A case of Cronkhite-Canada syndrome with multiple colon adenomas and early colon cancers

A 60-year-old man presented with diarrhea and weight loss. Colonoscopy revealed multiple reddish polypoid lesions throughout the gastrointestinal tract and was diagnosed as Cronkhite-Canada syndrome (CCS). Prednisolone therapy caused regression of polyps. Some of them were suspected to be early colon cancers and adenomas. We endoscopically performed mucosal resection for 15 polyps after prednisolone therapy. Histological examination of one of polyps showed invasion of the submucosal layer and colon resection was performed. This case suggests that diagnosis and treatment are important in polyps of CCS.     

Clinical experiences at St. Mark’s Hospital with multiple synchronous cancers of the colon and rectum

Summary We have reviewed the experience of St. Mark’s Hospital with double synchronous cancers of the large intestine. This occurs in 3.5 per cent of cancer resections, and in 75 per cent there are associated benign neoplasms. Patients with double or treble cancers fare much the same as those with single cancers, and the prognosis appears to be surprisingly favorable, even when the second growth is comparatively advanced. The second lesion, however, is usually not palpable at operation, and full clinical and radiologic investigation is therefore essential before any resection is undertaken for cancer of the colon or rectum. Read at the meeting of the American Proctologic Society, Detroit, Michigan, June 10 to 14, 1973.     

Neuroendocrine cancers of the colon and rectum

PURPOSE: Our goal was to define the incidence of neuroendocrine carcinomas of the colon and rectum, the patterns of neuroendocrine expression, and the cellular subtype within neuroendocrine tumors. We attempted to determine whether differences in neuroendocrine expression or specific cell type influenced survival. METHODS: Over a ten-year period, 988 patients had resections for colorectal cancer. Using immunohistochemical staining methods specific for neuroendocrine markers, 39 (3.9 percent) neuroendocrine cancers were identified retrospectively. Tumors were also stained with monoclonal antibody A-80 which is specific for exocrine differentiation. In this way we were able to determine the extent of neuroendocrine differentiation such as pure neuroendocrine, predominant neuroendocrine, and equal neuroendocrine-exocrine expression. RESULTS: Average patient age was 65.5 (range, 28–89) years; there were 25 males and 14 females. Nineteen tumors were located in the right colon, 11 in the left, and 9 were in the rectum. Three histopathologic patterns were identified: pure neuroendocrine (n=11), predominantly neuroendocrine (n=17), and cancers with equal exocrine and neuroendocrine differentiation (n=7). Three cellular subtypes were seen: small-cell (n=15), intermediate-cell (n=15), and well-differentiated neuroendocrine cancers (n=5). There was one Dukes A cancer, 7 Dukes B, 16 Dukes C, and 15 patients had metastases to distant sites at the time of diagnosis. As a group, neuroendocrine tumors have a poor prognosis: six-month survival was 58 percent, three-year survival was 15 percent, and five-year survival was 6 percent. Survival statistically correlated with tumor stage (P=0.01) but not with age, sex, tumor location, histopathologic pattern, or neuroendocrine subtypes. Median survival for pure neuroendocrine carcinomas was seven months and for predominantly neuroendocrine carcinomas was five months. Tumors with equal neuroendocrine and exocrine differentiation had a median survival of 22 months (P=0.3). Small-cell neuroendocrine carcinomas had a median survival of five months, intermediate-cell had 11 months, and well-differentiated had a median survival of 22 months (P=0.1). CONCLUSIONS: Neuroendocrine differentiation is found in at least 3.9 percent of colon and rectal cancers. Many of these tumors were initially diagnosed as carcinoids, the diagnosis was changed to neuroendocrine carcinoma after immunohistochemical staining. Overall survival is poor especially for small-cell and pure neuroendocrine carcinomas.Supported by the Bowman Research Fund, Chicago, Illinois.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.     

Proximal and distal cancers of the colon: 2 epidemiologically different cancers

During a seven year period ending in 1984, the Calvados Registry of Digestive Tract Tumors (France) recorded 1446 cases of colorectal cancer. The sex-ratio, age, and histologic type were studied with respect to location. From cecum to rectum, the sex-ratio varied from 1 to 1.9. Average age at diagnosis varied between 67.5 and 72.6 years for women but was invariable for males. The proportion of mucinous carcinoma varied between 13 p. 100 in the cecum and 5 p. 100 in the sigmoid and rectum. The study of incidence with respect to age and location showed that there were less elderly women with left colonic and rectal carcinoma. Epidemiologically, there seems to be two different types of colonic carcinoma: proximal and distal colonic carcinoma (including the rectum), the separation being determined by the splenic flexure.     

