Plain language summaries

We are committed to ensuring that the work of the UK Colorectal Cancer Intelligence Hub and the Yorkshire Cancer Research Bowel Cancer Improvement Programme is easily accessible to patients and the public in an easy to understand format.

Quality of life after treatment for rectal cancer.

A plain language summary of:
Functional outcomes and health-related quality of life following curative treatment for rectal cancer: A population-level study in EnglandDowning A, Glaser AW, Finan PJ, Wright P, Thomas JD, Gilbert A, Corner J, Richards M, Morris EJ, Sebag-Montefiore D, International Journal of Radiation Oncology • Biology • Physics (2019).

What was the study about?
The number of people surviving cancer has increased significantly in recent years. This leaves many at risk of problems related to their cancer treatment. We used data from a large survey of cancer survivors to look at the problems reported by people treated for rectal cancer.

What did we do?
In 2013, a survey was sent to people in England who had survived 1-3 years after being diagnosed with rectal cancer. The survey asked a wide range of questions about life after cancer. In this study we wanted to look at problems with bowel control, leaking urine and sexual matters. We also looked at problems with general health. To get more information about the type of treatment people had, we linked the survey responses with other datasets. Treatment could be surgery only or radiotherapy followed by surgery. Some patients who had surgery had a stoma formed (an opening in the tummy area connected to a bag).

What did we find?
6,713 people completed a survey (64% response). We looked in detail at the 3,998 people who had surgery and said their cancer had not come back (in remission). Some of these people had radiotherapy before surgery and some did not. People who had radiotherapy before surgery were more likely to say they had problems with bowel control, leaking urine and sexual matters compared to people who had surgery only. Just less than half (44%) of people had a stoma still open at the time of survey. People with a stoma still open were more likely to say they had problems with sexual matters compared to those who did not have a stoma (or had a stoma that had been closed). People with a stoma also said they had more problems with their general health. The results highlight key areas to focus on to improve the care and support of patients treated for rectal cancer.

Acknowledgements
The survey was designed and administered by the Department of Health in England. The survey responses were linked with cancer registration, hospital admissions and radiotherapy data through the National Cancer Registration and Analysis Service. The analysis and linkage work was supported by Cancer Research UK (C23434/A23706).

Does surgery to treat obesity reduce or increase cancer risk?

A plain language summary of:
Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study, Ariadni Aravani, Amy Downing, James D. Thomas, Jesper Lagergren, Eva J.A. Morris, Mark A. Hull, Cancer Epidemiology, Volume 53, April 2018, Pages 99-104, ISSN 1877-7821 .

What do we already know?
– People who are heavily over weight (obese) are known to be at increased risk of cancer.
– It seems likely that surgery to treat obesity will also reduce a person’s risk of cancer.
– However, a Swedish study has suggested surgery to treat obesity may increase the risk of bowel cancer.

What did we do in our study?
Our study looked at routine healthcare data from NHS patients to see if surgery to treat obesity made a difference to the risk of developing cancer.

What did we find for bowel, endometrial and kidney cancer?
Over a million obese patients were found and, as expected, they had an increased risk of bowel, endometrial and kidney cancer compared to the non-obese population.

Of the million obese patents:
– 3,280 developed bowel cancer.
– 43 of these cancers were in those who had previously had surgery to treat their obesity. Because only 4% of the obese patients had such surgery we did not have enough patients to detect an effect on the chances of subsequently developing bowel cancer.

What about other cancers?
We did have more definitive answers for other cancers. Our analysis showed that:
– Those who had surgery had a decreased risk of breast cancer, compared to those who did not have surgery.
– Surgery made no difference to the risk of endometrial and kidney cancers.

NHS surgery to treat obesity is becoming more common so, in time, we hope to have more information to answer these questions.

Acknowledgements
This work uses data provided by patients and collected by the NHS as part of their care and support. World Cancer Research Fund International (WCRF) (ref: 2012/596) and Cancer Research UK (C23434/A23706) funded this research. NHS Digital, the National Cancer Registration and Analysis Service (NCRAS) and the Office for National Statistics (ONS) provided the data. We would like to thanks these organisations, and NHS patients, for making this research possible.

