番茄社区

SAN FRANCISCO -- Curative therapy is still a possibility, even if a colon cancer patient is seen for the first time in the emergency department with acute symptoms such as abdominal pain, bleeding, and obstruction, researchers said here.

Emergency presentation as the first indication of colorectal cancer is generally thought to be associated with advanced disease and poor outcome, according to Andy Barnett, MD, from Oregon Health and Science University in Portland, and colleagues.

Yet, in a retrospective analysis of 376 colon cancer patients identified in a three-year period, 33 presented to the emergency department with acute symptoms and only 15.5% of those were given only palliative treatment, the group reported at the Multidisciplinary Gastrointestinal Cancers Symposium.

In comparison, of the 339 patients who initially presented in other departments, 20.5% received palliation.

"In our experience, better than 80% of these patients proved eligible for curative intent surgery, radiation therapy, and chemotherapy," Barnett said.

The goal of this study was to describe the characteristics of patients presenting to the emergency department at their index diagnosis, and to determine whether emergency presentation precludes treatment with curative intent.

The authors pulled data from their institution's registry to identify colorectal cancer patients diagnosed from 2008 to 2010. Emergency medical records were reviewed to identify which patients presented to the emergency department with acute symptoms of colorectal cancer as the initial sign of their illness.

Of the 376 patients, 57% were male and 43% were female, with mean age of 60.6.

The authors found that acute emergency department presentation with colorectal cancer symptoms did not preclude treatment with curative intent (P=0.47).

Compared with presentation in other departments, patients who presented emergently were more likely to be female (64% versus male 41%, P=0.01) and older (65 versus 60, P=0.02). There was no statistically significant relationship between age, gender, tumor location or type, and treatment approach.

Individuals who first present with symptoms in the emergency department should not be considered as having untreated, incurable disease, Barnett said. "The assumption is that patients who present with symptoms must be further along in their disease course, and therefore are more likely to just get palliative therapy and die. For some reasons which are unclear right now, presenting emergently doesn't have much relation to the extent of their disease."

The take-home message from this study is that the vast majority of people who present with symptoms of colon cancer are still curable, said Neal Meropol, MD, from at the Case Comprehensive Cancer Center, Case Western Reserve University in Cleveland.

However, he noted that the study did not describe the type of colorectal cancer patients who presented to the emergency room: Financially sound individuals with health insurance are more likely to seek care compared with individuals who do not have health insurance or do not regularly see doctors until they experience acute symptoms, he said.