Erdal UYSAL

Evaluation of Younger than Age 40 Years Patients Operated Due to Gastric, Colorectal and Pancreatic Cancer

Amaç Çalışmamızda malign gastrointestinal sistem tümörlerinin genç erişkinlerde daha ileri evrelerde tanı aldığına ve daha agresif seyirli olduğuna vurgu yaparak erken tanının önemine dikkat çekmek, genç erişkinlerde de malign gastrointestinal sistem tümörü tanısının akılda tutulması gerektiğinin belirtilmesi amaçlanmıştır. Bu amaç ışığında klinik deneyimlerimiz paylaşılmıştır. Merkezimizde 2012-2016 yılları arasında ameliyat edilen 40 yaş altı mide, kolorektal ve pankreas kanserli 30 hasta çalışmaya dahil edildi. Hastaların verileri retrospektif olarak dosya kayıtlarından elde edildi. Hastaların tanıları, demografik özellikleri, ailesel kanser öyküleri, yapılan cerrahi ve cerrahi dışı tedavileri, patolojik evrelendirmeleri kayıt edildi. Ayrıca hastaların takip ve survival süreleri kayıt edildi. Materyal ve Metod Bulgular Kadın erkek oranı 0.57 idi. Ortalama yaş, mide kanseri, kolorektal kanser ve pankreas kanserinde sırasıyla 34± 4.5, 33.7± 4, 30.6± 3.7 idi. Hastalarda en sık görülen bulgular sırasıyla kilo kaybı, karın ağrısı, kabızlık ve rektal kanamaydı. Mide kanseri 13 (% 43), kolorektal kanser 14 (%46), pankreas kanseri 3 (%11) hastada görüldü. Ortalama takip süresi, mide kanseri, kolorektal kanser ve pankreas kanserinde sırasıyla 13.9±7.8, 21.9±15.2, 25.3± 19.7 aydı. Survival oranı, mide kanseri, kolorektal kanser ve pankreas kanserinde sırasıyla 38% 71%, 66% idi. Hastaların 16'sında lenf nodu tutulumu ve ileri evre (evre III- IV) hastalık tespit edildi.Hastaların 4'ü Evre 1, 9'u Evre 2, 10'u Evre 3, 7'si Evre 4 aşamasında tespit edildi.Sonuç Malign gastrointestinal sistem tümörler kırk yaş altı genç erişkinlerde de görülmektedir. Mide kanserleri ve kolorektal kanserler sık görülürken, pankreas kanserinin görülme oranı daha düşüktür. Mide kanserlerinde histolojik tip olarak en sık signet ring cell adenocarcinoma görülmektedir. En düşük survival oranı ise mide kanserlerinde görülmüştür.( Sakarya Tıp Dergisi 2016, 6(4):217-223 )

Kırk Yaş Altı Mide, Kolorektal ve Pankreas Kanseri Nedeniyle Ameliyat Edilen Hastaların Değerlendirilmesi

Aim We aimed to draw attention to the importance of early diagnosis, and to remind that the diagnosis of malign gastrointestinal system tumors should be considered for young adults. For this purpose, our clinical experiences are shared. Material and Method Thirty patients under 40 year-old that have been operated in our center between the hear 2012 and 2016 for gastric, colorectal and pancreatic cancers were involved in our study. The data of patients were retrospectively obtained from their files. The diagnoses, demographical characteristics, familial cancer histories, surgeries and nonsurgical treatments, and pathological stages of the patients were recorded. Furthermore, the follow-up and survival durations of the patients were also recorded..Results The ratio of female/male was 0.57. Mean age were in gastric, colorectal and pancreas cancer respectively, 34± 4.5, 33.7± 4, 30.6± 3.7. The most frequently seen symptoms are loss of weight, stomachache, constipation, and rectal hemorrhage, respectively. Gastric cancer was seen in 13 (43%) patients, colorectal cancer in 14 (46%) patients, and pancreatic cancer in 3 (11%) patients. Mean followup period were in gastric, colorectal and pancreas cancer respectively,13.9±7.8, 21.9±15.2, 25.3± 19.7 month. Survival rate were in gastric, colorectal and pancreas cancer respectively, 38% 71%, 66%. The lymph node involvement and advanced stage (Stage III and IV) were detected in 16 of the patients. 4 of the patients were diagnosed in Stage 1, 9 in Stage 2, 10 in Stage 3, and 7 in Stage 4. Conclusion The malign gastrointestinal system tumors are also seen among younger than age 40 years, young adults. While gastric and colorectal cancers are seen more frequently, the incidence of pancreatic cancer is less. As histological type, the most frequently seen gastric cancer is signet ring cell adenocarcinoma. The lowest rate of survival is seen in gastric cancer cases. ( Sakarya Med J 2016, 6(4):217-223 )