Rectal cancer in old age – is it appropriately managed?

A plain language summary of:
Rectal cancer in old age – is it appropriately managed? Evidence from population-based analysis of routine data across the English national health service. Rebecca J. Birch, John C. Taylor, Amy Downing, Katie Spencer, Paul J. Finan, Riccardo A. Audisio, Christopher M. Carrigan, Peter J. Selby, Eva J. A. Morris, European Journal of Surgical Oncology (2019).

What do we already know?
More than a third of rectal cancers are diagnosed in people aged 75 and over. The treatment of older patients is controversial. Older patients are less likely to receive surgery, radiotherapy and chemotherapy than younger patients. This may partly explain why England has a worse survival rate than some other European countries. However, some studies have suggested older patients have worse treatment outcomes than younger patients and so reduced treatment rates in this group are acceptable. The challenge is to neither over treat nor under treat older rectal cancer patients.

What did we do in our study?
This study used routinely collected English healthcare data to examine the use of different treatments for rectal cancer and their associated outcomes. It also assessed how treatment and outcome varied across the English NHS.

What did we find?
The results confirmed that older people were less likely to receive treatment aimed at curing them of rectal cancer. However, those older people who received such treatment had similar outcomes to younger patients. The study suggests that these treatments should be offered to patients of all ages if they are fit enough to receive them. It might be argued that a lower proportion of older people received these treatments because older patients are more likely to have other healthcare conditions and experience complications. The study did find some evidence to support this. However, the study found major differences between hospital Trusts which could not be accounted for by differences in patient characteristics.

Acknowledgements
Cancer Research UK (grants C23434/A23706 and C34080/A16438) funded this research. This work involves patient-level information collected by the NHS that has either been provided by, or derived from, patients as part of their care and support. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England (PHE). Access to the data was facilitated by the PHE Office for Data Release.

Time to surgery following short-course radiotherapy in rectal cancer and its impact on post-operative outcomes.

A plain language summary of:
Time to surgery following short-course radiotherapy in rectal cancer and its impact on post-operative outcomes. A population-based study across the English NHS, 2009-2014. B.A.Levick, A.J.Gilbert, K.L.Spencer, A.Downing, Time to surgeryJ.C.Taylor, P.J.Finan, D.J.Sebag-Montefiore, E.J.A.Morris, Clinical Oncology (2019).

What was the study about?
Short course radiotherapy (SCRT) before an operation is an effective treatment for rectal cancer. Previous studies have shown that it reduces the risk of the disease returning in the same location. The recommended gap between completing SCRT and having surgery varies widely, with some studies suggesting that it should be less than four days. This study examined the time between SCRT and surgery and related it to post-operative outcomes up to a year after surgery.

What did we do?
Information was obtained on all rectal cancer patients who underwent surgery and received SCRT in the English NHS between April 2009-December 2014. Post-operative outcomes such as thirty day post-operative mortality, returns to theatre, length of stay and one year survival were investigated in relation to the amount of time between SCRT and surgery. Patients who had a gap of over 27 days were not included in the study.

What did we find?
The study found that although the majority of patients were operated on within seven days of SCRT, there was huge variation across the English NHS. The study did not find any associations between time to surgery following SCRT and surgical outcome.

Acknowledgements
This work involves patient-level information collected by the NHS that has either been provided by, or derived from, patients as part of their care and support. The data are collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England (PHE). Access to the data was facilitated by the PHE Office for Data Release. The data used for this study are available from the National Cancer Registration and Analysis Service via the PHE Office for Data Release, subject to relevant approvals. This work was supported by the Bobby Moore Fund/Cancer Research UK (grant number C23434/A23706) and Yorkshire Cancer Research (grant number L394). It was underpinned by the Leeds MRC Medical Bioinformatics Centre (grant number MR/L01629X/1). This study was approved by the South West – Central Bristol Research Ethics Committee (ref 18/SW/0134).

