Colorectal Cancer Emergencies

Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
Journal of Gastrointestinal Cancer (Impact Factor: 0.38). 02/2013; 44(2). DOI: 10.1007/s12029-012-9468-0
Source: PubMed


Colorectal cancer (CRC) is a common type of malignancy encountered in the United States. A significant proportion of patients with CRC will seek emergency medical care during the course of their illness and treatment.

Emergent presentations can be the result of either local tumor invasion, regional progression, or therapeutic techniques. Specific complications of CRC which present emergently include rectal bleeding, abdominal pain, and bowel obstruction. Less common issues encountered include malignant ascites, neutropenic enterocolitis, and radiation enteropathy.

The care of CRC patients in the setting of an acute severe illness typically requires the joint efforts of the emergency medical team in consultation with surgical, medical, and radiation oncology. A high degree of suspicion for the typical and atypical complications of CRC is important for all clinicians who are responsible for the care of these patients.

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    • "Emergency surgery may be required to control severe bleeding with persistent hemodynamic instability despite attempts of resuscitation, failure of other therapy, and recurrent bleeding [4] [24] [103] [104]. However, surgery is often difficult after a long trial of conservative treatment due to clinical deterioration after great blood loss or coagulopathies. "
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    ABSTRACT: An oncologic emergency is defined as an acute, potentially life threatening condition in a cancer patient that has developed as a result of the malignant disease or its treatment. Many oncologic emergencies are signs of advanced, end-stage malignant disease. Oncologic emergencies can be divided into medical or surgical. The literature was reviewed to construct a summary of potential surgical emergencies in oncology that any surgeon can be confronted with in daily practice, and to offer insight into the current approach for these wide ranged emergencies. Cancer patients can experience symptoms of obstruction of different structures and various causes. Obstruction of the gastrointestinal tract is the most frequent condition seen in surgical practice. Further surgical emergencies include infections due to immune deficiency, perforation of the gastrointestinal tract, bleeding events, and pathological fractures. For the institution of appropriate treatment of any emergency it is important to determine the underlying cause, since emergencies can be either benign or malignant of origin. Some emergencies are well managed with conservative or non-invasive treatment, whereas others require emergency surgery. The patient’s performance status, cancer stage and prognosis, type and severity of the emergency, and the patient’s wishes regarding invasiveness of treatment are essential during the decision making process for optimal management.
    Cancer Treatment Reviews 09/2014; 40(8). DOI:10.1016/j.ctrv.2014.05.005 · 7.59 Impact Factor
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    ABSTRACT: Background Small studies have examined the effect of faecal occult blood test (FOBT) screening on the proportion of hospital admissions for colorectal cancer (CRC) classed as an emergency. This study aimed to examine this and short-term outcomes in persons invited for screening compared with a control group not invited.Methods The invited group comprised all individuals invited between 1 April 2000 and 31 July 2007 in the Scottish arm of the UK demonstration pilot of FOBT, and subsequently diagnosed with CRC aged 50–72 years between 1 May 2000 and 31 July 2009. The controls comprised all remaining individuals in Scotland not invited for FOBT but diagnosed with CRC aged 50–72 years in the same period.ResultsThere were 2981 people diagnosed with CRC in the group invited for screening (58·3 per cent participated) and 9842 in the control group. Multivariable regression adjusted for sex, age, deprivation, co-morbidities, tumour site and Dukes' stage showed no difference between the groups for emergency admissions (odds ratio (OR) 0·89, 95 per cent confidence interval (c.i.) 0·77 to 1·02; P = 0·084) or length of hospital stay (LOS) (β coefficient −1·02 (95 per cent c.i. –1·05 to 1·01) days; P = 0·226). Comparing participants with controls, there were fewer emergency admissions (OR 0·59, 0·49 to 0·71; P < 0·001) and shorter LOS (β coefficient −1·06 (−1·10 to −1·02) days; P = 0·001). Short-term mortality was lower in the screened than the non-screened population (1·1 versus 2·8 per cent; P = 0·001).Conclusion People who participated in FOBT screening had fewer emergency admissions and a shorter LOS. Deprivation was associated negatively with participation, but the impact of FOBT participation on emergency admissions was independent of deprivation level. The reduction in LOS has potential to reduce financial costs.
    British Journal of Surgery 09/2014; 101(12). DOI:10.1002/bjs.9613 · 5.54 Impact Factor
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    ABSTRACT: Purpose: Cancer patients can experience problems related to their disease or treatment. This study evaluated reasons for presentation at the emergency room (ER) and outcome of surgical oncology patients. Methods: A retrospective chart review for all surgical oncology patients who presented at the ER of the UMCG for surgical consultation between October 1, 2012, and March 31, 2013. Results: A total of 200 cancer patients visited the ER for surgical consultation: 53.5 % with complications of (previous) cancer treatment, 25.5 % with symptoms caused by malignant disease, and 21.0 % with symptoms not related to cancer or cancer treatment. The 30-day mortality rate for patients with progressive disease was 25.5 %, and overall mortality rate was 62.8 %. The most frequent reason for ER presentation was intestinal obstruction (26.5 %), of which 41.5 % was malignant. Most cancer patients (59.5 %) did not undergo surgery during follow-up. The 30-day mortality for these patients was 14.3 % and overall mortality was 37.8 %. Most patients who died within the first 30 days after ER presentation had not undergone any surgery after presentation (89.5 %). Conclusions: There is great variation in mortality rates for cancer patients presenting at the ER for surgical consultation. The mortality in this study was greatest for patients with progressive disease (30-day mortality 25.5 % and overall mortality 62.8 %), and the majority of patients who died within 30 days (89.5 %) had not undergone surgery after ER presentation. Surgery should only be performed in the acute setting when essential and when the expected outcome is favorable for the patient.
    Annals of Surgical Oncology 10/2014; 22(5). DOI:10.1245/s10434-014-4180-x · 3.93 Impact Factor