PDF

___

1. Llanos O, Butte JM, Crovari F, Duarte I, Guzmán S. Survival of young patients after gastrectomy for gastric cancer. World J Surg. 2006;30 (1):17-20.
2. Goldvaser H, Purim O, Kundel Y, Shepshelovich D, Shochat T, Shemesh-Bar L, et al. Colorectal cancer in young patients: is it a distinct clinical entity? Int J ClinOncol. 2016;21(4):684-95.
3. Levine MS, Laufer I, Thompson JJ. Carcinoma of the gastric cardia in young people. AJR Am J Roentgenol. 1983;140 (1):69-72.
4. Lüttges J, Stigge C, Pacena M, et al. Rare ductal adenocarcinoma of the pancreas in patients younger than age 40 years. Cancer 2004;100 (1):173-82.
5. O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Do young colon cancer patients have worse outcomes? World J Surg. 2004;28 (6):558-62.
6. Wu MS, Chen CJ, Lin JT. Host-environment interactions: their impact on progression from gastric inflammation to carcinogenesis and on development of new approaches to prevent and treat gastric cancer. Cancer Epidemiol Biomarkers Prev 2005; 14(8): 1878–1882.
7. Nagini S. Carcinoma of the stomach: a review of epidemiology, pathogenesis, molecular genetics and chemoprevention. World J Gastrointest Oncol. 2012;4(7):156–169.
8. Hall TJ, Moulder J, Hsu HS, Achord J, Scott-Conner CE. Gastric carcinoma among younger individuals in Mississippi. South Med J. 1993;86 (3):302-4.
9. Sellam F, Harir N, Khaled MB, Mrabent NM, Salah R, Benchouk A, et al. Delayed diagnosis of pancreatic cancer reported as more common in a population of North Africanyoung adults. JGastrointest Oncol 2015;6 (5):505- 510.
10. Chan KK, Dassanayake B, Deen R, Wickramarachchi RE, Kumarage SK, Samita S, Deen K. Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: analysis of survival and prognostic markers. World J SurgOncol. 2010;15:8:82.
11. Schiffman SC, Chu CK, Park J, Russell M, Keilin S, Kooby DA, et al. Is prior cholecystectomy associated with decreased survival in patients with resectable pancreatic adenocarcinoma following pancreaticoduodenectomy? Am J Surg 2011;201 (4):519-24.
12. Koea JB, Karpeh MS, Brennan MF. Gastric cancer in young patients: demographic, clinicopathological, and prognostic factors in 92 patients. AnnSurgOncol. 2000; 7 (5): 346- 351.
13. Santoro R, Carboni F, Lepiane P, Ettorre GM, Santoro E. Clinicopathological features and prognosis of gastric cancer in young European adults. Br J Surg 2007; 94 (6): 737-742.
14. Alici S, Aykan NF, Sakar B, Bulutlar G, Kaytan E, Topuz E. Colorectal cancer in young patients: characteristics and outcome. Tohoku J ExpMed. 2003;199 (2):85-93.
15. Nakamura R, Saikawa Y, TakahashiT,Takeuchi H, Asanuma H, Yamada Y, et al. Retrospective analysis of prognostic outcome of gastric cancer in young patients. Int J ClinOncol. 2011;16(4):328-34.
16. İlhan Karabıçak, Savaş Yürüker, Tuğrul Kesicioğlu, Hamza Çınar, Necati Özen, Mete Kesim. Genç Hastalarda Mide Kanseri. Van Tıp Dergisi 2011;18 (2) :96-100.
