Primary malignant large bowel lymphoma

Primary gastrointestinal (GI) lymphomas constitute about 5.6 per cent of total gut neoplasms. The involvement of large bowel as primary site is all the more rare. We carried out this study to evaluate the prevalence and clinicopathological features of large bowel lymphoma at Gujarat Cancer and Research Institute and to compare our findings with published literature. We carried out a retrospective analysis of the records of histologically diagnosed cases of large bowel lymphoma over a 5 year period. A total of eight cases of large bowel lymphoma were identified compared with 57 cases of primary GI lymphoma of other sites, constituting about 12.3 per cent (eight of 65) of all GI lymphomas. Peak incidence was observed in the second decade of life with a mean age at presentation of 30.6 years (range 4-70 years). A male-to-female ratio of one to two was observed. The most commonly presenting feature was altered bowel habits and diarrhea in more than 50 per cent of the patients. One patient presented with acute intestinal obstruction. Diagnosis was made by colonoscopic biopsies in all but one case. All of the patients were treated with surgery and adjuvant chemotherapy. A 4-year disease-free survival of 66.7 per cent was observed (95% confidence interval 0.05-1.28). There was no significant difference in survival in patients with high-grade versus low-grade tumors (50% vs 66.7%; P = 0.88) and stage of disease (75% vs 50%; P = 0.45) in stage II and III respectively. We conclude that large bowel lymphoma is a curable disease if treated aggressively. We suggest that all patients should be treated by primary surgery and should receive adjuvant chemotherapy.     

The small carcinoma of the large bowel

Four small carcinomas (3, 6, 10, and 15 mm) of the large intestine have been examined for residual epithelial polyp; none was found. It is felt that these carcinomas arose from colonic mucosa without a preexisting visible epithelial precursor lesion; however, occasional glands having adenomatous change were seen near the edges of the carcinomas.     

直肠肛管疾病大肠癌的早期诊断

大肠癌是常见的恶性肿瘤,由于大肠癌的发病原因可能和高脂肪、低纤维素饮食有关,所以发达国家的发病率高,我国的发病率近年来也有所上升.和任何恶性肿瘤一样,早期发现,早期治疗是提高大肠癌远期生存率的唯一途径,如按Dukes分期,5年生存率,A期为90%,B期为75%,C期＜50%,D期＜10%,可见早期诊治的重要性.     

Mortality and prognosis of obstructing carcinoma of the large bowel.

In a series of 760 patients with adenocarcinoma of the colon and rectum, 103 patients presented with acute obstruction requiring urgent surgical decompression. Obstructed patients were slightly older and had slightly more advanced tumors than the total group. Obstructing lesions of the left colon treated primarily by staged procedures had relatively low mortality and five year survival figures comparable to unobstructed cases. Obstructing lesions of the right colon had a much poorer absolute five year survival rate, mainly because of the high operative mortality associated with primary resection in our institution. Five year survival after curative resection in patients with obstructing tumors of the right colon was considerably less than in patients with nonobstructing tumors. A suggestion is made for consideration of proximal external bowel decompression in association with resection of the right colon.     

Primary large cell neuroendocrine carcinoma of the urinary bladder

Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is rare. It is a type of neuroendocrine carcinoma morphologically distinct from small cell carcinoma. We report here a case of primary LCNEC of the urinary bladder. We observed a very large invasive tumor, which was not able to be detected three months previously by cystoscopy or computed tomography. The tumor cells morphologically and immunohistochemically resembled that of pulmonary LCNEC. With prompt cystoprostatectomy and chemotherapy, the patient is free of disease 16 months after diagnosis. Although LCNEC is usually very aggressive, it may be controlled by early diagnosis and treatment.     

Primary restorative colectomy in malignant left-sided large bowel obstruction.

A series of 18 consecutive patients who underwent primary resection and immediate anastomosis as the treatment for malignant left-sided large bowel obstruction are presented. Intraoperative mechanical preparation of the colon was omitted. There was no clinical evidence of anastomotic dehiscence or wound infection. The mean duration of hospital stay was 11 days. It is suggested that colonic continuity can be restored immediately and safely without mechanical bowel preparation, providing attention is directed to constructing an anastomosis that has a good blood supply and is free from tension.     

A pathologic-anatomical feature of carcinoma of large bowel in Japan

Summary The pathologic-anatomical features of large bowel carcinoma were compared between Japan and the United States in gross as well as histological type using 197 surgical specimens from western Japan during the period of 1963 through 1970. The result together with the materials collected from the literature suggested that there seemed to be definite difference in the anatomical distribution. A relatively high incidence of carcinoma of the rectum and concomitant low incidence of carcinoma of the sigmoid and descending colons in Japan was found to be the major difference when compared with the data published in the American literature. Some difference was also noted in a relatively high incidence of polypoid-type carcinoma and in a relatively low incidence of annular-type carcinoma among Japanese materials in contrast to those of American materials. The reason for these difference is not clearly understood at present and further collection of materials and pertinent data are necessary.     

