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Right-Sided and Left-Sided Colon Cancers are Two Distinct Disease Entities: an Analysis of 200 Cases in Pakistan

  • Hussain, Mudassar (Department of Pathology, Shaukat Khanum Memorial Cancer Hospital) ;
  • Waqas, Omer (Department of Pathology, Shaukat Khanum Memorial Cancer Hospital) ;
  • Hassan, Usman (Department of Pathology, Shaukat Khanum Memorial Cancer Hospital) ;
  • Loya, Asif (Department of Pathology, Shaukat Khanum Memorial Cancer Hospital) ;
  • Akhtar, Noreen (Department of Pathology, Shaukat Khanum Memorial Cancer Hospital) ;
  • Mushtaq, Sajid (Department of Pathology, Shaukat Khanum Memorial Cancer Hospital) ;
  • Yusuf, Muhammad Aasim (Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital) ;
  • Syed, Aamir Ali (Department of Surgery, Shaukat Khanum Memorial Cancer Hospital)
  • Published : 2016.05.01

Abstract

Background: There is growing evidence that there are differences in histological and genetic characteristics along with clinical behavior between right- and left-sided colon carcinomas. We have compared various parameters of the two types and assessed associations of the results with prognosis in patients in Pakistan. Materials and Methods: We reviewed 200 cases from our institutional database; 100 cases of right-sided and 100 cases of left-sided colon cancer. Parameters including age, gender, TNM stage, histological features and clinical outcome were analyzed. Results: The patients with right-sided colon cancer were significantly older as compared to their counterparts with left-sided cancer. They presented with a lumbar mass rather than symptoms of obstruction and perforation as seen in left-sided colon cancers, and the histology showed higher percentage of poorly differentiated tumors with advanced pT stage. Moreover, Crohn's-like reactions, intra tumoral lymphocyte responses and other poor prognostic factors like lymph vascular invasion and perineural invasion were more common in right-sided cancers. Conclusions: We found that right- and left-sided colon cancers are different from each other in terms of clinical presentation, histology and clinical behavior. Right-sided colon cancers are more aggressive and are associated with poorer clinical outcome as compared to left sided colon cancers in our population.

