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Colon Cancer Study
09/10/08 - 12:40 PM
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Tuquyen Mach - bio

Panama City, Fla:

Colon cancer is the second leading cause of cancer death in the United States.

Researchers say colon cancer patients should be asking additional questions when they choose a surgeon.

A study by Northwestern University shows the majority of hospitals are not following national guidelines after colon cancer is removed.

An estimated 149,000 cases of colon cancer will be diagnosed in the U.S. this year.  According to the Colon Cancer Foundation, surgery to remove colon cancer is the most common treatment.

The new research shows almost two thirds of hospitals are not following procedures to check lymph nodes.

“The lymph nodes help them determine if the cancer has spread, how far the cancer has spread, and what type of treatment that the patients need,” says Becky Palmer, Gulf Coast Medical Center’s Cancer Program Coordinator.

National guidelines state when colon cancer is removed, doctors should check at least 12 lymph nodes to see if the cancer is spreading.

Only 38 percent of hospitals studied by Northwestern University researchers were following the guidelines.

“I was disappointed in the study, because what we found at Gulf Coast for the past 4 years is we’ve used the CAP protocol, and that’s the College of American Pathology, and we’ve been 100 percent compliant,” says Palmer.

Palmer says Gulf Coast started following the guidelines even before they became mandatory.

Researchers recommend patients ask about the lymph node check when choosing a cancer surgeon and say patients should check their post-surgery pathology report to make sure the guidelines were followed.

The American Cancer Society says adults should have first colon cancer screening at age 50.

The following was released by Northwestern University.

U.S. Hospitals ‘Flunk’ Colon Cancer
Majority of Hospitals Don’t Check Enough Colon Lymph Nodes

Patients May Not Get Life-Saving Chemotherapy
Critical for Patient to Check Own Pathology Report

CHICAGO—School has barely begun, but many U.S. hospitals have already received their report card in colon cancer. They flunked.

A new study from Northwestern University’s Feinberg School of Medicine and the American College of Surgeons finds the majority of hospitals don’t check enough lymph nodes after a patient’s colon cancer surgery to determine if the disease has spread.

Checking more lymph nodes is linked to improved survival of colon cancer because it allows doctors to accurately diagnose the stage of disease and prescribe the most effective treatment. 

Over the past decade, a number of oncology organizations have recommended a minimum of 12 lymph nodes be examined to determine whether colon cancer has metastasized and to accurately diagnose the stage of cancer. That critical information affects whether a patient receives chemotherapy, which is highly effective in improving survival after colon cancer has spread.

Yet, more than 60 percent of nearly 1,300 institutions in the U.S. failed to comply with the recommendation to examine 12 nodes, the Northwestern study found. The study will be published in the Sept. 9 online issue of the Journal of the National Cancer Institute.

“It’s disappointing that despite so much emphasis on this particular issue, so many hospitals still aren’t checking enough lymph nodes to ensure they diagnose the accurate stage of cancer,” said Karl Bilimoria, M.D., lead author and a surgery resident at the Feinberg School.  “Knowing the accurate stage of your disease affects your survival and treatment. That’s critical.”

Colon cancer is the second leading cause of cancer death in the United States.

“Every surgeon has a story about a colon cancer patient where the pathology report showed only a few lymph nodes and no cancer was found,” said Bilimoria, who also is a research fellow at the American College of Surgeons. “Then the surgeon asks the pathologist to check six or eight more nodes, and one of those turns out to be positive for cancer.  That completely changes the treatment plan.”

In the study, Bilimoria found National Cancer Institute-designated Comprehensive Cancer centers had higher compliance with the 12- node measure than other academic hospitals, Veterans Administration hospitals and community hospitals (78 percent versus 52.4 percent, 53 percent, 33.7 percent respectively in 2004-2005.)

Hospitals have improved over the past decade, but not enough. In 1996-1997, 15 percent of hospitals were checking at least 12 nodes compared to 38 percent in 2004-2005. The hospitals that did not comply treat about 65 percent of colon cancer diagnosed in the U.S.

Patients can protect themselves by asking the surgeon ahead of time if she thinks this issue is important, and if she routinely has 12 or more nodes checked after surgery, Bilimoria advised. Then the patient can read the post-operative pathology report and see how many lymph nodes were actually examined. If the number is lower than 12, the patient should ask his surgeon about it, Bilimoria said. More lymph nodes can be checked in the tissue that has been previously removed with the cancerous colon. 

Bilimoria said hospitals need better education and cooperative efforts between pathologists and surgeons. He also recommended hospitals have a cancer committee that follows compliance with these types of quality measures. 

“When there is poor adherence, they should act on it and identify why they are not meeting that standard,” he said.

The study was funded by the American College of Surgeons, the American Cancer Society and the National Cancer Institute.

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