Variation in the use of resection for colorectal cancer liver metastases across the English NHS.

A plain language summary of:
Variation in the use of resection for colorectal cancer liver metastases across the English NHS’. Hayley Fenton, John Taylor, Peter Lodge, Giles Toogood, Paul Finan, Alastair Young, Eva Morris, Annals of Surgery, 2019.

What was the study about?
Bowel cancer is a common disease in the UK with over 42,000 people diagnosed every year. If at diagnosis the cancer is found to have spread then patient outcomes can be poor. A common site for such spread is the liver. When this happens, it is called secondary liver cancer (the primary cancer being in the bowel). The National Institute for Health and Care Excellence (NICE) recommends surgery to remove the cancer from the liver where possible (the surgery needs to leave enough of the liver to support the patient). Around 25% of people who have such surgery survive for at least ten years. Previous studies, some of which date back 10 years, have shown that use of liver surgery varies significantly across the English NHS. This study looked at more recent data to see whether this variation still exists.

What did we do?
The study identified all patients who underwent bowel cancer surgery in an NHS hospital between 2005-2012. All patients who received liver surgery within three years of their bowel surgery were then identified.

What did we find?
There were significant differences in the rate of liver surgery between NHS Trusts. Also, patients whose bowel surgery took place in a hospital with an onsite liver specialist team were more likely to receive a liver operation. This may mean more patients could be benefiting from surgery for secondary liver cancer.

More information about secondary liver cancer can be found on the Macmillan website.

Variation in bowel cancer rates after colonoscopies in England

A plain language summary of:
Variation in post-colonoscopy colorectal cancer across colonoscopy providers in the English National Health Service Nicholas E Burr, Edmund Derbyshire, John Taylor, Simon Whalley, Venkataraman Subramanian, Paul J Finan, Matthew colonoscopiesD Rutter, Roland Valori, Eva J A Morris, British Medical Journal, 2019.

Background
Around 40,000 people are diagnosed with bowel cancer every year in England. As well as being the main test to detect cancer, colonoscopies can also prevent cancer. Unfortunately, colonoscopies are not perfect and sometimes a person develops bowel cancer after having a colonoscopy. This is referred to as a post-colonoscopy colorectal cancer (PCCRC).

What did we do?
We looked at all individuals who had undergone a colonoscopy in the English NHS between 2005 and 2013 who then went on to be diagnosed with bowel cancer within the three years following the colonoscopy. Cancers diagnosed 6-36 months after a colonoscopy were categorised as PCCRC.

To see if some individuals were more at risk of developing a PCCRC, we looked at the rates in relation to age, sex, socio-economic status and whether they had any pre-existing health conditions, including a history of inflammatory bowel disease or diverticular disease, whether they had ever previously had bowel cancer and whether they had previously undergone a colonoscopy.

The rate of PCCRC was then calculated for each colonoscopy provider in the English NHS.

What did we find? 
The overall rate of PCCRC has fallen from 9% in 2005 to 6.5% in 2013. PCCRCs were more frequent in females, those with pre-existing health conditions, in people with inflammatory bowel disease and diverticular disease, in people who had undergone multiple colonoscopies and in people with a previous diagnosis of bowel cancer. PCCRCs were also more common in older patients.

The lowest rates of PCCRC were found in those performed as part of the Bowel Cancer Screening Programme. Colonoscopies performed at private providers for the NHS had much higher rates.

In the years 2011-2013 the rate of PCCRCs varied substantially across NHS Trusts with rates ranging from 3.3% in the best performing to 13.4% in the worst performing.

If all providers during the eight years of the study period had achieved the same rate of PCCRC as the colonoscopies performed as part of the Bowel Cancer Screening Programme, 3900 cases of colorectal cancer could have been diagnosed earlier or even prevented.