Synchronous colon primaries have the same prognosis as solitary colon cancers

PURPOSE: This study was designed to determine the prognosis of patients with synchronous colon primary tumors. METHODS: An 18-year, multi-institutional database of 4,878 colon cancer patients was reviewed, and patients with synchronous tumors were identified. Survival for each group was calculated by the Kaplan-Meier method and compared using log-rank analysis. RESULTS: There were 160 patients (3.3 percent) with 339 synchronous tumors. Eight percent of these patients had more than two tumors at the time of diagnosis. TNM staging of all synchronous tumors was 12 percent Stage 0, 41 percent Stage I, 21 percent Stage II, 16 percent Stage III, and 7 percent Stage IV. Based on highest stage lesion, 1 percent of patients were at Stage 0, 28 percent Stage I, 33 percent Stage II, 25 percent Stage III, and 11 percent Stage IV. Disease-specific five-year survival by highest stage was 87 percent for Stage O or I, 69 percent for Stage II, 50 percent for Stage III, and 14 percent for Stage IV (all differences significant by log-rank test). These highest stage survivals for patients with synchronous tumors were not significantly different from survival of patients with same stage solitary tumors in our database or from survival of patients with solitary colon cancer in national tumor databases. CONCLUSION: For patients with synchronous colon cancers, survival is the same as for patients with solitary colon tumors on a stage-for-stage basis, when highest stage synchronous tumor is considered.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.     

Microsatellite instability in interval colon cancers

BACKGROUND & AIMS: Colon cancers that develop after a complete colonoscopy may be the result of "failure of colonoscopy" or rapid tumor growth. Tumors that develop via the mismatch repair gene pathway demonstrate rapid tumor growth. The aim of this study was to determine if interval colon cancers were more likely than noninterval cancers to result from the loss of function of mismatch repair genes and hence demonstrate microsatellite instability (MSI). METHODS: We searched our institution's cancer registry for interval cancers, defined as colon cancers that developed within 5 years of a complete colonoscopy. These were frequency matched in a 1:2 ratio by age and sex to patients with noninterval cancers (defined as colon cancers diagnosed on a patient's first recorded colonoscopy). Archived cancer specimens for all subjects were retrieved and tested for MSI. RESULTS: Of the 993 colon cancers diagnosed during the study period, 51 (5.1%) were identified as an interval cancer, and 112 subjects with noninterval cancer served as a comparison group. Study subjects were almost all men. MSI was found in 30.4% of interval cancers compared with 10.3% of noninterval cancers (P = .003). After adjusting for age, interval cancers were 3.7 times more likely to show MSI than noninterval cancers (95% confidence interval, 1.5-9.1). This association was strongest for tumors located in the distal colon (odds ratio, 17.5; P = .008). No difference in TNM stage at diagnosis, histologic type or grade, or 5-year survival was found between groups. CONCLUSIONS: Interval colon cancers were almost 4 times as likely as noninterval colon cancers to be associated with mismatch repair gene dysfunction.     

Diminutive cancers of the colon and rectum: comparison between flat and polypoid cancers

A comparative study of polypoid and flat colorectal cancers less than 20 mm in size was made. A review of the characteristics of 56 polypoid cancers and 29 flat cancers treated between April 1989 and January 1996 was performed. Both groups of cancers showed similar age and location distribution. Polypoid cancers were more likely to be well differentiated (38%) than were flat cancers (17%) (P<0.05). Flat cancers were more likely to have reached the serosa (52% vs 12%; P<0.01) and also demonstrated a higher frequency of lymph node involvement (41% vs p 9%) (P<0.01) when compared to polypoid cancers. Flat colorectal cancers belong to a distinct subset which demonstrates greater biological aggressiveness than polypoid cancers of equivalent size. Accepted: 5 June 1998     

Multiple cancers of the colon and rectum. Incidence and results of surgical treatment

Out of 1,528 patients operated upon for cancer of the colon or rectum between 1964 and 1984, synchronous carcinomas were observed in 63 patients, metachronous carcinomas in 36 patients and both synchronous and metachronous carcinomas, in 3 patients. Synchronous carcinomas were double in 59 patients and triple in 4 patients. In 80 p. 100 of the cases, the lesions were confined to the same surgical segment or to an adjacent segment. Rectal locations were less frequent (18 p. 100). Preoperative diagnosis was made in only 40 p. 100 of cases. Ninety-three p. 100 had resection, 81 p. 100 with a curative intent. Associated benign polyps were found on the resected specimen in 58 p. 100 of the cases. The resectability rate (93 p. 100) and 5-year survival rate (55 p. 100 of all operated patients and 67 p. 100 of those who underwent curative resection) were similar to those observed in our personal series of single carcinomas of the colon. A second cancer of the colon or rectum occurred in 36 patients. The time interval between the first and second carcinomas ranged from 1 to 24 years and the mean interval time was 6.3 years. Three of the 36 patients developed a third metachronous lesion. The distribution of the sites of successive carcinomas was similar to that of synchronous carcinomas; the second carcinoma was located in the rectum in 8 p. 100 of cases. Diagnosis of the second carcinoma was made through routine periodic colonoscopy in one third of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hyperplastic polyposis associated with two asynchronous colon cancers

We report a patient with hyperplastic polyposis who had two asynchronous colon cancers, a combined adenoma-hyperplastic polyp, a serrated adenoma, and tubular adenomas. Hyperplastic polyposis is thought to be a precancerous lesion; and adenocarcinoma arises from hyperplastic polyposis through the hyperplastic polyp-adenoma-carcinoma sequence. Most polyps in patients with hyperplastic polyposis present as bland- looking hyperplastic polyps, which are regarded as non- neoplastic lesions; however, the risk of malignancy should not be underestimated. In patients with multiple hyperplastic polyps, hyperplastic polyposis should be identified and followed up carefully in order to detect malignant transformation in the early stage.