Significance of DNA content abnormalities in small rectal cancers

Article Abstract:

Most rectal cancers are treated with extensive surgery involving the area of the abdomen and perineum (the areas around the gastrointestinal and urogenital tracts). Small lesions may be treated more conservatively with just local excision or cautery or radiation. These methods are used when there is only a small possibility of tumor recurrence, and metastasis (spread) is unlikely. Unfortunately the criteria used to make this decision are not always accurate. Recent research has indicated that certain abnormalities in the DNA content of a tumor may be related to a poor prognosis in a variety of cancers. A study of 39 patients with small rectal cancers was undertaken to determine if information regarding the DNA content of the tumor was useful in predicting the outcome. All patients had lesions smaller than 3 cm. Patients were followed for five years. DNA was analyzed using flow cytometry. Other prognostic factors evaluated included: sex, age, tumor size, location, distance of the tumor from the outside margin of removed tissue, Dukes' tumor classification, and tumor differentiation based upon amount of gland formation or solid growth pattern noted. Analysis of these factors indicated that only Dukes' classification and tumor DNA content were independent indicators of prognosis. It is concluded that DNA content determination may provide additional information on the prognosis of these patients. In a related editorial comment, it is noted that the size of the patient population studied was small; however, these results suggest a role for DNA determination. If further studies of large populations show a similar correlation, another reliable prognostic factor in early rectal cancer may be close at hand. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Prognosis, DNA

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Local excision of rectal carcinoma

Article Abstract:

Cancer of the rectum in which the tumor is located within 6 centimeters (about 2 inches) of the anus is usually treated by surgical abdominoperineal resection, a procedure in which parts of the abdomen and pelvic region are removed. Sphincter-saving surgery may be performed for tumors located in the middle and upper rectum. Local tumor excision, as would be needed to remove tumors in the lower rectum, does not remove areas of regional spread. Therefore if local excision is to be used on these lower cancers, the risk of spread should be minimal or additional treatment should be given to control regional spread. Sixteen studies reporting the use of local excision to treat lower rectal cancer were reviewed to identify factors influencing regional spread, and to identify patient selection criteria for sphincter-saving surgery. There was no evidence of regional metastasis in 94 percent of the cases. The five-year cancer survival was 89 percent. There was local recurrence in 19 percent of patients; half of these were cured by further surgery. These results are comparable to those achieved when abdominoperineal resection is performed. Factors associated with tumor recurrence were: cancer in the margins of the removed tissue, poorly differentiated histology, and increased depth of invasion into the bowel wall. Tumor size greater than 3 centimeters does not appear to be significant. Local tumor excision may be attempted if the tumor is mobile, moderately or well differentiated tissue based on biopsy specimen, and there is no evidence of spread beyond the rectum. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods

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Rectal prolapse in infants and children

Article Abstract:

Rectal prolapse (sliding down of the tissue of the rectum from its original location) often occurs in infants and can be managed by prevention of constipation, rapid return of the rectal tissue to its proper location by observant parents, and normal growth and development. Some children do not respond to this management, and some parents are unable to care for the condition properly. Rectal prolapse may develop in patients with myelomeningocele (defect of the central nervous system involving the spine), cystic fibrosis or chronic lung disease; it also occurs in otherwise healthy children. A simple, safe method of treating this condition is described. Ten children were treated after conservative management failed. In 9 of the 10 children, the prolapse involved the mucosa of most of the anus, and the last child had complete prolapse. The technique used involved tightening the anus by placement of several sutures; this was performed under general anesthesia. There were no wound infections and no serious complications. The suture was left in place for an average of seven months, and all patients had control of their prolapse by the suture. This procedure may be safely used when children do not respond to conservative treatment for rectal prolapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Rectal prolapse, Sutures

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