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Colon cancer survival linked to number of lymph nodes examined
March 21, 2007HOUSTON-An analysis of 17 studies from nine countries has found that the more lymph nodes that are removed and examined during surgical treatment of colon cancer, the better the outcome appears to be for patients. The study suggests that removal of the nodes takes away a reservoir for potentially lethal cancer, and that knowing how far a cancer has spread leads to tailored and more beneficial treatment, according to researchers at The University of Texas M. D. Anderson Cancer Center.
Investigators say the findings, reported in the March 21 issue of the Journal of the National Cancer Institute, encourage a dialogue amongst physicians regarding the number of lymph nodes removed by surgeons and evaluated by pathologists as a measure of the quality of care that colon cancer patients receive.
"Currently just over one-third of colon cancer patients in the United States are getting an adequate lymph node evaluation," says the study's lead author, George Chang, M.D., assistant professor in the Department of Surgical Oncology at M. D. Anderson.
The results of this study were striking and should help support efforts now ongoing by some medical professional societies and expert panels to consider a minimum number of lymph nodes be extracted and examined during the surgery, continues Chang.
For example, the research team reports that one of the 17 studies examined, a national clinical trial enrolling more than 3,200 patients to look at the effects of chemotherapy on colon cancer recurrence after surgical resection, demonstrated a 14 percent increase in five-year survival if more than 20 lymph nodes were examined, compared to less than 11 nodes among patients who have Stage II cancers. The survival advantage was even greater-23 percent-in patients with Stage IIIA and IIIB cancer if more than 40 nodes were evaluated, compared with less than 11 nodes.
All but one of 17 studies of Stage II cancer showed the same association between the number of nodes evaluated and improved outcome, as did four of six studies of more advanced cancer, Chang says.
"This tells us that surgeons and pathologists involved in the care of colon cancer patients should make every effort to improve their collection and evaluation of lymph nodes."
Removing colon tissue during surgery in a way that captures all of the tumor-associated lymph nodes requires attentiveness, Chang acknowledges. A surgeon needs to trace back the origins of blood vessels closest to the tumor because the lymphatic system, with its nodes, closely tracks with the blood system.
Sometimes the nodes, which filter cancer cells from the lymph, can be difficult for pathologists to find, especially when the lymph nodes are small or when the patient is obese. "Everyone is different," he says. "Some people have more nodes, some people have fewer; nodes can be large and easy to identify or small, and the number may differ depending on which part of the colon contains the tumor. The factors that determine the total number of lymph nodes are not all together known."
These findings also should serve as an empowerment tool for patients in need of colon cancer surgery.
"Health care consumers are told all the time to ask surgeons how many operations they have done, but I think in this case they should ask how often they do colon cancer surgery. Surgeons responsible for the majority of these procedures do them infrequently," says Chang.
Studies have found that 70 percent of colon cancer resections are performed by general surgeons who do less than 10 of these surgeries a year, and that colon cancers removed by surgeons who perform colon cancer surgery more frequently are more likely to have more lymph nodes examined.
"We are not suggesting surgeons cut out more colon than necessary, but that they abide to the principals for cancer surgery, and that pathologists follow up in kind," Chang says.
Because all of the studies examined were observational, the researchers stress that they cannot definitively say increasing the number of lymph nodes examined leads to improved survival. Such a statement could only be supported by a randomized, controlled clinical trial-which would not be ethically possible to do.
University of Texas M. D. Anderson Cancer Center
The results of this study were striking and should help support efforts now ongoing by some medical professional societies and expert panels to consider a minimum number of lymph nodes be extracted and examined during the surgery, continues Chang.
For example, the research team reports that one of the 17 studies examined, a national clinical trial enrolling more than 3,200 patients to look at the effects of chemotherapy on colon cancer recurrence after surgical resection, demonstrated a 14 percent increase in five-year survival if more than 20 lymph nodes were examined, compared to less than 11 nodes among patients who have Stage II cancers. The survival advantage was even greater-23 percent-in patients with Stage IIIA and IIIB cancer if more than 40 nodes were evaluated, compared with less than 11 nodes.
All but one of 17 studies of Stage II cancer showed the same association between the number of nodes evaluated and improved outcome, as did four of six studies of more advanced cancer, Chang says.
"This tells us that surgeons and pathologists involved in the care of colon cancer patients should make every effort to improve their collection and evaluation of lymph nodes."
