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Aim Extramural vascular invasion ( EMVI) has been proposed as an adverse prognostic indicator in colorectal cancer, although its use remains both variable and controversial. This study aimed to determine the survival effect of EMVI in T4 rectal cancer. Method Patients undergoing surgery with curative intent for primary T4 rectal cancer between 1971 and 2011 were included from two prospectively collected rectal cancer databases. The main end-point was 3-year survival. Results From 1142 patients undergoing resection of rectal cancer during the study period, 126 (11.0%) had T4 rectal cancer and were included in the study group. Sphincter preservation was performed in 61 (48%) and a pathologically negative resection margin (R0) was achieved in 104 patients (82.5%). EMVI was present in 51 patients (40.5%) and was an independent predictor of positive lymph node status (adjusted odds ratio 2.66, P = 0.013). Considering all patients, EMVI was associated with reduced overall survival ( P = 0.007) and disease-free survival ( P = 0.002), but not local recurrence-free survival ( P = 0.198). In only those undergoing R0 resection, EMVI predicted reduced disease-free survival with positive nodal status ( P = 0.021); it did not predict survival with negative nodal status. Conclusion Overall, EMVI was a strong prognostic marker of survival. However, after complete surgical resection in patients with node-negative disease, EMVI did not predict local recurrence. [ABSTRACT FROM AUTHOR]

The goal of targeted therapy has driven a search for markers of prognosis and response to adjuvant therapy. The surgical resection of a solid tumour induces tissue ischaemia and acidosis, both potent mediators of gene expression. This study investigated the impact of colorectal cancer (CRC) surgery on prognostic and predictive marker levels. Tumour expression of thymidylate synthase, thymidine phosphorylase, cyclin A, vascular endothelial growth factor (VEGF), carbonic anhydrase-9, hypoxia inducible factor-1α, and glucose transporter-1 (GLUT-1) proteins was determined before and after rectal cancer surgery. Spectral imaging of tissue sections stained by immunohistochemistry provided quantitative data. Surgery altered thymidylate synthase protein expression (P=0.02), and this correlated with the change in the proliferation marker cyclin A. The expression of hypoxia inducible factor-1α, VEGF, and GLUT-1 proteins was also different following surgery. Colorectal cancer surgery significantly impacts on intratumoral gene expression, suggesting archival specimens may not accurately reflect in situ marker levels. Although rectal cancer was the studied model, the results may be applicable to any solid tumour undergoing extirpation in which molecular markers have been proposed to guide patient therapy.British Journal of Cancer (2006) 95, 928–933. doi:10.1038/sj.bjc.6603362 www.bjcancer.com [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined whether a pathological complete response in the primary tumor following pre-operative chemoradiation (CRT) for T3-T4 rectal cancer can predict a response within the perirectal lymph nodes, a low risk of local recurrence and the appropriateness of local excision. The characteristics, treatment details and outcome of patients undergoing preoperative CRT for rectal carcinomas considered unresectable between November 1993 and August 2003 were recorded. Patients were reassessed after completing CRT. Planned surgical resection was carried out after treatment. 68 patients did not proceed to surgery due to preoperative death, inoperable disease and patient refusal or concurrent medical problems.

Two case studies of patients with tumours arising from neorectal mucosa following colonic pull-through surgery, are presented. A case of 44-year old male presented with intractable pelvic pain is discussed. Reportedly, he had undergone multiple operations for imperforate anus. A case of 53-year old male born with an imperforate anus associated with a rectourethral fistula is also discussed. Biopsies showed adenocarcinoma with pools of mucus. Origin of both the tumours is discussed.

The article focuses on the treatment of anal cancer. Earlier, the disease was treated mainly by surgeons, and patients had to undergo rectal excision. However, in 1974, surgeon Norman Nigro proposed that anal cancer could be treated by radiotherapy and chemotherapy, and patients needed to be referred to an oncologist, instead of a surgeon. Radiotherapy and chemotherapy were found to be very successful for the treatment of the disease.

The article focuses on the clinical practice guidelines of the European Society for Medical Oncology (ESMO) for the diagnosis, treatment, and follow-up treatment of patients with an epidermoid anal cancer. It mentions that the diagnosis of epidermoid anal cancer includes documentation of predisposing factors and history of symptoms, and protoscopy. It states various recommendations for the treatment of anal cancer which include local excision, radiobiologically, and modality chemoradiation.