Conclusion
Although the rates of PCCRC are improving, significant difference between providers exists. There is a need for all providers of colonoscopy to examine their cases of PCCRC, and local reasons for them.

From this, providers may be able to identify measures which once put into practice will lead to improved rates and improved outcomes for patients.

The lower rates of PCCRC found in the Bowel Cancer Screening Programme colonoscopies is noteworthy. All colonoscopies performed as part of the Bowel Cancer Screening Programme take place within accredited screening centres by colonoscopists who have undergone an accreditation test and who adhere to strict performance criteria. This shows that where strict standards are applied, quality is better.

Key Findings

  • There is significant variation in the rate of post-colonoscopy colorectal cancers (PCCRCs) in the English NHS from 13.4% in the worst performing to 3.3% in the best.
  • Colonoscopies performed as part of the Bowel Cancer Screening Programme have the lowest rate of PCCRCs.
  • If all providers during the eight years of the study period had achieved the same rate of PCCRC as the colonoscopies performed as part of the Bowel Cancer Screening Programme, 3900 cases of colorectal cancer could have been diagnosed earlier or even prevented.
  • High risk groups were identified: patients with a previous diagnosis of cancer, patients who have had multiple colonoscopies, and patients with inflammatory bowel diseases.

Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer: Can a regional intervention promote national change?

A plain language summary of:
Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer: Can a regional intervention promote national change?  John C. Taylor, Daniel Swinson, Jenny F. Seligmann, Rebecca J. Birch, Alice Dewdney, Victoria Brown, Joanna Dent, Hannah L. Rossington, Philip Quirke, Eva J. A. Morris, YCR BCIP Study Group

Background:
Surgery is the main treatment for bowel cancer. In order to try and reduce the chances of the cancer coming back, some patients are also offered additional treatment either before or after they have surgery. This is usually done by chemotherapy, which is where a patient is given a drug or a combination of drugs over a number of months. When chemotherapy is given after surgery, this is referred to as adjuvant chemotherapy. There are guidelines in place which help doctors decide when to offer this treatment to a patient.

The aim of this study is to identify which patients received adjuvant chemotherapy and look at whether treatment is more common in any particular groups of patients or at any particular hospital. This information could then be used to improve the guidance provided to doctors therefore improving the care of patients.

What did we do?
The differences in the use of adjuvant chemotherapy was investigated using data from all hospitals treating colorectal cancer in England. A more detailed investigation then took place focusing just on the hospitals within the Yorkshire and Humber region.

Alongside the investigation into the data, questionnaires about the uses of adjuvant chemotherapy were sent to the doctors who prescribe the chemotherapy, known as Oncologists, in the Yorkshire and Humber region.

A series of meetings for all Oncologists from the Yorkshire and Humber region were held to address the differences in adjuvant chemotherapy use both at a regional and national level. A further round of questionnaires were then sent to the Oncologists to see if the differences identified in the previous meetings had been addressed.

A final meeting took place during which a new set of guidelines was agreed in order to reduce the differences in treatment across the Yorkshire and Humber region.

What did we find?
The study found that there are large differences in the use of adjuvant chemotherapy for bowel cancer both nationally and regionally. Through bringing this information to the attention of the Oncologists in the Yorkshire and Humber region, all hospitals in the region agreed to a new set of guidelines which aims to reduce the differences in care that patients receive. This process could be copied in other regions in England.

Improving outcome prediction in individuals with colorectal cancer and diabetes by accurate assessment of vascular complications: Implications for clinical practice

A plain language summary of: Improving outcome prediction in individuals with colorectal cancer and diabetes by accurate assessment of vascular complications: Implications for clinical practice  Rebecca J Birch, Amy Downing, Paul J Finan, Simon Howell, Ramzi A Aijan, Eva JA Morris

Background:
Up to 20% of people with cancer also have diabetes. Patients with both cancer and diabetes are more likely to have worse outcomes after surgery. For patients with bowel cancer and diabetes there is also a poorer chance of receiving treatment to cure the cancer, a higher rate of chemotherapy related toxicity as well as an increased risk of dying after surgery. In order to understand what the relationship is between diabetes and the outcomes for patients with cancer, it is first important to understand the difference between patients with complicated (a person with other underlying health conditions which are caused by the diabetes) and uncomplicated diabetes (a person who has no other underlying health conditions that are linked to their diabetes). This would then lead to a better understanding of whether diabetes itself is associated with a higher risk or whether it is the complications that arise from diabetes that cause more risks for patients.