17. Dhobi MA, Wani KA, Parray FQ, Wani RA, Wani ML, Peer GQ, et al. Gastric cancer in young patients. Int J SurgOncol. 2013;2013:981654.
18. Holburt E, Freedman SI. Gastric carcinoma in patients younger than age 36 years. Cancer.1987; 60 (6):1395- 1399.
19. López-Basave HN, Morales-Vásquez F, Ruiz-Molina JM, Namendys-Silva SA, Vela-Sarmiento I, Ruan JM, et al. Gastric cancer in young people under 30 years of age: worse prognosis, or delay in diagnosis? Cancer ManagRes. 2013;5:31-6.
20. E.A. Myers, D.L. Feingold, K.A. Forde, T. Arnell, J.H. Jang, R.L. Whelan. Colorectal cancer in patients under 50 years of age: a retrospective analysis of two institutions' experience World J. Gastroenterol. 2013;19 (34):5651–5657.
21. Mocci E, Guillen-Ponce C1, Earl J, Marquez M, Solera J, Salazar-López MT et al. PanGen-Fam: Spanish registry of hereditary pancreatic cancer. Eur J Cancer. 2015;51(14):1911-7.
22. Umeyama K, Sowa M, Kamino K, Kato Y, Satake K. Gastric carcinoma in young adults in Japan. AnticancerRes 1982; 2(5): 283-286.
23. Fuchs CS, Mayer RJ, Medical progress: gastric carcinoma. New England Journal of Medicine 1995;333 (1):32–41.
24. D.W. Mercerand E. K. Robinson, Stomach. Sabiston’s Text Book of Surgery, vol. 2, 17th edition.
25. Fendrich V, Langer P, Bartsch DK. Familial pancreatic cancer-status quo. Int J ColorectalDis. 2014;29 (2):139-45.
26. Ahnen DJ, Wade SW, Jones WF, Sifri R, Mendoza Silveiras J, Greenamyer J, et al. The increasing incidence of youngonset colorectal cancer: a call to action. Mayo ClinProc. 2014;89(2):216–224.
27. Yurgelun MB, Masciari S, Joshi VA, Mercado RC, Lindor NM, Gallinger S, et al. Colon Cancer Family Registry. Germline TP53 Mutations in Patients With Early-Onset Colorectal Cancer in the Colon Cancer Family Registry. JAMA Oncol. 2015;1 (2):214-21.
28. Mori M, Sugimach K, Ohiwa T, Okamura T, Tamura S, Inokuchi K. Early gastric carcinoma in Japanese patients under 30 years of age. Br J.1985; 72 (4): 289-291.
29. Isik M, Caner S, Metin Seker M, et al. Gastric adenocarcinoma under the age of 40; more metastatic, less differentiated. J BUON. 2011;16 (2):253–256.
30. Berry L. Pancreatic cancer diagnosis delayed in people under 55. Cancer Nursing Practice 2014;13:7.
31. Minardi AJ Jr, Sittig KM, Zibari GB, McDonald JC. Colorectal cancer in the young patient. AmSurg. 1998;64 (9):849-53.
32. Kim DY, Ryu SY, Kim YJ, Kim SK. Clinicopathological References characteristics of gastric carcinoma in young patients. Langenbecks Arch Surg 2003; 388 (4): 245-249.
33. Kuvshinoff BW, Bryer MP. Treatment of resectable and locally advanced pancreatic cancer. Cancer Control 2000;7 (5):428-36.
34. Işık A, Eken H, Demiryılmaz İ, Yılmaz İ, Fırat D, Çimen O, et al. Rektal Lenfoma. Kolon Rektum Hast Derg 2015;25 (3):106-108.
35. Işık A,Fırat D, Soytürk M, Demiryılmaz İ, Yılmaz İ. İdiopatik Periportal Lenfadenopati. GMJ. 2016; 27: 51-52