Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc...

55
Synchronous Colorectal Cancer Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr November, 2015 The University of British Columbia St. Paul’s Hospital

Transcript of Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc...

Page 1: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Synchronous Colorectal Cancer

Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvrNovember, 2015

The University of British Columbia St. Paul’s Hospital

Page 2: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Colorectal Cancer Risk

• Lifetime risk of colorectal cancer is 6.5%

• Rectal cancer 1/3 of this risk

Page 3: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Synchronous Colorectal Cancer (sCRC)

Page 4: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Multiple Primary Malignancies

Warren S and Gates O, American Journal of Cancer, 1932

Proven Adenocarcinoma

Proven to be Distinct

Exclusion of Probable Metastatic Tumour from Primary

Page 5: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

sCRC -

Epidemiology

Author Publication Country Years Population % sCRC

Lasser 1978 USA 1967-76 1002 6.2%

Langevin 1984 USA 1978-83 166 4.8%

Evers 1988 USA 1977-85 320 7%

Passman 1996 USA 1976-93 4878 3.3%

Takeuchi 1997 Japan 1990-93 225 4%

Chen 2000 China 1987-93 1780 3%

Oya 2003 Japan 1984-99 876 4.8%

Wang 2004 China 1974-98 1348 1.1%

Nikoloudis 2004 Greece 1990-2003 283 2.1%

Pinol 2004 Spain 2000-2001 1522 6.2%

Kim 2007 Korea 2001-2006 316 5.4%

Larournerie 2008 France 1976-2004 15562 3.8%

Mulder 2011 Holland 1995-2006 13586 3.9%

Page 6: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

sCRC -

Epidemiology

Cancer registry study in Burgundy, France

1976-2004

586 pts with sCRC

Page 7: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

sCRC -

Epidemiology

sCRC related to age, gender,adenoma

55% (322/586) were in same segment of colon

Letournie, BJS, 2008

Page 8: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

sCRC and Survival

Page 9: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

sCRC -

Survival

Rotterdam CRC database 1995-2006

16 Hosp (2.4million) 13,683 pts with CRC

Page 10: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Synch CRC -

Survival

Mulder, Cancer Epi, 2011

Page 11: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Synch CRC -

Survival

Mulder, Cancer Epi, 2011

Page 12: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Synch CRC -

Survival

Author Publication Years Population % sCRC Survival

Lasser 1978 1967-76 1002 6.2%

Langevin 1984 1978-83 166 4.8%

Evers 1988 1977-85 320 7%

Passman 1996 1976-93 4878 3.3% No diff

Takeuchi 1997 1990-93 225 4%

Chen 2000 1987-93 1780 3% No diff

Oya 2003 1984-99 876 4.8% No diff

Wang 2004 1974-98 1348 1.1%

Nikoloudis 2004 1990-2003 283 2.1% No diff

Pinol 2004 2000-2001 1522 6.2%

Kim 2007 2001-2006 316 5.4%

Larournerie 2008 1976-2004 15562 3.8% No diff

Page 13: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Surgery for sCRC

Page 14: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Total Mesorectal Excision

Standard Rectal Cancer surgical technique

Local recurrence 8%

Historic 20-30%

Page 15: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Surgery for Colon Cancer

Page 16: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Surgery for Colon Cancer

Simlar to TME

CME defines surgical planes and lympadenectomy

Page 17: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Complete Mesocolic Excision

Page 18: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

CME –

Impact of Colon Cancer Outcomes

2008-2011 –

Denmark

Validated Complete Mesocolic Excision (CME) centre compared to conventional surgery

CME (n=364) vs. standard (n=1031)