The aim of this study is to identify a reliable and practical system to categorise people with complicated and uncomplicated diabetes in order to better predict outcomes for patients with diabetes following bowel cancer surgery.

What did we do?
We looked at individuals who had been diagnosed with primary bowel cancer in England between 2005 and 2016 who underwent surgery to remove some or all of their bowel. From this group of people we then identified the individuals with diabetes. The status of the individual’s diabetes was determined using a measure called the adapted Diabetes Complications Severity Index (aDCSI) which is designed to measure how severe a patient’s diabetes is. We put individuals into three categories, no diabetes, uncomplicated diabetes and complicated diabetes and looked at the outcomes of patients in each of the three categories.

What did we find?
We found that patients with complicated diabetes have worse outcomes after bowel cancer surgery than patients with uncomplicated diabetes. We also found that patients with uncomplicated diabetes have similar outcomes as patients who do not have diabetes. This finding suggests that poor outcomes after surgery are linked to the complications arising from diabetes rather than from the diabetes itself. The results of this study show the importance of accurately defining diabetes complications when assessing the risks associated with bowel cancer surgery for patients.

National variation in pulmonary metastasectomy for colorectal cancer.

A plain language summary of:  National variation in pulmonary metastasectomy for colorectal cancer. Fenton HM, Finan PJ, Milton R, Shackcloth M, Taylor JC, Treasure T, Morris EJA.

Background:

Bowel cancer is the fourth most common cancer in the UK. At diagnosis, around 20% of patients (which subsequently increases to 50% of patients) with bowel cancer are told that their cancer has metastasised. This means that the cancer has spread to another part of the body. One place that the cancer often spreads is to the lungs. It is uncommon for the cancer to spread only to the lungs in patients with bowel cancer, with over 80-85% of patients also having metastases in other areas, most commonly the liver.

There are a number of recommendations on what surgical practice should be taken in the NHS when dealing with bowel cancer lung metastases. One such recommendation is a pulmonary metastasectomy which is the surgical removal of tumours in the lungs. Despite this being a recommendation, there does not appear to be any large scale trials looking into the practice of pulmonary metastasectomy.

This study aims to investigate the use of pulmonary metastasectomy in the bowel cancer population across the English NHS and to find the extent of any differences in practice amongst NHS hospitals and differences in outcomes for patients.

What did we do?
All patients with a primary bowel cancer (this means that the cancer originated in the bowel) and who had received surgery to remove the tumour at an NHS hospital between 1 January 2005 and 31 December 2013 were identified. From here, all patients who had then undergone a pulmonary metastasectomy within three years of the original cancer surgery were identified.

What did we find?
2% of patients who had surgery to remove a tumour in the bowel went on to have a pulmonary metastasectomy within three years. The number of patients receiving a pulmonary metastasectomy varied significantly between hospital trusts.

Lynch syndrome screening in colorectal cancer: results of a prospective two-year regional programme validating the NICE diagnostics guidance pathway across a 5.2 million population

A plain language summary of:  Lynch syndrome screening in colorectal cancer: results of a prospective two-year regional programme validating the NICE diagnostics guidance pathway across a 5.2 million population Nicholas P West, Niall Gallop, Danny Kaye, Amy Glover, Caroline Young, Gordon G A Hutchins, Scarlet F Brockmoeller, Alice C Westwood, Hannah Rossington, Philip Quirke

Background:
In 2017 the National Institute for Health and Care Excellence (NICE) released new guidance which recommended that all patients newly diagnosed with bowel cancer in the UK should be screened for Lynch Syndrome.

