Cancer program annual report 2010 - Evangelical Community Hospital

eing said, mitigating circumstances could be present
insofar as reasons against radiation oncology referral are
concerned in this particular case.
Summary and Conclusion
In essence, 41 cases of colorectal carcinoma were
treated at Evangelical in 2009. The patient distributions
of age and sex were, essentially, in accordance with
national guidelines. It appears as though there was an
exceptionally high number of early-grade carcinomas of
the colon treated at Evangelical. This is likely indicative
of enhanced screening protocols put in place by the
primary care physicians.
The utilization of adjuvant chemotherapy in patients
with Stage III adenocarcinoma was found to be in
100 percent compliance. The utility of radiation in the
context of rectal cancer was sorely understated in the
given study; one could argue the validity of such results
given a patient population of one.
The primary point of contention in the current study is
that of lymph node harvest. Disregarding the Stage 0
carcinomas, the percentage of cases in which 12 or more
lymph nodes were harvested is woefully inadequate.
Analysis of the surgeon and pathologist data failed
to reveal any clear-cut correlation to the analysis in
question. Ultimately, the data presented indicate
that an increase in aggressive surgical intervention is
indicated as it pertains to colorectal surgery. One could
argue that an anticipated increase in vascular injury
might be anticipated as one pursues more aggressive
resections in the context of colorectal cancer, but this
remains to be seen. A counter-argument would be
that of incorporating genomic assays into the staging
of colorectal cancers, which could serve to enhance
staging criteria and potentially lead to a situation in
which aggressive surgical resection is unnecessary.
Commission on Cancer CP3R
Quality Measure for Colorectal Cancers
• At least 12 regional lymph nodes are removed and
pathologically examined for resected colon cancer.
• Adjuvant chemotherapy is considered or administered
within four months (120 days) of diagnosis for
patients under the age of 80 with American Joint
Committee on Cancer (AJCC) Stage III (lymph node
positive) colon cancer.
• Radiation therapy is considered or administered
within six months (180 days) of diagnosis for patients
under the age of 80 with clinical or pathologic AJCC
T4N0M0 or Stage III and who are receiving surgical
resection for rectal cancer.
Evangelical resected colon cases 2009
• Total number of surgical colon cases: 37 (9 cases Stage 0)
• Twelve cases: >12 lymph nodes removed
Evangelical Stage III colon cases 2009— patients under the age of 80—
considered or administered chemotherapy within four months (120 days)
• Total number of Stage III colon cases-patient under the age
of 80: 8 of 8 (100 percent)
• All eight cases met this criterion
Radiation therapy is considered or administered to patients under the age of 80 with clinical or
pathologic AJCC T4N0M0 or Stage III rectal cancer.
Evangelical had one rectal case in 2009 where the patient was under 80, pathologic Stage IIIB, surgically
resected and received chemotherapy per Cancer Care; there is no documentation that the patient was
seen or considered for radiation.
Prepared by Cynthia Miller, CTR
Source: Evangelical Community Hospital Tumor Registry
2009 colorectal cancer cases
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