Presenter
Presentation Notes
Methods Data for all patients who underwent elective resection for Union for International Cancer Control (UICC) stage I–III colon adenocarcinomas in the Capital Region of Denmark between June 1, 2008, and Dec 31, 2011, were retrieved for this population-based study. The CME group consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients were excluded if they had stage IV disease, metachronous colorectal cancer, rectal cancer (≤15 cm from anal verge) in the absence of synchronous colon adenocarcinoma, tumour of the appendix, or R2 resections. Survival data were collected on Nov 13, 2014, from the DCCG database, which is continuously updated by the National Central Offi ce of Civil Registration. Findings The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85ÅE8% (95% CI 81ÅE4–90ÅE1) after CME and 75ÅE9% (72ÅE2–79ÅE7) after non-CME surgery (log-rank p=0ÅE0010). 4-year disease-free survival for patients with UICC stage I disease in the CME group was 100% compared with 89ÅE8% (83ÅE1–96ÅE6) in the non-CME group (log-rank p=0ÅE046). For patients with UICC stage II disease, 4-year disease-free survival was 91ÅE9% (95% CI 87ÅE2–96ÅE6) in the CME group compared with 77ÅE9% (71ÅE6–84ÅE1) in the non-CME group (log-rank p=0ÅE0033), and for patients with UICC stage III disease, it was 73ÅE5% (63ÅE6–83ÅE5) in the CME group compared with 67ÅE5% (61ÅE8–73ÅE2) in the non-CME group (log-rank p=0ÅE13). Multivariable Cox regression showed that CME surgery was a signifi cant, independent predictive factor for higher disease-free survival for all patients (hazard ratio 0ÅE59, 95% CI 0ÅE42–0ÅE83), and also for patients with UICC stage II (0ÅE44, 0ÅE23–0ÅE86) and stage III disease (0ÅE64, 0ÅE42–1ÅE00). After propensity score matching, disease-free survival was signifi cantly higher after CME, irrespective of UICC stage, with 4-year disease-free survival of 85ÅE8% (95% CI 81ÅE4–90ÅE1) after CME and 73ÅE4% (66ÅE2–80ÅE6) after non-CME (log-rank p=0ÅE0014). Interpretation Our data indicate that CME surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I–III colon adenocarcinoma. Implementation of CME surgery might improve outcomes for patients with colon cancer.
Page 19: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

CME –

Disease Free Survival

Stage I

Stage III

All Patients

Stage II

Presenter
Presentation Notes
All stages
Page 20: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

CME –

Disease Free Survival

Bertelsen, Lancet Onc, 2015

Presenter
Presentation Notes
All stages, propensity score matched
Page 21: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Surgery for sCRC

Page 22: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

48 year old man, Hx of Ulcerative Colitis x5 years

Treated with sulfasalazine

IV and/or PO steroids 2x/year for flares

Last surveillance scope 4 years ago –

“pseudopolyps” but no further details available

May 2010 –

referred to different GI

Started on Imuran

1 bm/day, no blood

Occ abdo pain

Case #1

Page 23: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #1

Nov 2010 –

flare of UC

3 bloody diarrheal stools per day

Wt loss 20 lbs x 6 weeks

Progressive lower extremity edema since July

Hb 72, Albumin 14

Admitted to hospital for W/U of hypoalbuminemia and anasarca

Renal causes (negative) and GI causes considered

Page 24: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #1

Biochemical W/U for protein-losing enteropathy negative

Colonoscopy

multiple partially obstructing pseudopolyps

Could not pass transverse colon

Bx –

reactive dysplasia

CT chest -

multiple small PE

Dopplers –

bilateral DVT

Page 25: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #1

CT Abdo Pelvis

Pan colitis

Colon thickened/stranding from ascending to mid- descending

‘can’t exclude mass’

Prominent mesenteric nodes

Numerous polyps

Left colo-colic intussusception

Only mild disease mid-descending to rectum

SB normal

Page 26: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 27: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 28: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 29: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 30: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 31: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 32: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 33: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 34: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 35: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Surgery

Ongoing protein loss thought to be from pseudopolyps

Subtotal colectomy/ileostomy

IVC filter

Page 36: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Pathology

Pancolitis with extensive inflammatory pseudopolyps

2 low grade adenocarcinomas

Right colon

Transverse colon (at intussussception)

At worst T3N0 (55 nodes negative)

Some extranodal mesenteric deposits

Perineural invasion

All margins negative

Page 37: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Next Steps?

Stage II

Average risk or high risk?

UC

Extranodal tumour deposits

Age

Synchronous cancers

“Stage III equivalent”

Page 38: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #1

8 cycles CAPOX –

tolerated well

Transient neutropenia –

G-CSF

Scope of rectosigmoid stump 1 year later

UC

No pseudopolyps

No lesions

No dysplasia

Sept 2012

Completion proctocolectomy and pelvic pouch

No dysplasia or neoplasia on final path

Page 39: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #1

What if cancer found in rectum and transverse colon?