Lynch Syndrome is a hereditary genetic condition that significantly increases the risk of a person developing bowel cancer as well as other types of cancers such as womb and stomach among others. It is one of the most common hereditary cancer syndromes and it is estimated that around 1 in 300 people may be carriers of a gene associated with Lynch Syndrome.

As Lynch Syndrome is genetic, after a patient has received a diagnosis, testing is offered to other family members. This testing is known as germline testing where tests are carried out on cells that do not currently have cancer to see if a person has a gene mutation such as Lynch Syndrome. If an individual is found to have a gene mutation such as Lynch syndrome, further screening, such as regular colonoscopies can be offered in order to help identify early tumours or prevent their development, therefore improving the outcomes for patients and saving lives.

The Yorkshire Cancer Research Bowel Cancer Improvement Programme is a programme of work with the primary aim to improve bowel cancer outcomes for patients in Yorkshire and the Humber. The programme included funding to carry out Lynch Syndrome screening for all newly diagnosed patients with bowel cancer over the age of 50 in the Yorkshire region until a time when the screening could be commissioned through the NHS. This paper reports the results of the two-year study as validation of the 2017 NICE guidance.

What did we do:
Lynch screening was offered to all bowel cancer Multidisciplinary Teams (MDT’s) in the Yorkshire and Humber region. All patients over the age of 50 who were diagnosed with bowel cancer between 1st April 2017 and 31st March 2019 were eligible for testing. Testing was not offered for patients under the age of 50 due to other screening guidance in place prior to 2017 which recommends the routine screening of bowel cancer patients under the age of 50.

The screening was carried out at the University of Leeds and involved a tissue sample removed at the time of surgery as part of the routine clinical care pathway being sent to the central laboratory for testing.

What did we find?
Over 3,000 individual cancers were tested during the two year study period. Of the 3,000 cancers tested, 81 patients were found to potentially have Lynch Syndrome and would require germline testing to confirm it.

As the largest UK regional study to validate the 2017 guidance on Lynch Screening to date, it was found that the guidance is achievable at scale and can be carried out routinely following engagement with local commissioners to ensure that the pathology departments have enough funding and resource.

In addition to screening for Lynch Syndrome, the results from this study are being used to inform the treatment of patients including the use of chemotherapy and immunotherapy.

What factors determine specimen quality in colon cancer surgery? – A cohort study

A plain language summary of: What factors determine specimen quality in colon cancer surgery? – A cohort study Kheng-Seong NG, Nicholas. P. West, Nigel Scott, Melanie Holzgang, Phil Quirke and David,G. Jayne

Background:
There is evidence that a patient’s survival from colon cancer is influenced by the quality of the surgery.

It is undecided, however, what factors determine good quality surgery and whether the quality of surgery can influence the future health of a patient and the risk of death.

This study looks at the quality of colon cancer surgery by looking at the section of the bowel that is removed during surgery, also known as the pathological specimen. This is done to look for factors that influence the quality of surgery and assess whether the quality of surgery affects the occurrence of complications afterwards. Clinical data was also used in the assessment.

What did we do?
The study included all patients who had undergone surgery to remove a primary colon cancer at St James’s Hospital, Leeds between January 2015 and December 2017.

The area of the colon that was removed during surgery was assessed. The quality of the specimen was assessed by looking at the area that was removed known as the plane of mesocolic dissection as well as the area and length of the tissue that was removed. Whether any complication occurred after surgery was also measured.

What did we find?
The study found that the majority of good quality specimens were from open surgery which is often associated with a bigger risk of complications occurring after surgery.

The study found that there is still a need for routine photographs and assessments of the pathological specimen to be taken in order to help understand what surgeons do with colon cancer in the 21st century. It found that there is room for improvement in colon surgery, in particular in the quality of laproscopic surgery (also known as key hole surgery which is when a surgeon operates through smaller openings in the body instead of larger cuts), as well as surgeries that are performed in an emergency.

