent an effective therapeutic option for patients with metastatic colorectal carcinoma, free of activating mutations in KRAS and NRAS. However, the research of mutations is of high cost and scarcely accessible. The expression of the EGFR by immunohistochemistry predicting the mutation status of the expanded RAS (KRAS and NRAS), may allow treatment by a diagnostic method less costly and more accessible.
Investigate the correlation between the clinical-pathological data, the cytoplasmic-membrane expression of the EGFR and the mutational status of the expanded RAS.
A total of 139 patients with colorectal carcinoma from the archives of Instituto Goiano de Oncologia e Hematologia were evaluated.
Mutation of the expanded RAS was detected in 78 (56.1%) cases. The EGFR expression was stratified in 23 (16.5%) “positive”, 49 (35.2%) "negative" and 67 (48.2%) "uncertain". No significant correlation was found between the mutational status of the RAS and the EGFR expression in comparison to age, gender, location, histological type, histological grade and stage. From 23 "positive” cases, 21 (91.3%) showed wild-type RAS gene, and 49 "negative”, 41 (83.7%) presented mutation, resulting in a strong association between EGFR "positive", "negative” groups and the mutational status of the RAS (p<0.001), with 86.1% of accuracy.
The cytoplasmic-membrane analysis of the EGFR expression stratified into "positive", "negative" and "uncertain" predicts mutational status of the RAS in 51.7% of the cases (p<0.001), with 86.1% of accuracy.
Desenvolvido por Surya MKT