A756 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4

4075CONTRASTING EPIDEMIOLOGY AND MOLECULAR PATHOL·OGY OF COLORECTAL CARCINOMA IN EGYPTIAN ANDWESTERN PATIENTS.Amr S. Soliman, Melissa 1. Bondy, Nadia Mokhtar, Sherif Bayomy, P.Scott Houlihan, Patti A. Longo, Jeff R. Lukish, Tashiaki Watanabe, ChrisAmos, Bernard Levin, Stanley Hamilton, M D Anderson Cancer Ctr,Houston, TX; The National Cancer Institute, Cairo, Egypt; Tanta CancerCtr, Tanta, Egypt; Johns Hopkins Univ, Baltimore, MD; National NavalMed Ctr, Bethesda, MD.

Background: Colorectal carcinoma is uncommon in Egypt as compared towestern populations, but a higher proportion of Egyptian cases has its onsetbefore 40 years of age and location in the rectum. We therefore comparedthe molecular pathology of a series of Egyptian colorectal carcinomas tothree groups of western patients previously published from our laboratory:sporadic, early onset «40 years old), and hereditary non-polyposis colo­rectal cancer syndrome patients. Methods: We studied 59 patients aged17-67 years representing different geographical regions in Egypt. Informa­tion was collected on demographics, residence, family history, and tumorsite. We analyzed paraffin-embedded specimens for tumor histopathology,microsatellite instability (MSI), k-ras proto-oncogene mutation, and p53

particular looking at the extent, number and type of polyp found, deter­mining whether guidelines needed to be modified on the basis of race.Methods: Using medical records, GI procedure records and pathologyresults, 425 consecutive screening flexible sigmoidoscopies were comparedat a Veteran's Hospital. As they were asymptomatic and were referred forflexible sigmoidoscopies, they were assumed to have no family history ofcolon carcinoma. The patients were categorized into race (African Amer­ican, Caucasian and other) and were analyzed regarding the total numberand largest size of polyps. The polyps were classified histologically intoadenomatous and non-adenomatous polyps. The two racial groups werecompared looking at (i) the absolute numbers of polyps found on flexiblesigmoidoscopy; (ii) the largest size of these polyps and (iii) whether thesepolyps were adenomatous or not. Results: Of the 425 patients, 121 wereAfrican American, 287 were Caucasian and 17 were of another race. Theaverage ages of African Americans and Caucasians were comparable (64.7and 64.1 years respectively). Polyps were found in 22 (18.2%) AfricanAmericans and in 66(23.0%) Caucasians (p=NS). There was no statisticaldifference in the average number or largest size of polyps per patientbetween the two groups. There were a comparable number of patients withadenomatous polyps between the two populations. This represented 13.8%of African American patients versus 10.4% of Caucasian patients (p=NS).Conclusions: African American and Caucasian patients have similar prev­alence, numbers and sizes of polyps on screening flexible sigmoidoscopy.There is no significant difference in the proportion of patients with adeno­matous polyps, and screening guidelines do not need to be modified on thebasis of these racial differences.

4074TRENDS IN UPPER GASTROINTESTINAL CANCER: A 12 YEARREVIEW.Jeremy D. Sanderson, Ingrid Rowe, Frances Biggins, Naseema Ghazali,Catherine N. Chinyama, Acad & St Thomas' Hospitals, London, UnitedKingdom.

Background: Previous studies have suggested that the incidence of distalgastric cancer (GC) is decreasing whilst that of proximal GC has increased.Moreover, studies suggest that the incidence of Barrett's associated distaloesophageal cancer (DOC) has increased significantly in the last decade.However, these studies are conflicting because of variation in the definitionand coding of upper gastrointestinal cancers. Aim: The aim of this studywas to examine as accurately as possible trends in referrals for DOC andGC over a 12 year period at a single large university hospital. Methods: Allcases of gastric and oesophageal cancer undergoing surgical resection wereascertained over the period 1987 to 1998 by search of histopathology,endoscopy and hospital coding data. All tumours were carefully re-stagedby TNM criteria and divided into proximal GC, distal GC and Barrett'sassociated DOC according to strict macroscopic and microscopic histolog­ical criteria. Tumours that could not be classified accurately were excluded.Results: 446 cases were ascertained over the 12 year period (68 DOC, 378GC). Changes over time were analysed in 3 year periods (see table 1).Cases of distal GC declined whilst those of proximal GC remained con­stant. Cases of Barrett's associated DOC increased significantly over themost recent 6 years. Tumour stage at presentation, age and gender did notalter over the 12 year period studied. Conclusions: This study of referralsto one large hospital confirms the remarkable rise in Barrett's associatedcancers in recent years. Distal GC does appear to be declining whilstproximal GC remains constant.

Table 1:Cases ofUpper GIcancer 1987 ·1998

103102113121

Total

63615941

DistalGC

33393343

Prox GC

72

2137

DOC

1987·891990·921993·951996·98

4071

COLORECTAL CARCINOMA IN YOUNG FEMALE PATIENTS.Olusola Olofinlade, Priya Grewal, Nicholas Gualtieri, Hal Freiman, StVincent's Hosp, New York, NY.