Preop radiation?

Resection and pouch?

Subtotal colectomy, radiation, then completion proctocolectomy and pouch?

Page 40: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #2

52 woman

No risk factors

Healthy

FIT+ve

Colonoscopy

Right colon circ lesion –

biopsy adenoCA

Rectal Polyp –

biopsy adenoma

Page 41: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #2

Page 42: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Synchronous Adenoma

6 pts with synch rectal and colon lesion

TEM/Colon Resection

Presenter
Presentation Notes
Suggest – TEM first – If colon
Page 43: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Case #2

TEM

Villous adenoma –

clear margins

Lap Right Hemicolectomy

Stage II colon CA

Page 44: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Summary

sCRC occurs in 3-6% of patients with CRC

In most patients, both tumours in same anatomic segment

When separated, careful planning tailored to the individual patient critical

Managed properly, sCRC should have no additive impact on survival

Page 45: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

“The people in cancer clinics all over the world need people who believe in miracles.

I am not a dreamer, and I am not saying that this will initiate any kind of definitive answer or cure to cancer.

But I believe in miracles.

I have to.”Terry Fox, October 1979

Page 46: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s
Page 47: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

National Polyp Study

Zauer, NEJM, 2012

Page 48: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Importance of Colon Screening%

Red

uctio

n in

Col

orec

tal C

ance

r Ris

k

Steffen, Med Journal Aust, 2014

Presenter
Presentation Notes
Population study in Aus of over 190,000
Page 49: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Is it just delinquent men?

Page 50: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Prostate Screening

Kadiyala, Int J Qual Health Care, 2011

Page 51: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

SPH CRC Surgical Oncology

Provincial referral centre

Highest volume CR cancer centre in BC

Comprehensive care

Colonoscopy screening

Minimally Invasive Surgery

Cancer follow up

Page 52: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Rectal Cancer Surgery -

BC

Page 53: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Transanal Endoscopic Microsurgery

Page 54: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

TEM –

Endoscopic Follow Up

Preop Image 1 Year Later

Page 55: Synchronous Colorectal Cancer...Synchronous Colorectal Cancer November, 2015 Carl J. Brown, MD MSc FACS FRCSC Twitter @drcarl_vancouvr The University of British Columbia St. Paul’s

Colorectal Cancer -

Treatment


Colorectal cancer review FINAL 112010phi.uhce.ox.ac.uk/pdf/CancerReviews/PROMs_Oxford...Colorectal Cancer Colorectal cancer, also known as colon/rectal/large bowel cancer, includes

Colorectal cancer review FINAL 112010phi.uhce.ox.ac.uk/pdf/CancerReviews/PROMs_Oxford...Colorectal Cancer Colorectal cancer, also known as colon/rectal/large bowel cancer, includes

Cancer Colorectal

Cancer Colorectal

Colorectal Cancer Survivorship - MD Anderson … Cancer... · Colorectal Cancer Survivorship: Evaluation of Inherited Colorectal Cancer Risk ... Jeghers, la poliposis juvenil y la

Colorectal Cancer Survivorship - MD Anderson … Cancer... · Colorectal Cancer Survivorship: Evaluation of Inherited Colorectal Cancer Risk ... Jeghers, la poliposis juvenil y la

Colorectal Cancer Resources

Colorectal Cancer Resources

Case Report Synchronous primary gastric diffuse …...Case Report Synchronous primary gastric diffuse large B cell lymphoma and colorectal cancer: a case report and literature review

Case Report Synchronous primary gastric diffuse …...Case Report Synchronous primary gastric diffuse large B cell lymphoma and colorectal cancer: a case report and literature review

Virtual Colonoscopy Colorectal Cancer Screening Saves Lives · 2014. 10. 13. · Colorectal Cancer Screening Saves Lives. Colorectal cancer is the second leading cancer killer—but

Virtual Colonoscopy Colorectal Cancer Screening Saves Lives · 2014. 10. 13. · Colorectal Cancer Screening Saves Lives. Colorectal cancer is the second leading cancer killer—but

Colorectal Cancer Awareness Infographic and Article · Colorectal cancer is the cause of CANCER DEATH in Nebraska The American Cancer Society estimates 840 new colorectal cancer cases

