Synchronous cancers of the colon and rectum

Introduction The cancer of the large bowel and rectum accounts for 10% of cancers in men and for 11% of cancers in women. It was the second most-common site-specific cancer in Europe in 2006 (Ferlay et al 2007) affecting both men and women (after the breast cancer), with an increasing incidence. One study from western region of Romania revealed that the prevalence of colorectal cancer is relatively high (Fratila et al 2010). In men prostatic cancer was on the first place and lung cancer on the second place; in women the first and second places were for breast cancer and colorectal cancer, the third being for endometrial cancer. It is considered that the frequency of the disease increases with age, reaching a maximum around the age of 75 years. A lot of environmental and genetic factors were implicated in the epidemiology of colorectal cancer. Sporadic cancers are frequently diagnosed than the cases in which we know genetic predisposition for colorectal cancer. More than 50% of the malignant tumours arise in the large bowel. Polyps, benign tumours of the large bowel are found in 25% of the cases. A percent of 4-6% of the patients are diagnosed with synchronous cancers (Fante et al 1996; Hohenberger 2000). Lynch syndrome (hereditary nonpolyposis colorectal cancer) is characterized by mutations that occurs in the DNA mismatch-repair genes. Until now we have information concerning five genes: MSH2 (mutS homolog 2) on chromosome 2p16; MLH1 (mutL homolog 1) on chromosome 3p21; MSH6 (mutS homolog 6) on chromosome 2p16; PMS2 (postmeiotic segregation 2) on chromosome 7p22; and EPCAM or TACSTD1 gene, which is responsible for a small percentage of HNPCC cases, it’s deletion mutations inactivate MSH2 (Kovacs et al 2009; Ligtenberg et al 2009). The affected members of the family tend to develop colon cancers, usually in the right colon, earlier than usually, in their 30’s to 40’s, being also at elevated risk for developing cancer at different sites: genital, gastric, ureter, bile ducts, brain and skin. Hereditary colon cancer syndromes are caused by specific inherited mutations that can lead to colon polyps, colon cancers, and non-colonic cancers. Hereditary colon cancer syndrome is able affect multiple members of a family. It is considered that 5% of all colon cancers are due to hereditary colon cancer syndromes. Patients who have inherited one of these syndromes have an extremely high risk (90-100%) for developing colon cancer. The risk to develop a colon cancer is 6% if one first degree relative has history of colon cancer; and if there is a second cancer, the risk rises up to 17%. For the development of colon cancer there are four different sequential mutations found: the APC gene (adenomatous polyposis coli), K-ras, DCC (deleted in colon cancer) and p53 gene. The APC gene is a tumour suppression gene, located on chromosome 5, having an autosomal dominant transmission for FAP. The p53 protein has multiple functions, among them there are: regulation of the cell growth, the repair of DNA, inhibiting the cell growth meanwhile the repair of DNA and the apoptosis. The MYH syndrome is an autosomal recessive form of colorectal adenomatous polyposis, in which the patients develop 10-100 polyps during their 40’s and they are at high risk to degenerate Abstract. Objective: we want to evaluate the cases with synchronous malignant tumors of the colon and rectum among the patients admitted in our hospital between 2005-2012. Material and Methods: there is a retrospective study of 20 cases diagnosed with multiple malignant tumors of the large bowel and rectum, collected from the patients observational datas. Results: 6 of these patients died in this period, but the others are still alive and in a good condition. Conclusion: in some sites the cancer has a better survival rate because of an earlier diagnosis, some of these patients develop synchronous or metachronous malignant lesions and in such cases is needed an agressive approach. There is still a small number of multiple malignant synchronous lesions, usually met with a colorectal localisation, discovered when we investigate the entire large bowel and rectum and not only a small portion of them. A synchronous malignant lesion associated with colorectal cancer can be discovered if the lesion has symptoms or when we perform CT scan, or MRI or another imagistic method which permit the diagnosis. Also, it is important not only for metachronous lesions but for synchronous lesions not diagnosed with the first tumor, an appropriate control of the patients postoperatively, giving the patient a chance of cure.