Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Characteristics of Colorectal Cancer in Elderly Patients in Comparision with Younger Patients

장년 대장암 환자와의 비교를 통해 본 노인 환자의 특성

Lee, Hyung-Suk;Lee, Seok-Young;Seo, Ji-Hyun;Kwack, Kyeng-Kunn;Chung, Su-Jin;Lee, Kwang-Hyuck;Park, Young-Soo;Hwang, Jin-Hyeok;Kim, Jin-Wook;Jung, Sook-Hyang;Kim, Na-Young;Lee, Dong-Ho;Jung, Hyun-Chae;Song, In-Sung
이형석;이석영;서지현;곽경근;정수진;이광혁;박영수;황진혁;김진욱;정숙향;김나영;이동호;정현채;송인성

  • Published : 20070200
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Abstract

Background/Aims: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. Methods: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. Results: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. Conclusions: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer. (Korean J Gastrointest Endosc 2007;34:76-82)

목적: 국내의 대장암 발생은 지난 10년 동안 빠르게 증가하고 있으며 이러한 추세는 국내 노인 인구의 증가 속도를 고려해 볼 때 앞으로도 계속 이어질 것으로 판단된다. 이에 저자들은 노인과 장년에서 발생한 대장암의 임상, 내시경, 조직 특성의 비교를 통해 국내 노인 대장암의 특성을 분석함으로써 증가되고 있는 노인 대장암에 대한 효율적 진단을 위한 기초 자료를 얻고자 하였다. 대상 및 방법: 2003년 3월부터 2004년 11월까지 분당서울대학교병원에서 대장암으로 진단받은 232명을 대상으로 후향적으로 조사하였다. 환자들을 연령에 따라서 65세 미만의 장년층과 65세 이상의 노년층으로 구분하여 두 군에 대해 성별, 증상, 증상의 기간, 암의 위치 및 형태, 병기, 병리, 검사실 자료, 동반 대장병변 등에 대한 비교 분석을 시행 하였다. 결과: 노인층에서 배변습관의 변화가 유의하게 높게 관찰되었으며(p=0.018) 혈변, 흑색변의 비율도 상대적으로 높게 관찰되었다. 검진에 의한 대장암 발견비율은 장년층에서 유의하게 높았다(p=0.015). 연령대가 증가함에 따라 우측대장암의 비율이 증가하였으며 여자에서 현저하였다. 노인층에서 Duke C 병기의 비율이(p=0.007), 장년층에서는 Duke D 병기의 비율이(p=0.022) 유의하게 높았다. 우측대장암에서 전이의 비율이 높았으며(p=0.009) 성별로는 여자에서 유의하였다(p=0.042). 노인층에서 전이암 중 우측암이 차지하는 비율이 더 높았으며(46.2% vs. 29.6%) 여자의 경우에 현저하였다. 장년층에서 고분화암(p=0.016) 및 저분화암(p=0.031)의 비율이 유의하게 높았으며 인환세포 또는 점액선 형태의 고위험병리암은 여자의 경우에 노인층에서 높은 경향을 보였다(12.8% vs. 4.9%). CEA는 진행된 병기에서 노인층에서 현저하게 낮았다. 동반선종은 노인층에서 평균 2.4±4.0개로 유의하게 많았으며(p=0.004) 동시성 대장암의 경우 노인층에서 많이 발생하는 경향을 보였으며(8.1% vs. 3.4%) 위치는 모두 이웃한 분절 이내에 있었다. 결론: 노인 환자가 배변습관의 변화와 혈변을 호소하는 경우 대장암 가능성을 반드시 고려하여야 한다. 고령일수록 특히 여자의 경우 우측대장에 대한 철저한 검사가 필요하다. 우측대장암의 경우 전이에 대한 평가가 이루어져야 하며 여자의 경우 더욱 주의하여야 한다. 낮은 CEA 값을 보이는 경우에도 진행된 병기 가능성을 고려해야 한다. 동시성 대장암의 유무는 암이 발견된 분절과 인접분절을 중심으로 점검하여야 한다.

Keywords

References

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