Colorectal Cancer Awareness Infographic and Article · Colorectal cancer is the cause of CANCER DEATH in Nebraska The American Cancer Society estimates 840 new colorectal cancer cases

Colorectal cancer

Colorectal cancer

Synchronous colorectal liver mets

Synchronous colorectal liver mets

Colorectal Cancer: Basic Fact Sheet Spanish · Colorectal Cancer: Basic Fact Sheet Spanish Author: Center for Disease Control and Prevention Subject: Colorectal Cancer Keywords: Colorectal

Colorectal Cancer: Basic Fact Sheet Spanish · Colorectal Cancer: Basic Fact Sheet Spanish Author: Center for Disease Control and Prevention Subject: Colorectal Cancer Keywords: Colorectal

COLORECTAL CANCER WITH SYNCHRONOUS … CANCER WITH SYNCHRONOUS LIVER METASTASES ... Low anterior resection of rectosigmoid colon with ... Swedish rectal Ca trial surgery vs S+RTx ,

COLORECTAL CANCER WITH SYNCHRONOUS … CANCER WITH SYNCHRONOUS LIVER METASTASES ... Low anterior resection of rectosigmoid colon with ... Swedish rectal Ca trial surgery vs S+RTx ,

Colorectal Cancer Screeningnccrt.org/wp-content/uploads/CRCToolboxSlideSet_2009.pdf · Colorectal Cancer Screening and ... Colorectal Cancer Risk Factors Age ... • Family history

Colorectal Cancer Screeningnccrt.org/wp-content/uploads/CRCToolboxSlideSet_2009.pdf · Colorectal Cancer Screening and ... Colorectal Cancer Risk Factors Age ... • Family history

Colorectal Cancer. Summary: Content of Colorectal Cancer Tutorial Statistics Anatomy of the gastrointestinal tract Colorectal cancer Cancer progression.

Colorectal Cancer. Summary: Content of Colorectal Cancer Tutorial Statistics Anatomy of the gastrointestinal tract Colorectal cancer Cancer progression.

Primary tumor with synchronous metastases · Metastatic colorectal cancer: special clinical situations Primary tumor with synchronous metastases Stefan Heinrich & Hauke Lang Department

Primary tumor with synchronous metastases · Metastatic colorectal cancer: special clinical situations Primary tumor with synchronous metastases Stefan Heinrich & Hauke Lang Department

Colorectal Cancer in Europe - Mercuric · Colorectal Cancer in Europe A Framework for Improving Outcomes for Patients 7 Understanding colorectal cancer Colorectal cancer (CRC) is

Colorectal Cancer in Europe - Mercuric · Colorectal Cancer in Europe A Framework for Improving Outcomes for Patients 7 Understanding colorectal cancer Colorectal cancer (CRC) is

American Cancer Society Colorectal Cancer Survivorship Care Guidelines · guidelines. American Cancer Society Colorectal Cancer Survivorship Care Guidelines

American Cancer Society Colorectal Cancer Survivorship Care Guidelines · guidelines. American Cancer Society Colorectal Cancer Survivorship Care Guidelines

Pattern of Comorbidities among Colorectal Cancer Patients in Spain · 2019-05-15 · Background Colorectal Cancer Colorectal cancer (CRC) was the most frequently diagnosed cancer

Pattern of Comorbidities among Colorectal Cancer Patients in Spain · 2019-05-15 · Background Colorectal Cancer Colorectal cancer (CRC) was the most frequently diagnosed cancer

A GUIDE TO UNDERSTANDING COLORECTAL CANCER …...colorectal cancer; ultimately resulting in the empowerment of colorectal cancer patients and families during their cancer journey.

A GUIDE TO UNDERSTANDING COLORECTAL CANCER …...colorectal cancer; ultimately resulting in the empowerment of colorectal cancer patients and families during their cancer journey.

Colorectal cancer online

Colorectal cancer online

Colorectal or bowel cancer - SearchTheLibrary · Colorectal or bowel cancer. What is colorectal or bowel cancer? Colorectal cancer is a malignant (spreading) tumour that affects the

Colorectal or bowel cancer - SearchTheLibrary · Colorectal or bowel cancer. What is colorectal or bowel cancer? Colorectal cancer is a malignant (spreading) tumour that affects the