Current concepts in imaging for local staging of advanced rectal cancer.

A plain language summary of: Current concepts in imaging for local staging of advanced rectal cancer.

P.J.Brown, R. Hyland, A.J.Quyn, N.P.West, D. Sebag-Montefiore, D. Jayne, P.Sagar, D.J.Tolan.

Background:
Many advancements in the treatment of rectal cancer using surgery were made in the 1980’s and 1990’s. The practice of staging a tumour before surgery and identifying any high risk tumours, has enabled clinicians to be more selective in how the tumour is managed ahead of treatment and improved overall outcomes.

What did we do?
This review looks at the importance of the features of locally advanced rectal cancer using standard magnetic resonance imaging (MRI) and the potential impact of functional MRI techniques. Standard MRI scans produce 3D images of an area of the body whereas, Functional MRI scans produce images of activity within the specific area of the body.

What did we find?
MRI remains the best method to stage rectal cancer and to decide upon the best way of managing the tumour however, despite advancements in the quality of imaging, it is still a challenge for clinicians to accurately categorise tumour characteristics.

The paper identifies the need for further developments and education to gain a better understanding of the risks to the patient and improve personalised therapies. In addition to this the paper also identifies that work is required to improve the accuracy of rectal cancer staging in routine practice.

Additional loss of MSH2 and MSH6 expression in sporadic deficient mismatch repair colorectal cancer due to MLH1 promoter hypermethylation.

A plain language summary of: Additional loss of MSH2 and MSH6 expression in sporadic deficient mismatch repair colorectal cancer due to MLH1 promoter hypermethylation.

Alice Westwood, Amy Glover, Gordon Hutchins, Caroline Young, Scarlet Brockmoeller, Rachel Robinson, Lisa Worrilow, Dave Wallace, Kate Rankeillor, Julian Adlard, Philip Quirke, Nicholas West, Journal of Clinical Pathology 2019

Background:
3% of patients with bowel cancer are found to have an inherited mutation in the genes that repair DNA damage, known as Lynch syndrome. An inherited mutation is a change in the gene of a sperm or egg cell that is passed on from parents to their children. The passed on gene becomes part of the DNA of all the cells in the child.

Cancer is often caused by gene mutations that cause cells to grow too quickly; these mutations can happen randomly when a cell is growing and dividing and would normally be corrected by mismatch repair proteins. Individuals with Lynch syndrome are not able to repair the damaged cells due to faulty DNA mismatch repair genes therefore they have a higher chance of developing cancer, specifically bowel cancer.

The UK National Institute for Health and Care Excellence (NICE) guidance published in February 2017 recommends that all patients diagnosed with bowel cancer are screened for Lynch syndrome by testing their cancer for signs of deficient mismatch repair.

What did we do?
Lynch screening was made available to all patients newly diagnosed with bowel cancer in all 16 hospitals in the Yorkshire and Humber region from May 2017 as part of the Yorkshire Cancer Research Bowel Cancer Improvement Programme.

What did we find?
In the first 829 cases that were screened, 94 cases showed evidence of deficient mismatch repair in the tumour of which 20 patients showed possible features of Lynch syndrome requiring further testing.

Conclusion
It is important that Lynch screening results are interpreted correctly so that patients are not referred unnecessarily for further testing, which could lead to anxiety for them and their family as well as unnecessary costs for the healthcare system.

 

Radiologist and MDT clinician opinions on the quality of MRI rectal cancer staging reports: how are we doing?

A plain language summary of: Radiologist and MDT clinician opinions on the quality of MRI rectal cancer staging reports: how are we doing? P.J. Brown, H. Rossington, J. Taylor, D.M.J. Lambregts, E.J.A. Morris, N.P. West, P. Quirke, D. Tolan, YCR BCIP Study Group

Background:
The most accurate way of staging and assessing rectal cancer before surgery is through Magnetic Resonance Imaging (MRI). MRI reports, which are written by radiologists, contain information called key tumour features which are used by specialist clinicians in the colorectal cancer multidisciplinary team to personalise a patient’s treatment.