Keywords

References

  1. Jemal A, Bray F, Center M, Ferlay J, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  2. Kawamoto H, Kato J, Nawa T, et al (2008). Differences between right and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol, 23, 418-23. https://doi.org/10.1111/j.1440-1746.2007.04923.x
  3. Kennedy G, Weiss JM, LoConte N, et al (2011). Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results-medicare data. JCO, 29, 4401-9. https://doi.org/10.1200/JCO.2011.36.4414
  4. Smith DR, Goh HS, Elnatan J (1996), Activation and the biological behavior of proximal and distal colonic adenocarcinomas. Eur J Cancer, 32, 491-7. https://doi.org/10.1016/0959-8049(95)00567-6
  5. Behling CA, Saltzstein SL (2007). Age and time as factors in the left-to right shift of the sub site of colorectal adenocarcinoma: a study of 213,383 cases from the california cancer registry. j clin gastroenterol, 41, 173-7. https://doi.org/10.1097/01.mcg.0000225550.26751.6a
  6. Karapanagiotou I, Oikonomakis I, Papagiorgis P, et al (2006). The impact of tumor location on the histopathologic expression of colorectal cancer. J BUON, 11, 317-21.
  7. Hansen IO, Gamborg M, Jess P, Jess T (2013). A nationwide Danish cohort study challenging the categorization into right-sided and left-sided colon cancer. BMJ, 3, 2608
  8. Benedix F, Meyer F, Lippert H, Gastinger I, Kube R, Schmidt U, (2010). Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology and survival, Dis Colon Rectum, 53, 57-64. https://doi.org/10.1007/DCR.0b013e3181c703a4
  9. Wolfgang CL, Chang DC, Slidell MB, Ahuja N, Meguid RA (2008). Is there a difference in survival between right-versus left-sided colon cancers? Ann Surg Oncol, 15, 2388-94. https://doi.org/10.1245/s10434-008-0015-y
  10. Kawamoto H, Kohno H Kato J, Nawa T, et al (2008). Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol, 23, 418-23. https://doi.org/10.1111/j.1440-1746.2007.04923.x
  11. Jiang J, Lin J, Chen W, Yang S, Lin T, Lan Y, et al (2006). Obstructive left-sided colorectal cancer: a comparison between primary resection and delayed resection. J Soc Colon Rectal Surgeon, 51, 306-11
  12. Chu KW, Poon RT, Law WL, Lee YM (2001). Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg, 192, 719-25. https://doi.org/10.1016/S1072-7515(01)00833-X
  13. Abir F, Cuffy M, Audisio RA, Longo WE (2004). Colorectal cancer presenting as surgical emergencies. Surg Oncol, 13, 149-57. https://doi.org/10.1016/j.suronc.2004.08.002
  14. Othman A, Brauner E, Ben-Ishay O, Kluger Y, Peled Z (2013). Clinical presentation predicts the outcome of patients with colon cancer. World J Gastrointest Surg, 5, 104-9. https://doi.org/10.4240/wjgs.v5.i4.104
  15. Gul A, Gul Sharif G, Alam SI (2012). Clinical presentations of colorectal carcinoma in patients below 40 years of age presenting to a tertiary care level hospital. J Med Sci, 20, 67-7
  16. Fuchs CS, Nosho K, Ogino S (2009). Lymphocytic reaction to colorectal cancer is associated with longer survival, independent of lymph node count, Msi and CpG island methylator phenotype. Clin Cancer Res, 15, 6412-20. https://doi.org/10.1158/1078-0432.CCR-09-1438
  17. Buckowitz A, Benner A, Blaker H, et al (2005). Microsatellite instability in colorectal cancer is associated with local lymphocyte infiltration and low frequency of distant metastases. British J Cancer, 92, 1746-53. https://doi.org/10.1038/sj.bjc.6602534
  18. Sugai T, Habano W, Jiao Y, et al (2006). Analysis of molecular alterations in left- and right-sided colorectal carcinomas reveals distinct pathways of carcinogenesis. J Molecular Diagnostics, 8, 193-201 https://doi.org/10.2353/jmoldx.2006.050052
  19. Blair GE, Cross D, Lewis FA, Bell SM, et al (1993). Prognostic value of p53 overexpression and K-Ras gene mutations in colorectal cancer. Gastroenterol, 104, 57-64. https://doi.org/10.1016/0016-5085(93)90835-Z
  20. Nakamura S (2005). Analysis of allelic imbalances at multiple cancer related chromosomal loci and microsatellite instability within the same tumor using a single tumor gland from colorectal carcinomas. Int J Cancer, 114, 337-45. https://doi.org/10.1002/ijc.20689
  21. Leggett BA, Young J, Walsh MD, Jass JR, Whitehall VL (2001). Methylation of O-6-methylguanine DNA methyltransferase characterizes a subsetof colorectal cancer with low- low-level DNA microsatellite instability. Cancer Res, 61, 827-30.
  22. Karrenbeld A, Hayes VM, Bleeker WA, et al (2000). Impact of KRAS and TP53 mutations on survival in patients with left and right-sided Dukes' C colon cancer. Am J Gastroenterol, 95, 2953-7. https://doi.org/10.1111/j.1572-0241.2000.02327.x
  23. Powell B, Elsaleh H, Soong R, et al (2000). Prognostic significance of TP53 gene mutation in 995 cases of colorectal carcinoma. Influence of tumor site, stage, adjuvant chemotherapy and type of mutation. Eur J Cancer, 36, 2053-60. https://doi.org/10.1016/S0959-8049(00)00285-9
  24. Issa JP, Ohe-Toyota M, Toyota M, Ahuja N, (2000). Distinct genetic profiles in colorectal tumors with or without the CpG island methylator phenotype. Proc Natl Acad Sci, 97, 710-15. https://doi.org/10.1073/pnas.97.2.710
  25. Terdiman JP (2005). Is time to get serious about diagnosing Lynch syndrome (HNPCC with defective DNA mismatch repair) in the general population? Gastroenterol, 129, 741-74. https://doi.org/10.1016/j.gastro.2005.06.033
  26. Umar A, Chapelle A, Boland CR, Terdiman JP, Syngal S, et al (2004). Revised Bethesda guidelines for Lynch Syndrome and MSI. JNCI, 96, 261-68. https://doi.org/10.1093/jnci/djh034
  27. Leggett BA, Jass JR, Young J, Simms LA, Walsh MD, (2002). Distinction between familial and sporadic forms of colorectal cancer showing DNA microsatellite instability. Eur J Cancer, 38, 858-66. https://doi.org/10.1016/S0959-8049(02)00041-2
  28. Glavac D, Ravnik-Glavac M, Golouh R, Potocnik U (2001). Causes of microsatellite instability in colorectal tumors: implications for hereditary non-polyposis colorectal cancer screening. Cancer Genet Cytogenet, 126, 85-96. https://doi.org/10.1016/S0165-4608(00)00399-X
  29. Vasen HF, Peltomaki P (1997). Mutations predisposing to hereditary nonpolyposis colorectal cancer: database and results of a collaborative study. Gastroenterol, 113, 1146-58. https://doi.org/10.1053/gast.1997.v113.pm9322509
  30. Miller GA, Terdiman JP, Gum JR Jr, Conrad PG, Crawley SC, Weinberg V, et al (2001). Efficient detection of hereditary non-polyposis colorectal cancer gene carriers by screening for tumor microsatellite instability before germline genetic testing. Gastroenterol, 120, 21-30. https://doi.org/10.1053/gast.2001.20874
  31. Eng C, Fox EA, Garber JE, Kolodner RD, Syngal S (2000). Sensitivity and specificity of clinical criteria for hereditary non-polyposis colorectal cancer associated mutations in MSH2 and MLH1. J Med Genet, 37, 641-5. https://doi.org/10.1136/jmg.37.9.641
  32. Percesepe A, Di Gregorio C, Borghi F, Losi L, Foroni M, Menigatti M, et al (2001). Molecular screening for hereditary non-polyposis colorectal cancer: a prospective, population-based study. J Clin Oncol, 19, 3944-50. https://doi.org/10.1200/JCO.2001.19.19.3944
  33. Benson AB, McGee MF (2014). Adjuvant chemotherapy for stage II colon cancer: everyone still needs a tailor. Ann Surg Oncol, 21, 1765-67 https://doi.org/10.1245/s10434-014-3635-4
  34. Sargent DJ, Monges G, Marsoni S, et al (2010). Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil based adjuvant therapy in colon cancer. J Clin Oncol, 28, 3219-26. https://doi.org/10.1200/JCO.2009.27.1825
  35. Hansen IO, Jess P (2012). Possible better long-term survival in left versus right-sided colon cancer - a systematic review. Dan Med J, 59, 4444
  36. Santi I, Hemminki K, Weires M, et al (2010). Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes. BMC Cancer, 10, 688. https://doi.org/10.1186/1471-2407-10-688

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