Background: We sought to determine the clinicopathologic characteristicsand prognosis in young female patients with colorectal cancer. We alsoexamined the association with anemia which is a common clinical findingin young menstruating female patients. Methods: We performed a retro­spective analysis of all female patients (ages 18-40) diagnosed with colo­rectal cancer over a 17 year period (June 82-June 99). Findings: A total of1546 cases of colorectal cancer were diagnosed and treated at St Vincent'sHospital over thisl7 year period. 42/1546 (2.7%) were young patients withan age range of 22-40 years. 22/1546 (1.4%) were female patients. Only 3patients had a family history of colon cancer and an additional patient hada personal and family history of familial adenomatous polyposis (FAP).The most common clinical presentation in the young female patients werelower abdominal pain (63%), rectal bleeding (50%) and weight loss (32%).18122 (73%) of these patients had anemia on clinical presentation. Two ofthese patients had diagnosis of colorectal cancer made during the peripar­tum period and all of their signs and symptoms had unfortunately beenattributed to pregnancy. 73% of these female patients had left sidedtumors.l5122 (69%) of young female patients had lymph node involvementas compared to 11120(45%) of young male patients, although this was notstatistically significant. However significantly more women 10/22 (45%)had metastatic disease (Duke's D disease) as compared to only 5/20 (25%)of young male patients. The overall 5 year survival for all young patientswith colorectal cancer was 49%. However the survival in young femalepatients was only 39% compared to 57% for young male patients. This wasstatistically significant with a P value of <0.05 using Kaplan Meier'ssurvival curves. Conclusion: Clinicians need to be aware that colorectalcancer does occur in young menstruating women and unfortunately tendsto present with metastatic disease as evidenced by this study. More detailedattention should therefore be paid to young female patients who presentwith anemia coupled with symptoms of rectal bleeding, lower abdominalpain and weight loss. This might conceivably allow for earlier diagnosisand potential for cure in this patient group.

4072CHANGES IN NUTRITIONAL STATUS AND EATING HABITS INAPPARENTLY WELL NOURISHED GI CANCER PATIENTS.Tatjana Schuetz, Sandra Priepke, Monika Nitschkoff-Breitmann, MathiasPlauth, Herbert Lochs, Medicine Clin, Gastroenterologie, Charite, Berlin,Germany; Aerztin fuer Allgemeinmedizin, Zepernick, Germany.

Patients with GI cancers frequently develop malnutrition. Changes ineating habits are considered a major factor, however only few data havebeen reported on the development of these alterations. We therefore in­vestigated the nutritional status, eating habits and food preferences in notovertly malnourished patients with GI cancers (T) in comparison to age andsex matched controls (C). Method: In 43 patients (63.7:': 11.7 years; 20 m,23 f) with gastrointestinal tumors (23 colon, 7 liver, 6 bile duct, 3 stomach,3 esophagus, I pancreas) who were not yet overtly malnourished, and 25controls (62.9:': 11.5 years; 12 m, 13 f) nutritional habits and taste prefer­ences were evaluated using a questionnaire. Additionally, patients wereasked to rate 48 food items and beverages on a Likard scale from 0 ('I liketo eat') to 10 ('I refuse to eat'). Body composition was assessed byanthropometry (arm muscle area: AMA; arm fat area: AFA) and bioelectricimpedance analysis (body cell mass: BCM B1A). Results are given asmean t sd. T-test and )(- test were used for statistical analysis. Results:Body composition was not different between T and C in terms of bodymass index (T: 25.3:':4.8 vs. C: 26.3:':2.8 kg/rrr'), AMA (T: 44.7:': 12.1 vs.C: 51.5:':14.6 crrr') and AFA (T: 25.7:':11.6 vs. C: 23.9:':10.8 em").BCMB1A, however, was significantly lower in T (33.4:':5.5 vs. 37.7:':6.8%BCMBJAlbody weight; p<O.05». The number of meals per day was notdifferent (T: 3.7:': 1.1 vs, C: 3.6:':0.8), whereas the size of lunch servingswere smaller in T (p<O.05). There were no differences in the preferredpreparation of food (cooking, stewing, roasting). Changes in taste wererecorded more often in T than in C (30% vs 8%; p<0.05). Tumor patientsdisliked cheese, cabbage, raw vegetables, fruit, nuts, and carbonated oralcoholic beverages but preferred sweets and pudding. Conclusion: Patientswith GI cancers develop protein malnutrition at a stage when they appearstill well nourished. This correlates with a reduction in food intake andchanges in food preferences. Dietary counselling should therefore bestarted early in the course of disease aiming for an increase in the numberof meal servings and making use of the preference of sweet flavours.Randomized studies are warranted to test whether this approach canpostpone the evolution of malnutrition.

4073THE IMPACT OF RACE ON THE CHARACTERISTICS OF POL­YPS FOUND ON SCREENING FLEXIBLE SIGMOIDOSCOPY: ACOMPARISON OF AFRICAN AMERICAN VERSUS CAUCASIANPATIENTS.Priyajit Prasad, Rajeev Jain, Arshad Malik, David Park, K. Shiva Kumar,Maneesha Singh, UT-Southwestern Med SchoollDallas VA Med Ctr, Dal­las, TX; Dallas VAMC, Dallas, TX.

Aims: The aims of the study were to compare findings on routine screeningflexible sigmoidoscopy between African Americans and Caucasians, in