Principles of surgical technique in the treatment of carcinoma of the large bowel

The principles of surgical technique for the operative management of colon cancer are described. With the background of the evolution of anastomotic alternatives, the methods for reestablishing intestinal continuity and the approach to the treatment of complicated presentations of colonic cancer are reviewed. While one may construe this paper to have a certain author bias, I have tried to present diverse options where pertinent, but there should be little question as to where my opinion lies.

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Resumen Se describen los principio de la técnica quirúrgica para el manejo operatorio del cáncer del colon. Sobre el trasfondo de la evolutión de las alternativas anastomóticas, se revisan los diversos métodos para restablecer la continuidad intestinal y el aproche al tratamiento de las complicaciones del cáncer del colon. Aunque se puede pensar que el presente artículo puede tener un cierto sesgo, el autor, ha tratado de presentar las diversas opciones pertinentes, aunque no debe dudarse sobre donde reside su opinión.

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Résumé Les principes du traitement chirurgical du cancer colique sont décrits. Tenant compte de l'évolution des différentes méthodes d'anastomose, les techniques de rétablissement de la continuité et le traitement des complications sont présentées. L'auteur a essayé de donner toutes les options thérapeutiques mais a insisté également sur ses propres convictions.

     

A perspective on clinical research strategies in carcinoma of the large bowel

Experience with screening for colorectal cancer has been disappointing. Prevention of this disease seems to be a more beneficial research direction. Although radical surgery presents the best treatment option, it is nonetheless an inadequate strategy by itself. A new dose intensive approach would temporally combine surgery and chemotherapy as a coordinated event. This would allow maximal cytoreduction over a minimal time period and little or no development of resistant cancer cells. This approach has resulted in a 75% projected 5 year survival in patients with peritoneal carcinomatosis from cystadenocarcinoma. Strategies for application of this cytoreductive approach in many patients with advanced gastrointestinal cancer are present.

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Resumen La experiencia con el tamizaje para la detección del cáncer colorrectal ha sido decepcionante, y la prevención de esta enfermedad aparece como un panorama de mayor beneficio. Aunque la cirugía radical representa la mejor opción de tratamiento, es, sin embargo, una estrategia inadecuada en si misma. Un nuevo enfoque de más intensa dosificación podría combinar temporalmente la cirugía y la quimioterapia como un evento coordinado. Esto lograría una citorreducción máxima en un período mínimo de tiempo y leve o ningún desarrollo de células cancerosas resistentes. Este aproche ha resultado en una sobrevida proyectada a 5 años de 75% en pacientes con carcinomatosis peritoneal por cistadenocarcinoma. Se presentan las estrategias para la aplicación de este aproche de citorreducción en muchos pacientes con cáncer gastrointestinal avanzado.

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Résumé L'expérience du dépistage des cancers colorectaux a été décevante. La prévention relève peut-être plus du domaine de la recherche. Bien que la chirurgie radicale représente le meilleur traitement actuel, elle est une stratégie insuffisante en ellemême. Une attitude moderne voudrait une combinaison de la chirurgie et de la chimiothérapie. Cette attitude pourrait fournir une cytoréduction maximale sur une période minimale et peu ou pas de résistance des cellules cancéreuses. Cette attitude donne une survie projetée à 5 ans de 75% chez les patients atteints d'une carcinose péritonéale secondaire à un cystadénocarcinome de l'appendice. La stratégic d'application de cette approche thérapeutique chez les patients ayant un cancer digestif est présentée.

     

大肠癌的靶向治疗

大肠癌是常见的恶性肿瘤之一,发病率及死亡率亦逐年上升,严重威胁人们的生命。目前对大肠癌的治疗仍是以手术为主、辅以局部或全身放疗及化疗的综合治疗。早期大肠癌手术治疗效果明确,但有20～25%左右的患者在首诊时已有其它器官的转移给治疗带来了困难。而靶向治疗作为一种新的治疗手段,为晚期大肠癌的治疗开辟了新途径。     

大肠癌术后肝转移的外科治疗

目的: 探讨大肠癌术后肝转移的手术治疗效果. 方法: 对20例大肠癌术后肝转移病人施行手术切除及/或肝动脉/门静脉插管化疗(DDS),结合文献对手术适应证、手术方式以及随访结果进行分析. 结果: 全组无手术死亡.所有患者跟踪随访2年,1年、2年存活率分别为85.0%和45.0%. 结论: 手术切除是治疗大肠癌术后肝转移的最有效治疗方法.