The Spread of Rectal Cancer and its Effect on Prognosis

Abstract

IT is well known that in all forms of cancer treated by radical surgery the patient's prognosis depends very much on the extent of local and lymphatic spread and on the likelihood of venous dissemination. To proceed further than this and to attempt to define the relative importance of each of these three methods of spread is only possible when a large series of carefully documented cases has been kept under observation for several years by a really efficient follow-up. This information is now available with regard to cases of rectal cancer treated by radical surgery at St. Mark's Hospital and the purpose of this paper is to record the degree to which the prognosis is influenced by the extent of local, lymphatic and venous spread.St. Mark's Hospital is a special hospital for diseases of the colon and rectum, and since 1924 a research into the pathology and treatment of rectal cancer has been continued in the pathology department with the help of a grant from the British Empire Cancer Campaign. Some preliminary reports have already been published but the present analysis is the first comprehensive summary of this long-term research project and covers the 25 years 1928-52.During these 25 years a total of 3596 rectal cancer patients were admitted to hospital or seen in the Out-patient Department. Of these, 2447 were treated by a surgical operation which removed the primary tumour. Every possible endeavour has been made to keep in touch with operation survivors, and only 28 have not been traced. These have been assumed to be dead, but since they constitute only 1 1 per cent of all cases they exert no appreciable effect on the statistics.The crude 5-year survival rate of all patients treated by surgical removal of the primary tumour was 48x3 per cent. It might be assumed that this figure would provide a basic standard by which to measure the effect of various forms of spread subsequently to be considered, but crude survival rates are not altogether satisfactory for such a purpose because of variation in the age and sex composition of the groups of patients to be compared. When comparing groups of patients of dissimilar age and sex, it is more accurate to use " age and sex corrected " 5-year survival rates. This point will be appreciated when we recall that the crude 5-year survival rate simply records the percentage of individuals still living after 5 years and makes no distinction between deaths which have been due to cancer and deaths due to intercurrent diseases, the incidence of which is a function of both age and sex.There is more than one statistical device for producing a corrected survival rate and the one adopted here was recommended by Dr. Percy Stocks and has already been described (Dukes, 1957). The effect of this correction on our figures

Prognostic index for patients with parotid carcinoma

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The effect of deprivation and the systemic inflammatory response on outcome following curative resection for colorectal cancer

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Increased serum p53 antibody levels indicate poor prognosis in patients with colorectal cancer

“…Routine biopsies from each tumour were taken for histopathological classification. The tumours were graded according to the WHO classification (Morson and Sobin, 1976) and staged according to the Dukes' classification system (Dukes and Bussey, 1958). Immunohistochemical analysis of overexpression of p53 protein p53 protein overexpression was evaluated using an immunohistochemical method (Kressner et al, 1996).…”