Background Worldwide, the annual mortality from CRC is estimated to be 500.000. The incidence and mortality of CRC increase with age especially after 60 years of age. In Sudan there are no present population-based cancer registries that can provide database for epidemiological studies on CRC and its risk factors, for an effective implementation of the suitable screening programs. Methods A retrospective hospital-based study was conducted on all CRC patients who attended Soba University Hospital (SUH) between January 2004 and December 2007 to describe the pattern of CRC according to age, race, gender and sub-site location of the tumor. We considered that SUH is one of the largest central hospitals in Sudan that has integrated gastrointestinal and endoscopy units and receives patients from different sources of referral. Results During the study period, 202 patients with CRC attended both hospital clinical wards and endoscopy units between the ages of 10-90 years. Age was found to be independently significantly associated with both proximal and distal CRC (p=0.01). Gender and race were found to be insignificantly associated with both proximal and distal CRC (p=0.839 and 0.522 respectively). Fifty-two percent of patients were found to be of 50 years of age and below. The mean age for CRC was found to be 50 years. Almost 70% of the patients were found to have distal CRC and about 85% of them were having rectal cancer. Conclusions Fifty-two percent of the patients were found to be of 50 years of age and below with predominance of distal CRC among all patients. This gives a clue that screening with flexible sigmoidoscopy starting at the age of 40 can be of an appreciated secondary preventive value.Background Aim of the study is to assess tolerance, toxicities and results of multimodality treatment in elderly patients with rectal cancer. Methods 48 patients with rectal cancer aged over 70 years (70-84) were treated in our center. There were 31 males and 17 females with localized disease in the pelvis (19 stage II, 29 III disease, ECOG performance status 0/1 in 35 and 2/3 in 13). Nineteen patients were initially treated surgically followed by postoperative radiotherapy and chemotherapy. Twenty patients were primarily treated with radio-chemotherapy followed by surgery in 14 while 9 were treated with palliative radiotherapy because of their poor condition. Radiotherapy was 3D conformally planned and delivered with 3-field technique on 18MV linear accelerator. Post-operatively the median administered dose was 40Gy and preoperatively 45Gy. Chemotherapy consisted of orally administered capecitabine in most patients. Results Apart from 9 patients in poor general condition, we treated the rest with radical intent. Treatment toxicity was significant in both groups (post-op and pre-op radio-chemotherapy). Hematological and gastro-enteric grade II-III toxicity occurred in 80% of those treated post-operatively resulting in treatment modifications in 78%. Those treated with preoperative therapy had better tolerance; grade II-III tox...

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Background: State health insurance authorities in Greece do not reimburse genetic testing for cancer predisposition. The Hellenic Society of Medical Oncology has launched and carries out a national program covering genetic testing for BRCA1/2 mutations detection, with the financial support of pharmaceutical industry. Aim: This analysis evaluates how, during this program, access to genetic testing transformed the oncologists' therapeutic approach toward their ovarian cancer patients and how the results impacted treatment decisions concerning PARP inhibitors. Adoption of testing by healthy relatives and timing of testing in the disease continuum were also evaluated. Methods: Adult patients with high-grade epithelial ovarian carcinoma, irrespectively of family history or age at diagnosis were eligible for this program. Genetic counseling was recommended before testing, and both were offered at no financial cost. First degree family members of pathogenic mutation carriers were also offered free counseling and testing. Results: From March 2015 through January 2018, 708 patients were enrolled and tested. One hundred and forty seven (20.7%) mutation carriers were identified, 102 (14.4%) in BRCA1 and 45 (6.3%) in BRCA2 gene. Testing was more often pursued at initial diagnosis (61%) than at recurrence (39%), as recorded for 409 patients with available relevant information. During the 1st year of the program, average monthly tests performed were 25.1, while during the 3rd year this number increased to 34.3 tests per month. Among patients who tested positive for deleterious BRCA1/2 mutations, relapse was reported in 58 patients, 94.8% of which (n= 55) received treatment with the PARP inhibitor olaparib as per its indication. Family members of 21 patients (14.3%), out of the 147 who tested positive, received genetic counseling and testing for the mutation identified in the context of the program. Conclusion: Free access to genetic testing for BRCA1/2 for ovarian cancer patients and genetic consultation facilitates testing uptake, affects common clinical practice & has major impact on patients and their families. Still, diffusion of genetic information and broader testing of family members require further efforts by the oncological community.

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