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Cancer of the Colon and
Rectum Colorectal cancer is the fourth most common cancer in the US accounting for 11% of all cancers. At St. Anthony’s Hospital (SAH) this cancer is the third most common cancer and accounts for 14% if all cases in the Cancer Registry. We reviewed all analytic cases in the registry from 1987 through 2004 and compared this to the available data from the National Cancer Data Base (NCDB.)
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There were 1,882 cancers and the numbers have been stable over the years of the study. There were 1,358 colon cancers with a male: female ratio of 44:56 (NCDB was 49:51.) There were 526 rectum/rectosigmoid cases with a gender ratio of M:F 48:52 (NCDB 57:43). The race distribution was 93% white and 7% black (NCDB was 83% and 11%.) The SAH patients were slightly older with a median age of 76 (versus 72y national) and as in figure 1. Stage distribution and comparisons are shown in figures 2 and 3 and survival comparisons in figures 4 and 5. The relative 5-year survival for all cases of colorectal cancer was 65%, which compares well with national survival data reported form SEER (62%). Using observed survival (which doe not correct for death from other causes) the survival at SAH is slightly lower than NCDB (44%/5 years compared that for NCDB colon 47.5% and rectum 50.6%) which would be expected since the patient population is older. The overall stage distribution and survival by stage compare favorably with national data. Current treatment guidelines advise the use of adjuvant chemotherapy for patients with stage III colon cancer. In 2002 the NCDB reported that 45% of stage III colon cases were treated with surgery only versus 57% in the SAH data.. We compared the outcome and age of patients who did and did not receive adjuvant therapy, and as noted, those who did not were older and had a shorter survival. For stage II/III rectal cancer the NCDB report that 22% of the patients in 2002 were treated with surgery only at SAH over the whole study period the number was higher (47%). The patient who did not receive adjuvant were older (77y versus 66.6y) but paradoxically had a better survival (68% versus 62%.) We looked at all stage II/III rectal cancer by year and found a declingin incidence (downward trend) in patients who did not receive adjuvant therapy (figure 6.) The NCCN (National Comprehensive Cancer Network) guidelines recommend that all stage II/III rectal cancer and stage III colon cancer patients receive adjuvant therapy. Summary: The stage distribution and survival of colorectal cancer at SAH compare favorably with national benchmark standards. This cancer has been shown to benefit from staging (colonoscopy) and efforts to increase public awareness if a goal of the committee and the results should be reflected in stage shifting to the earlier stages. The NCCN guidelines are becoming the standard of care for cancer in the US and it has been a goal of the cancer committee to promoted used of these guidelines and is regularly included ion the tumor board presentations. |
