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Tumour growth rate of carcinoma of the colon and rectum

The growth pattern of colorectal cancer (CRC) is seldom investigated. Now a cohort study published in BSJ Open explores tumour growth rate in CRCs managed non-surgically or deemed not resectable, and determines its implication for prognosis.

Carried out by John Golligher Colorectal Surgery Unit in Leeds and St James's University Hospital, Leeds Teaching Hospitals NHS Trust, consecutive patients with colonic or rectal adenocarcinoma were identified through the colorectal multidisciplinary team database at Leeds Teaching Hospitals NHS Trust over a two-year interval.

Patients who received no treatment (surgery, stenting, colonic defunctioning procedures, chemotherapy, radiotherapy) and who underwent CT twice, more than five weeks apart, were included. Multidetector CT/three-dimensional image analysis was performed independently by three experienced radiologists.

Of 804 patients reviewed, 43 CRCs were included in the final analysis. Median age at first CT was 80 (73-85) years and the median interval between scans was 150 (interquartile range [IQR] 72-471) days.

An increase in T category was demonstrated in 31 of 43 tumours, with a median doubling time of 211 (112-404) days.

The median percentage increase in tumour volume was 34.1% (13.3-53.9) per 62 days. All-cause three-year mortality was 81%, with a median survival time of 1.1 (0.4-2.2) years after the initial diagnostic scan.

In patients with obstruction, the relative risk of death from subsequent perforation was 1.26 (95% CI 1.07 to 1.49; P=0.005).

The study demonstrates a median doubling time of 211 days, with a concerning suggestion of tumour progression.


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