Colorectal cancer - clinical and morphological aspects

Colorectal cancer (CRC) is one of the most common and most serious malignancies worldwide. Its incidence has increased by more than 200 000 in 2008, both in men and in women. Although CRC is a well-studied malignancy which has a slow progression, known risk factors and pre-neoplastic lesions that can be detected and treated, its incidence is on the rise. In our study, we clinically, histologically and immunohistochemically evaluated a group of 317 patients with colorectal cancer who underwent surgery.

The trial included 317 colorectal cancer patients hospitalized in the second Department of General Surgery within the Emergency County Hospital of Craiova, Romania, between January 2005 and December 2009, aged between 18 and 89 years. After undergoing clinical and laboratory work-up, all patients were submitted to surgery with curative intent. Resection specimens were collected and histological slides were produced from the biological material. Usual histological staining, Hematoxylin-Eosin and trichromic Goldner-Szekely, as well as immunohistochemistry with anti-Ki67, anti-caspase 3, anti-p53 and anti E-cadherin antibodies was also performed.

Regarding gender distribution of cases in the study group was a slightly higher incidence in the number of women affected by neoplasia (n=166, 52.35%) than males (n=151, 47.65%). Analysis of incidence per decade of age showed highest figures between 61-70 years, but we also observed comparable values for the decade 51-60 years. Analysis of topography showed higher incidence of cancer of the rectum (119 cases, representing 37.53%) compared to individual segments of the colon. Average size determined for all locations was 5.05 cm, with a median located at 4.82 and a standard deviation of 1.99. Regarding the degree of cell differentiation, out of the total of 245 adenocarcinomas, a number of 87 (35.52%) were well-differentiated adenocarcinomas, 127 (51.83%) were moderately differentiated, and 31 (12.65%) cases were poorly differentiated adenocarcinomas. Index of cell proliferation, Ki67, had a moderate and intense reaction to all the cases studied. Very few tumor cells were immunohistochemically positive for caspase 3, regardless of the degree of tumor differentiation. E-cadherin was intense in well-differentiated adenocarcinomas. In our study, of 42 colon adenocarcinomas, 29 (69%) were highly positive to anti-p53 antibody, the remaining being negative.

Colorectal cancer was diagnosed especially in people over 50 years. Analysis of topography showed higher incidence of cancer of the rectum compared to segments of the colon. More than half were presented in stages III and IV. The histopathological study showed that about 98% of colorectal neoplasms were adenocarcinomas, frequently with moderate differentiation.