Removing colon tissue during surgery in a way that captures all of the tumor-associated lymph nodes requires attentiveness, Chang acknowledges. A surgeon needs to trace back the origins of blood vessels closest to the tumor because the lymphatic system, with its nodes, closely tracks with the blood system.
Sometimes the nodes, which filter cancer cells from the lymph, can be difficult for pathologists to find, especially when the lymph nodes are small or when the patient is obese. "Everyone is different," he says. "Some people have more nodes, some people have fewer; nodes can be large and easy to identify or small, and the number may differ depending on which part of the colon contains the tumor. The factors that determine the total number of lymph nodes are not all together known."
These findings also should serve as an empowerment tool for patients in need of colon cancer surgery.
"Health care consumers are told all the time to ask surgeons how many operations they have done, but I think in this case they should ask how often they do colon cancer surgery. Surgeons responsible for the majority of these procedures do them infrequently," says Chang.
Studies have found that 70 percent of colon cancer resections are performed by general surgeons who do less than 10 of these surgeries a year, and that colon cancers removed by surgeons who perform colon cancer surgery more frequently are more likely to have more lymph nodes examined.
"We are not suggesting surgeons cut out more colon than necessary, but that they abide to the principals for cancer surgery, and that pathologists follow up in kind," Chang says.
Because all of the studies examined were observational, the researchers stress that they cannot definitively say increasing the number of lymph nodes examined leads to improved survival. Such a statement could only be supported by a randomized, controlled clinical trial-which would not be ethically possible to do.
University of Texas M. D. Anderson Cancer Center
Colon Cancer Current Events and Colon Cancer News RSSOther Illnesses, Body Weight Do Not Explain Racial Disparities in Colon Cancer Survival, UAB Researchers Say
A new study by University of Alabama at Birmingham (UAB) researchers shows that body-mass index (BMI) and co-existing medical conditions (co-morbidity) do not explain the decreased survival observed among African-Americans compared to Caucasians who also have colon cancer.
Paradoxical protein might prevent cancer
One difficulty with fighting cancer cells is that they are similar in many respects to the body's stem cells. By focusing on the differences, researchers at Karolinska Institutet have found a new way of tackling colon cancer. The study is presented in the prestigious journal Cell.
Coffee break: Compound brewing new research in colon, breast cancer
A compound in coffee has been found to be estrogenic in studies by Texas AgriLife Research scientists.
Curry-cure? Spicing up the effectiveness of a potential disease-fighter
Scientists are reporting development of a nano-size capsule that boosts the body's uptake of curcumin, an ingredient in yellow curry now being evaluated in clinical trials for treatment of several diseases.
Colon cancer screening more effective earlier in day, UCLA study finds
The effectiveness of a screening colonoscopy may depend on the time of day it is performed. According to a new UCLA study, early-morning colonoscopies yielded more polyps per patient than later screenings, and fewer polyps were found hour by hour as the day progressed.
Study shows hormone replacement therapy decreases mortality in younger postmenopausal woman
Hormone replacement therapy (HRT) to treat menopausal estrogen deficiency has been in widespread use for over 60 years. Several observational studies over the years showed that HRT use by younger postmenopausal women was associated with a significant reduction in total mortality; available evidence supported the routine use of HRT to increase longevity in postmenopausal women.
Experts issue call to reconsider screening for breast cancer and prostate cancer
Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece published in the "Journal of the American Medical Association."
Metals could forge new cancer drug
Drugs made using unusual metals could form an effective treatment against colon and ovarian cancer, including cancerous cells that have developed immunity to other drugs, according to research at the University of Warwick and the University of Leeds.
New data: Hospital imaging centers poised to pull back, hitting patients hardest in rural areas
Survivors and patients with cancers and heart disease, along with patient advocate organizations and physicians, today urged policymakers to enhance early diagnosis of deadly diseases by preserving access to advanced imaging, such as MRI and CT scans, in final health care reform legislation.
Whole-brain radiotherapy after surgery or radiosurgery not recommended for brain metastases
Whole-brain radiotherapy should not be given routinely to all patients whose cancer has spread to the brain, say researchers who found that using it after surgery or radiosurgery in patients with a limited number of brain metastases and stable cancer in the rest of the body did not extend lives or help patients remain functionally independent for longer.
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