Emergency presentation of colon cancer

Colon cancer is the second most common form of non-skin cancer in Sweden for men and women respectively. Up to one fourth of all colon cancer cases are reported to present as emergencies, which is associated with a higher postoperative mortality and a lower 5 year survival, and affects the total survival in the colon cancer group. The overall aim of this thesis was to explore factors associated with emergency presentation of colon cancer.

In a population-based record study (n=604) including all patients from the GDH in Eskilstuna, 1996- 2005 it was found that the rate of emergency cases using a strict definition was 17% . These patients had more late-stage cancers and were most frequent during summer (36%), (the corresponding number for elective cases was 16%, 7.8; p<0.049) (I).

An even larger population-based record study (n=853) was also performed including four different counties in the Uppsala-Örebro region, 2006-2008. The symptom profile differed according to mode of presentation and 54% in the subacute (reported as emergencies, but operated after >3 days from admittance) group had reported ≥2 symptoms associated to colon cancer the last 12 months prior to surgery, and 44% had already undergone a recent examination of the large bowel. Postoperative and 90-days mortality were lower in the acute group (8% and 15%) but more pronounced in the subacute group (15% and 28%). Five-year survival was 40% in the acute group and the corresponding number in the subacute group was 28% (II).

The association between socioeconomic factors (SES) and mode of presentation was investigated in a register study including all patients with colon cancer in the Stockholm and Uppsala-Örebro regions 1997-2006 (n=12 293). Emergency presentation of colon cancer was most common in patients above the age of 80 (27.8%), stage IV (34.6%) and among patients with the lowest income (Q1) (27.7%). In a multiple regression model, OR for emergency presentation was 1.24 (95% CI 1.04-1.49) for unmarried and 1.22 (95% CI 1.03-1.45) for low income patients (III).

Within the context of this thesis a pilot study concerning gene expression was also performed in which differences between emergency and elective colon cancer was found.

List of scientific papers

I. H. Gunnarsson, T. Holm, A. Ekholm, LI. Olsson. Emergency presentation of colon cancer is most frequent during summer. Colorectal Disease. 2010 Mar; 13: 663-8.
https://doi.org/10.1111/j.1463-1318.2010.02270.x.

II. H. Gunnarsson, K. Jennische, S. Forssell, J. Granström, P. Jestin, A. Ekholm, LI. Olsson. Heterogeneity of Colon Cancer Patients Reported as Emergencies. [Submitted]

III. H.Gunnarsson, A. Ekholm, LI. Olsson. Emergency presentation and socioeconomic status in colon cancer. Eur J Surg Oncology. 2013 Apr; 1-6.
https://doi.org/10.1016/j.ejso.2013.04.004.