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Phenotype submission - Distant metastasis after colorectal cancer

Cohort Definition Name: Distant metastasis following colorectal cancer
Contributor name: Andreas Weinberger Rosen
Contributor OrcId: 0000-0001-9990-8155
Logic Description: First event distant metastasis following colorectal cancer
Recommended study application: Outcome, indication. There are three code sets attached: one narrow, medium, and wide, indicating how wide the definition is, with more specific codes for metastasis after colorectal cancer in the narrow set, but more possible metastasis code in the wide, with the medium in between. The code sets are intended to be used after colorectal cancer
Assertion statement: These cohort definitions were executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person for the wide and medium; during development, we hadn’t access to a dataset where the codes used in the narrow codes set were available.
Submitted cohort definition:

distant metastasis - wide.txt (112.9 KB)
distant metastasis - medium.txt (9.5 KB)
distant metastais - narrow.txt (1.9 KB)

Target Clinical Description

Distant metastasis following colorectal cancer signifies the spread of malignant cells from the primary colorectal tumor to distant organs and tissues such as the liver, lungs, peritoneum, or bones. This advanced stage of the disease marks a significant decline in curative options and necessitates a shift in therapeutic goals towards palliation and extension of survival.
Presentation of Distant Metastasis Following Colorectal Cancer

Common presentations for distant metastasis may include:

  • Unexplained weight loss
  • Jaundice or other liver dysfunction symptoms (in case of liver metastasis)
  • Persistent cough or dyspnea (in case of lung metastasis)
  • Bone pain or fractures (in case of bone metastasis)
  • Abdominal distension or discomfort (in case of peritoneal metastasis)

Assessment for Distant Metastasis Following Colorectal Cancer

  • Imaging studies like CT, MRI, and PET scans to identify and characterize metastatic lesions
  • Biopsy of suspected metastatic tissue for histopathological confirmation
  • Blood tests including tumor markers such as carcinoembryonic antigen (CEA)
  • Comprehensive review of previous surgical and medical treatment history

Differential Diagnosis of Distant Metastasis Following Colorectal Cancer

  • Hepatic hemangiomas or liver cysts (in case of liver involvement)
  • Primary lung cancer or benign lung nodules (in case of lung involvement)
  • Osteoporosis or benign bone lesions (in case of bone involvement)
  • Ascites due to other causes like liver cirrhosis (in case of peritoneal involvement)

Treatment Plan for Distant Metastasis Following Colorectal Cancer

Treatment usually involves systemic therapies like chemotherapy, targeted therapy, or immunotherapy. In selected cases, surgical resection or localized therapies such as radiofrequency ablation may be employed to treat solitary metastases. Palliative measures like pain management and supportive care are essential components of treatment.
Prognosis for Distant Metastasis Following Colorectal Cancer

The prognosis for patients with distant metastasis following colorectal cancer is generally poor, but it can vary depending on factors like the number and location of metastatic sites, response to therapy, and overall health. Advances in targeted therapies and immunotherapies are offering improved survival rates for some patients, although the disease at this stage is generally not curable.

Assignment for Peer Review:

Peer review of the phenotype would be more than welcome

Wide: Imported to the OHDSI Phenotype Library. It may be expected to be found with id = 810 in the next release. Thank you

Medium: Imported to the OHDSI Phenotype Library. It may be expected to be found with id = 854 in the next release. Thank you

Narrow: Imported to the OHDSI Phenotype Library. It may be expected to be found with id = 855 in the next release. Thank you

Hi Andreas,

As metastasis in colorectal cancer was mentioned here, I have a question that might not be directly related to this.

I’m curious how we differentiate between secondary cancer and colorectal cancer, which is metastasis or non-metastasis, if we’re using ATLAS. Is it already identifiable on the Concept Set, or will it only be shown after we use either the characterization, estimation, or prediction feature?

Thank you

Dear Yudha,

Thank you for your question, and I hope I understand it correctly:
For colorectal cancer I would say the commen vocabulary allows for potentially a very clear identification of primary malignancies of the colon and rectum, e.g concept ID 197500 and metastasis from a tumor of the colon or rectum e.g. concept ID 4196264.
These codes would implicity specify the it is either a primary tumor or metastasis from a tumor in a specific anatomical location. However, several codes exist that only specific a secondary malignant tumor to a specific organ e.g. concept ID 198700, which could originate from several primary malignant tumors. In my opinion in some contexts might be suitable to use a metastasis to a specific organ to estimate colorectal metastasis based on clinical reasoning. Due to the possible limitations of source data, we added several diffinitions which includes less specific concepts to be used to estimate the distant metastasis following colorectal cancer.
The concept set were designed to be used in an analytical setting investigationg patients with colorectal cancer in e.g. a estimation study, where we intended to use the concept set to define a cohort, so I don’t think you will get much value from the conceptset outside such a framework.

I hope this answers your question, if not please let me know and I’ll try to rephrase.