Rationale and Objectives
Computed tomographic colonography (CTC) is a robust tool for evaluating colorectal lesions in both screening and diagnostic settings. The purpose of this study was to assess the relationship between colorectal cancer (CRC) tumor characteristics and patient symptomatology.
Materials and Methods
This is a retrospective analysis of all pathology-confirmed cases of CRC evaluated with CTC at our institution from October 2004 to October 2012. Cases were reviewed to determine tumor size, morphology, and degree of luminal narrowing. An electronic medical record review was performed to delineate specific patient symptomatology and determine depth of invasion.
Results
A total of 55 patients (36 symptomatic and 19 asymptomatic) with a total of 63 CRCs were evaluated by CTC during the study time period. The most common symptoms were gastrointestinal (GI) bleeding/anemia ( n = 26), followed by obstructive symptoms ( n = 23), and constitutional symptoms ( n = 5). Symptomatic cancers were more likely to have annular morphology ( n = 30/43, 70% vs. n = 3/20, 15%; odds ratio [OR] = 13.1, P = 0.0003), whereas asymptomatic cancers were more likely to be polypoid ( n = 11/20, 55% vs. n = 6/43, 14%, OR = 7.5, P = 0.001). Symptomatic cancers were also larger (46.1 ± 22.4 vs. 38.8 ± 18.4 mm, P = 0.005) and resulted in greater luminal narrowing (8.7 ± 8.5 mm vs. 35.8 ± 18.8 mm, P < 0.0001) with deeper invasion ( n = 29/35 [invasion unknown for 8 cases], 83% vs. n = 6/20, 30%, OR = 11.3, P = 0.0003). Invasive cancers were more likely to have annular morphology (66%, 23/25, P = 0.002).
Conclusions
There is an intuitive and predictable relationship between tumor characteristics on CTC and patient symptoms. Annular morphology, tumor size, degree of luminal narrowing, and invasive disease all correlate with the presence of symptoms.
Introduction
Colorectal cancer (CRC) is the third most frequently diagnosed cancer in the United States and is the second deadliest cancer, accounting for 50,310 cancer-related deaths in 2014 . Despite current evidence-based screening guidelines, CRC remains a prominent cause of cancer-related mortality, owing in part to suboptimal adherence to recommended screening protocols within the average-risk patient population .
Early in the time course of disease when prognosis is most favorable, CRC presents in completely asymptomatic individuals. However, as the disease progresses and prognosis becomes worse, symptoms may become evident. Symptoms of obstruction, nausea and vomiting, and abdominal distension are of prognostic significance in CRC patients in terms of both overall survival and disease-free survival . Abdominal pain, change in bowel habits, bleeding/anemia, malaise/fatigue, and weight loss are among the most common clinical manifestations of CRC prompting medical evaluation. Symptoms of CRC are often attributed to tumor size, location, degree of obstruction, and extent of disease .
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Materials and Methods
Study Group
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CTC Technique
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Procedures, Classification, and Definitions
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Statistical Analysis
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Results
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Table 1
Patient Demographics
Symptomatic Asymptomatic No. of patients 36 19 Male : female 15:21 (42%) 10:9 (53%) Mean age (years) 67 60 Colorectal cancer history 6% 0% Screening 0 19 No. of cancers 43 20 No. of patients with synchronous cancers 5 1
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Table 2
Tumor Morphology
Symptomatic Asymptomatic Annular 72% (31/43) 15% (3/20) Plaque like 14% (6/43) 30% (6/20) Polypoid 14% (6/43) 55% (11/20)
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Table 3
Symptom Category by Morphological Type
Annular Plaque Like Polypoid Obstructive 85% (17/20, P = 0.07) 5% (1/20, P = 0.07) 10% (2/20, P = 1.00) Gastrointestinal bleeding/anemia 73% (15/23, P = 0.27) 15% (5/23, P = 0.39) 12% (3/23, P = 1.00) Constitutional 100% (5/5, P = 0.29) 0 0
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Table 4
Number of Symptomatic and Asymptomatic CRCs by Location
Colonic Location Symptomatic (Total: 43) Asymptomatic (Total: 20) Rectum 6 (14%) 5 (25%) Sigmoid 16 (37%) 4 (20%) Descending 7 (16%) 1 (5%) Transverse 4 (9%) 4 (20%) Ascending 5 (12%) 2 (10%) Cecum 5 (12%) 4 (20%)
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Discussion
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Author disclosures
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