Report in English with a Dutch summary (KCE reports 45A)

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28 Screening for Colorectal Cancer KCE reports vol.45 UICC AJCC staging Table 4: CRC staging systems: TNM, MAC & Dukes TNM - correlate TNM description Modified Astler- Coller (MAC) Dukes Stage 0 Tis N0 M0 Carcinoma in situ (intraepithelial or intramucosal carcinoma) N/A N/A Stage I T1, N0, M0 T2, N0, M0 Tumor invades the submucosa Tumor invades the muscularis propria Tumor invades through the muscularis A B1 A Stage IIA T3, N0, M0 propria into the subserosa or into the nonperitonealized pericolic or B2 perirectal tissues Tumor directly invades other organs or B Stage IIB T4, N0, M0 structures (T4a) or perforates the visceral peritoneum (T4b) B3 Stage IIIA T1-T2, N1, M0 Tumor confined to the submucosamuscularis propria with lymph node metastasis in one to three lymph nodes C1 Stage IIIB T3-T4, N1, M0 Tumor through the bowel wall with lymph node metastasis in one to three lymph nodes C2,C3 C Stage IIIC Any T N2 M0 Any tumor with lymph node metastasis in four or more lymph nodes C1,C2,C3 Stage IV T1-T4, N0-N2, Distant metastases M1 D N/A 2.5 MORTALITY AND SURVIVAL In Flanders, a total of 6,991 patients died of colorectal cancer in the period 2000-2003 (data kindly provided by Vlaams Agentschap Zorg en Gezondheid). After standardising for age, there are yearly about 12 colorectal cancer deaths per 100.000 inhabitants registered (Figure 6). This mortality rate remained rather constant throughout those years. These rates turn out to be somewhat higher than those released by the NCI-SEER in the USA, possibly due to a difference in stage distribution at diagnosis between the USA and Flanders. The same observation was made for Europe as a whole by the Istituto Nazionale per lo Studio e la Cura dei Tumori, Italy 46. Apparently there are wide variations in diagnostic and surgical practice between Europe and the USA.
KCE reports vol.45 Screening for Colorectal Cancer 29 WSR / 100.000 20 18 16 14 12 10 8 6 4 2 0 Males, Flanders Females, Flanders Males + females, Flanders NCI - SEER, USA, males & females Age standardised CRC mortality rates per 100.000 inhabitants, 2000-2003 Flanders versus NCI - SEER, USA (World Standard population - WSR) Males, Flanders Females, Flanders Males + females, Flanders NCI - SEER, USA, males & females Males, Flanders Females, Flanders Males + females, Flanders 2000 2001 2002 2003 2000-2003 Figure 6: Age standardised (world standard population) CRC mortality rates per 100.000, Flanders 2000-2003 (source: Flemish Agency for Care and Health) compared to age standardised (world standard population) CRC mortality rates per 100.000, USA 2000- 2003 (source: NCI-SEER, USA) NCI - SEER, USA, males & females Stratified by gender and age, Flemish mortality data for the year 2003 show that, together with increasing incidence, also the mortality rates increased clearly with age (Figure 7). Although in absolute numbers more elderly women died from colorectal cancer (Figure 8), the age-specific mortality rate was higher in men, due to the demographic reality that there are more elderly women left at those ages. Males, Flanders Females, Flanders Males + females, Flanders NCI - SEER, USA, males & females Males, Flanders Females, Flanders Males + females, Flanders NCI - SEER, USA, males & females
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KCE reports 1. Effectiviteit en kos
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