The two-week rule in colorectal cancer. Can it deliver its promise?

Despite recent advances in technology, a high percentage of patients with colorectal cancer present with disease that is already advanced, leading to an overall 5-year survival rate of 49.6% in men and 50.8% in women. In order to facilitate access to specialist cancer units, across specialities, the Department of Health formulated the NHS Cancer Plan in 2000 which consisted, in part, of the 'two-week rule' (TWR). The TWR was launched to ensure that all patients meeting specific referral criteria for suspected colorectal cancer were seen by a hospital specialist within 14 days of referral. The TWR referral system was set up with the intention of identifying 90% of patients with bowel cancer for prompt treatment. This study was conducted to investigate the difference in presentation between patients referred via the TWR pathway compared to those referred via an elective (non-TWR) route and to examine the impact of these referral routes on the time to treatment and clinical outcome.

Extruded Filshie clip presenting as an ischiorectal abscess.

This report adds to the small, but significant, literature base describing late complications following laparoscopic sterilisation. In women with recalcitrant peri-anal sepsis (who have previously undergone a sterilisation procedure) the possibility of tubal clip migration should be borne in mind. This is also an important learning point from a medicolegal point of view as patients presenting with the sequelae of clip migration will need to be counselled, and possibly investigated, with respect to the efficacy of their sterilisation procedure.

Proteomic analysis of nipple aspirate fluid throughout the menstrual cycle in healthy pre-menopausal women.

A proteomic approach to nipple aspiration fluid (NAF) has been used in a number of studies comparing women with breast cancer and healthy women. However, to make useful comparisons between women with breast cancer and healthy women it is necessary to establish whether there is physiological variation in the proteomic profiles of NAF. The purpose of this study was, for the first time, to examine how the proteomic profile of NAF using surface-enhanced laser desorption ionisation time-of-flight mass spectrometry varies across the menstrual cycle in healthy pre-menopausal women. Twelve women were recruited and nipple aspiration was carried out weekly from both breasts of each subject for two menstrual cycles. Matching serum samples for luteinising hormone, follicle stimulating hormone and oestradiol were obtained at each aspiration attempt. Statistically significant peaks were found for three healthy volunteers (p < 0.05). However, the peaks that varied across the menstrual cycle were different from one healthy volunteer to another and the differences were small compared with the large variation in proteomic profiles between healthy volunteers. This study provides proof of concept that the NAF proteomic profile does not vary substantially during the menstrual cycle and that therefore it is valid to compare NAF profiles from pre-menopausal women that have been taken at different stages in the menstrual cycle.

The intraductal approach to breast cancer biomarker discovery.

Established methods of breast cancer detection have well-described limitations, and new diagnostic techniques are evolving continually to improve diagnostic accuracy. The intraductal approach encompasses the modalities of nipple aspiration, ductal lavage, and duct endoscopy, and is a means of directly accessing the microenvironment of the breast and either sampling or visualizing this intraductal milieu. The aim of sampling this mammary microenvironment is to obtain samples from the physical surroundings of cells that are undergoing malignant transformation, thereby providing a new method of detection before the development of a clinically or radiologically discernible mass. A literature review was conducted to investigate the evolution of the intraductal approach and its particular application in the field of biomarker discovery, primarily using the intraductal technique of nipple aspiration, in combination with emerging protein profiling techniques.