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Nurses should be ready when younger patients present with symptoms.
New research has uncovered a previously unnoticed 20-year increase in the incidence of rectal cancer in patients younger than 40 years. A team of researchers conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) cancer-registry database of the National Cancer Institute. They identified a total of 7,661 patients with colon, rectal, or rectosigmoid cancer diagnosed before the age of 40 years, from 1973 through 2005. Analyzing this trend over time, they found that the incidence of rectal and rectosigmoid cancer began climbing 3.8% annually in 1984, while the incidence of colon cancer remained unchanged. The increase was independent of sex and race. Approximately 70% of the tumors were adenocarcinomas. Lead author Joshua E. Meyer, assistant professor in the Department of Radiation Oncology at Fox Chase Cancer Center in Philadelphia, emphasized that rectal cancer shouldn't be confused with anal cancer, which is most often a squamous cell carcinoma associated with human papillomavirus or HIV infection.
Colorectal cancer is the second most common cause of cancer-related death in the United States, but it's often considered a disease of older adults. Younger patients often have more advanced disease on presentation, and their survival rate is lower than older patients', perhaps because of delayed diagnosis. "This research is very relevant to nurses, who see these patients frequently," Meyer said. "If clinicians see inflamed hemorrhoids or rectal bleeding, we suggest flexible sigmoidoscopy to rule out rectal cancer." The researchers don't yet recommend a change in current screening guidelines.
Pamela J. Haylock, director of the Association for Vascular Access and former president of the Oncology Nursing Society, agreed, saying that nurses should keep this diagnosis in the back of their minds, "especially when young people have unusual symptoms. Nurses often complain about not having enough time, but we've got to be more aggressive in ruling this out and following up. It costs practically nothing to do a fecal blood test as a first step in ruling out rectal cancer."-James M. Stubenrauch
* $520 million: Aggregate hospital charges related to urinary tract infections in U.S. children in 2006.
* $70 billion: The one-year (2005) cost of medical care and productivity losses associated with injuries incurred in motor vehicle accidents, according to the Centers for Disease Control and Prevention (CDC).
* 5 million: The number of U.S. children eligible for Medicaid or the Children's Health Insurance Program but not enrolled, according to the Department of Health and Human Services.
* 9,237: The estimated number of cases of heat-related illness in high school athletes that lead to missed days, according to the CDC.
Meyer JE, et al. Cancer 2010;116(18):4354-9.
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