Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

Lee, Su Ann; Poh, Angeline Choo Choo

doi:10.11622/smedj.2015072

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…From 2015 to 2020, an average of 92.5% of CRC was diagnosed in those over the age of 50 years and the absolute incidence rates of EOCRC are a small fraction of those seen in older patients (Table 1). It is also worth considering that for patients over the age of 80 years, the increasing incidence rates may be a result of increased detection, rather than a true increasing prevalence of disease, e.g., increasing incidental findings of CRC picked up on cross sectional imaging for another indication [58]. Whatever the cause, due to the rapidly aging population the volume of CRC diagnoses in patients over 80 years is set to increase dramatically.…”

Section: Discussionmentioning

confidence: 99%

The incidence of early onset colorectal cancer in Aotearoa New Zealand: 2000–2020

Waddell,

Pearson,

McCombie

et al. 2024

BMC Cancer

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Background The incidence of early-onset colorectal cancer (EOCRC), diagnosed before age 50, has been rising in many countries in the past few decades. This study aims to evaluate this trend in Aotearoa New Zealand and assess its impact on Māori. Methods Crude incidence and age-standardized incidence of colorectal cancer (CRC) was analyzed from all new cases from the Aotearoa New Zealand national cancer registry for the period 2000–2020. Trends were estimated by sex, ethnicity, age group and location of cancer and projections made to 2040. Results Between 2000 and 2020, there were a total of 56,761 cases of CRC diagnosed in Aotearoa New Zealand, 3,702 of these being EOCRC, with age-standardized incidence decreasing significantly (P = 8.2 × 10− 80) from 61.0 to 47.3 cases per 100,000. EOCRC incidence increased on average by 26% per decade (incidence rate ratio (IRR) 1.26, p = < 0.0001) at all sites (proximal colon, distal colon and rectum), while the incidence in those aged 50–79 years decreased on average by 18% per decade (IRR 0.82, p = < 0.0005), again across all sites. There was no significant average change in CRC incidence in those over 80 years. In Māori, there was no significant change in age-standardized incidence. There was however a significant increase in crude incidence rates (IRR 1.28, p = < 0.0005) driven by significant increases in EOCRC (IRR1.36, p = < 0.0005). By 2040, we predict the incidence of EOCRC will have risen from 8.00 to 14.9 per 100,000 (6.33 to 10.00 per 100,000 in Māori). However, due to the aging population an estimated 43.0% of all CRC cases will be diagnosed in those over 80 years of age (45.9% over 70 years of age in Māori). Conclusion The age-standardized incidence of CRC from 2000 to 2020 decreased in Aotearoa New Zealand, but not for Māori. The incidence of EOCRC over the same period continues to rise, and at a faster rate in Māori. However, with the ageing of the population in Aotearoa New Zealand, and for Māori, CRC in the elderly will continue to dominate case numbers.

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Section: Discussionmentioning

confidence: 99%

The incidence of early onset colorectal cancer in Aotearoa New Zealand: 2000–2020

Waddell,

Pearson,

McCombie

et al. 2024

BMC Cancer

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“…The Danish screening program paper from 2015 revealed that the rate of incidentally detected malignant polyps was 2.3% [ 3 ]. It is also reported as an incidental finding in CT or PET scans being performed for other indications [ 2 ]. Incidental large bowel malignancy also has been noticed during surgery for other causes as in resected inguinal hernia sac, or during laparotomy for intestinal foreign body [ 10 ], and it was also detected in resected bowel after gunshot injuries [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Incidental colorectal carcinoma is defined as a clinically inapparent carcinoma of the large intestine diagnosed or discovered unexpectedly. It can be detected in imaging for other reasons [ 2 ], during colonoscopy bowel cancer screening [ 3 ], during surgical intervention for unrelated causes, as well as in autopsy. In this case, it was discovered during pathologic examination of a subtotal colectomy specimen removed for ischaemic colitis.…”

Section: Introductionmentioning

confidence: 99%

Incidental Malignant Colonic Polyp Detected in a Resected Ischaemic Large Bowel: A Case Report and Literature Review

Idaewor¹,

Lesi²,

Elremeli³

et al. 2021

Cureus

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Most patients with bowel cancer are symptomatic at the time of the diagnosis. They may present with a change in bowel habit, bleeding per rectum, abdominal pain, anaemia, weight loss or bowel obstruction. Colonic carcinoma can also be diagnosed incidentally during screening programs. Moreover, it may be incidentally detected in CT scans being performed for other indications or encountered during surgery for other causes. Some patients with colonic bowel ischaemia have associated large bowel cancer, where the ischaemic segment is usually proximal to the tumour and not necessarily associated with bowel obstruction. We are presenting a rare case of incidental malignant colonic polyp detected in a resected ischaemic large bowel in an 88-year-old gentleman. This was a very small tumour that was not visible macroscopically or detectable by imaging. Pathological examination of non-tumour colorectal resection specimens, as in this case, should include careful macroscopic examination and sequential block selection along the length of the colon, and where there is diffuse mucosal abnormality, block selection at 100mm interval is also advised. Attention to and block selection from any suspicious-looking area is warranted in all cases of non-tumour colorectal resections if such microscopic-sized malignancies of the type seen in our patient are to be picked up.

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“…CT scan is actually a poor diagnostic tool for detection of colonic malignancies with only 70% sensitivity with an unprepared bowel and even less in the setting of acute appendicitis [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Rates of colorectal cancer detection in screening colonoscopy post appendicectomy in patients 50 years and over

Dhadlie¹,

Mehanna²

2018

Annals of Medicine and Surgery

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IntroductionAcute appendicitis in older adults is relatively uncommon and could be the first presentation of an underlying colorectal carcinoma. Colonoscopy in these individuals affords the opportunity for earlier diagnosis and treatment. The finding of increased rates of colorectal cancer (CRC) with older patients who have had appendicitis was supported by a number of small studies and case reports in the early 1980s.With the advent of CT scanning and laparoscopic appendicectomy, increased ability to visualize the caecum has been achieved.PurposeA retrospective 12-month study of all patients presenting with acute appendicitis aged 50 years and over from 1st May 2017 to 31st May 2018, and review of post operative screening colonoscopy findings.ResultsForty-three patients met inclusion criteria. The patients’ median age was 62 years (range 50–85 years). 47% of the patients were male. 86% of patients had abdominal CT scans prior to surgery with acute appendicitis visualized in 97% of these cases. Acute appendicitis was found in 100% of cases with no clinical suggestion of CRC operatively or pathologically. 46% of patients had pertinent findings on colonoscopy. This included a malignant obstructing tumour at the hepatic flexure and a tubular adenoma in the transverse colon in a second patient. The remaining findings in this cohort of patients included diverticular disease and benign polyps.ConclusionDespite the advancement in visualization of anatomy with CT scan and laparoscopic appendicectomy there is still a role for screening colonoscopy in patients greater than 50 years of age with appendicitis particularly if they have associated bowel symptoms or risk factors for CRC.

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Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

Cited by 8 publications

References 16 publications

The incidence of early onset colorectal cancer in Aotearoa New Zealand: 2000–2020

The incidence of early onset colorectal cancer in Aotearoa New Zealand: 2000–2020

Incidental Malignant Colonic Polyp Detected in a Resected Ischaemic Large Bowel: A Case Report and Literature Review

Rates of colorectal cancer detection in screening colonoscopy post appendicectomy in patients 50 years and over

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