The standard of rectal cancer staging MRI reports are not consistent and as a result guidelines have been issued by the European Society of Gastrointestinal Abdominal Radiology (ESGAR) and Society of Abdominal Radiology (SAR) which recommend the use of structured report templates.

Structured report templates are increasingly being thought to improve the communication of imaging and pathological findings however they are not widely used by radiologists as many still prefer the free style reporting.

As rectal cancer staging MRI techniques have increased, so have the number of key tumour features that it is recommended to include in the reports. The demand to include these features is usually led by colorectal cancer specialists in order to optimise and personalise a patient’s treatment. So therefore the input and opinion from colorectal cancer clinicians on the quality and contents of rectal cancer staging reports could guide radiologists.

What did we do?
This study evaluated the standard of, and satisfaction with, rectal cancer MRI reports in the UK.

Sixteen UK colorectal cancer Multi-Disciplinary Teams (MDT’s) were invited to take part in the study. The colorectal cancer MDT lead clinician in each hospital was asked to send out a questionnaire about the quality of the MRI reports to colleagues in their MDT. This was sent via email to participants which included surgeons, medical oncologists, clinical oncologists, histopathologists and clinical nurse specialists. A different version of the questionnaire was sent to the MDT clinical radiologists.

The questionnaire included 25 questions, 22 of these were closed questions and three were open questions which asked for more feedback and suggestions.

What did we find?
The study found that both groups of people recognised that key tumour descriptors are often missing from the rectal cancer MRI reports.  Both groups recognised that rectal cancer MRI scans can be difficult to interpret, even by specialist consultant radiologists, which potentially leads to different opinions on the key tumour features.

Conclusion:
The implementation of a standardised report template may improve the completeness and clarity of MRI reports for rectal cancer as well as lead to an improvement in the clinical management and outcomes of rectal cancer. Further work is required to assess the variation in interpretation of the key tumour features by different consultant gastrointestinal radiologists.

Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice,

A plain language summary of: Standardised reports with a template format are superior to free text reports:  the case for rectal cancer reporting in clinical practice,P.J. Brown, H. Rossington, J. Taylor, D.M.J. Lambregts, E. Morris, N.P. West, P. Quirke, D. Tolan on behalf of the Yorkshire Cancer Research Bowel Cancer Improvement Programme Study Group

Background:
The most accurate way of staging and assessing rectal cancer before an operation is through Magnetic Resonance Imaging (MRI).

Primary–staging MRI is used to determine how a cancer is managed by the clinical team, including whether radiotherapy or chemotherapy is given before surgery. A re-staging MRI can help determine the operation technique or alternatively what other treatment options could be offered. MRI reports greatly influence the decision on what treatment is used, so it is very important that they are accurate.

There is growing interest amongst radiologists to have a more structured reporting system in order to improve the communication of the findings and to generate consistent reports. The European Society of Gastrointestinal Abdominal Radiology (ESGAR) and Society of Abdominal Radiology (SAR) recommend the use of report templates for primary staging and re-staging MRI reports.

MRI reporting templates have been produced however they are not widely used.

What did we do?
This study evaluated the standard of primary staging rectal cancer MRI reports.

Sixteen UK colorectal cancer Multi-disciplinary Teams (MDT’s) were invited to take part in the study. Each MDT was asked to submit ten consecutive primary staging reports for each of their radiologists all which had to be within a 12 month period from January 2016 to January 2017. Four hundred and ten primary staging reports were submitted. Out of these, 360 were analysed. Eighty one were reported using a standardised template and 279 were reported as free text.

Twenty-two key tumour descriptors were evaluated within each report using a simple reporting scoring system.

What did we find?
The study found that important information describing tumours is consistently omitted from primary staging rectal cancer reports. The use of a template in primary staging MRI reporting significantly increased the inclusion of key tumour descriptors when compared to free-text reporting.