Colorectal cancer diagnosis

Approximately 8% to 20% of patients with UC and 7% to 26% of patients with CD are elderly at initial diagnosis.42 In general, IBD presents similarly in elderly patients compared to younger individuals. Elderly patients may have more comor-bid diseases, some of which may make the diagnosis of IBD more difficult. Such conditions include ischemic colitis, diverticular disease, and microscopic colitis. Increased age is also associated with a higher incidence of adenomatous polyps, but the onset of IBD at an advanced age does not appear to increase the risk of developing colorectal cancer. Elderly patients may also use more medications, particularly NSAIDs, which may induce or exacerbate colitis. 

Stage of colorectal cancer should be determined at diagnosis to predict prognosis and to develop treatment options. Stage is based on the size of the primary tumor (T ), presence and extent of lymph node involvement (N0-2) and presence or absence of distant metastases (M). 

Imaging modalities play an even more important role in the setting of suspected recurrence of colorectal cancer. Around 30% of the patients with recurrence within 2 years of initial diagnosis appear to have limited recurrent disease, but only 25% of them are actually curable by surgery [9]. At surgery, up to 75% of the patients reveal to have non-resectable disease due to distant metastases or widespread disease [10,11]. In order to decrease the number of futile surgeries, it is essential to improve the accuracy of preoperative detection of recurrent disease. 

The stage of colorectal cancer upon diagnosis—determined by depth of bowel invasion, lymph node involvement, and presence of metastases—is the most important prognostic factor for disease recurrence and survival. 

Complete surgical resection of discrete hepatic, pulmonary, abdominal, or brain metastases in patients with colorectal cancer, if possible, may offer selected patients an opportunity to experience extended DPS. Patients who have from one to three small nodules isolated to the liver, lungs, or abdomen have the most favorable outcome. Up to 25% of patients will present with hepatic metastases at time of diagnosis, and 60% of patients with colorectal cancer wfll develop hepatic metastases sometime during the course of their disease. 

Vasen HFA. Clinical diagnosis and management of hereditary colorectal cancer syndromes. J Clin Oncol 2000 18(Nov 1 suppl) 81s-92s. 

Jover R, Paya A, Alenda C, et al. Defective mismatch-repair colorectal cancer clinicopathologic characteristics and usefulness of immunohistochemical analysis for diagnosis. Am J Clin Pathol. 2004 122 389-394. 

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