Mucinous carcinomas of the colon and rectum and their relation to polyps

A study of 44 mucinous carcinomas (MC) from a series of 324 colorectal cancers was made (221 surgical resections and 103 endoscopic biopsies). This study showed that MC were associated, in a significantly higher proportion when compared to non MC, with polypoid adenomas of different kinds (hyperplastic polyps not included), in other segments of the surgical specimen (P less than 0.001). MC originated from adenomas, particularly villous, but also mixed and tubular, in a significantly higher proportion than non-MC (P less than 0.001). Carcinomas arising from adenomas were mucinous in 11/14 cases. The type of adenomas from which MC arose were characterized by usually having areas with a particular arborizing mucus hyperplasia. At the time of resection, MC had metastases (Stages C and D) more frequently then non MC (P less than 0.02).     

Colloid carcinoma of the colon and rectum

To determine the clinicopathologic significance of colloid carcinoma in carcinoma of the colon and rectosigmoid/rectum, a retrospective review of 462 patients who underwent potentially curative surgery at the New England Deaconess Hospital was performed. Seventy-seven patients (17%) were identified who had tumors with some component of colloid present. Colloid carcinoma occurred in 49 (11%). The remaining 28 (6%) had adenocarcinoma with colloid features. Compared to patients with pure adenocarcinoma, the 5-year actuarial survival of patients with colloid carcinoma was lower in the colon, rectosigmoid/rectum, and colorectum. Patterns of failure, expressed as the actuarial incidence of failure at 5 years, were examined by histologic condition and stage. Patients with Dukes' Stage B colloid carcinoma had a higher incidence of total failure, and patients with Dukes' Stage C colloid carcinoma had a higher incidence of local, abdominal, and total failure. None of the differences reached statistical significance. The presence of colloid carcinoma may have a real but small impact on the patterns of failure and survival in colorectal cancer.     

Pelvic exenteration for carcinoma of the colon and rectum.

Carcinoma of the colon and rectum is one of the most common causes of cancer deaths in the United States. The mortality of patients treated by surgery alone is 55% within 5 years of surgery. Despite efforts to decrease local recurrence and their concomitant problems of pain and disability, a significant number of patients will still have pelvic recurrences that carry a significant morbidity. In selected cases, pelvic exenteration may cure or provide palliation of the symptoms of colorectal carcinoma. Pre-operative evaluation is performed to detect signs of unresectability. During surgery, exploration is performed for evidence of metastases to the liver, omentum, and peritoneum, followed by an assessment of the local extent of the tumor. The margins of resection must be clear even if resection of contiguous organs or bony structures is necessary. The urinary tract is resected with an ileal loop, sigmoid or transverse colon conduits, or continent urinary diversion. Depending upon the involvement of neighboring structures, exenterative pelvic surgery can be modified for organ preservation.     

Adenosquamous Carcinoma of Colon and Rectum

In colon and rectum, adenosquamous carcinoma is extremely rare. 6 patients with adenosquamous carcinoma of colon and rectum were identified by Tianjin Medical University Cancer Hospital from Jan. 1967 to Dec. 1997. 2 male and 4 female had a median age of 48 (range, 40-60) years. All patients were treated surgically. The pathology confirmed the diagnosis of adeno-squamous carcinoma, that was 0.19% (6/3098) with colorectal adenocarcinoma during the same period. The clinical symptom was nearly…     

Clinicopathological characteristics of mucinous carcinoma of the colon and rectum

BACKGROUND AND OBJECTIVES: Clinicopathological significance of colorectal mucinous carcinoma (MC) remains controversial. The aim of the current study was to investigate the clinicopathological characteristics of colorectal MC. METHODS: Eighteen patients with MC and 265 with moderately or well differentiated adenocarcinoma of the colon and rectum, were clinicopathologically compared. RESULTS: MCs occurred in the right colon significantly more frequently than did non-mucinous carcinomas (NMCs). The maximal size of the tumors in MCs (7.0 +/- 2.9 cm) was significantly larger than that in NMCs (5.1 +/- 2.1 cm) (P < 0.001). Although the ratio of patients with peritoneal metastasis in MCs (22.2%; 4/18) was significantly higher than that in NMCs (6.0%; 16/265) (P < 0.05), there was no significant difference regarding liver metastasis. The proportion of lymph node metastasis in MCs (72.2%; 13/18) was significantly higher than that in NMCs (44.9%; 119/265) (P < 0.05). There was no significant difference regarding the lymphatic and venous invasion. The 1-, 3-, and 5-year survival rates of patients with MCs were 77. 8%, 45.4%, and 30.3%, respectively, and were significantly lower than those in patients with NMCs, that were 88.9 %, 65.6%, and 60.8%, respectively (P < 0.05). CONCLUSIONS: As colorectal MCs proliferate and metastasize more rapidly than do NMCs, surgeons should realize that more aggressive surgical treatment should be occasionally administered to improve the postoperative prognosis of the patients with colorectal MCs.     

Patient's and doctor's delay in carcinoma of the colon and rectum

Despite sophisticated diagnostic equipment and modern surgical therapy, the prognosis for patients with colorectal carcinoma has not improved during the last few decades. One of the factors, possibly contributing to the prognosis, is the time between the patient's visit to the doctor and the final therapy. In order to estimate patients' and doctors' delay and to investigate the factors which may influence the time of delay, a prospective study was designed including 50 patients with carcinoma of the rectum or the sigmoid colon and 50 patients with colonic carcinoma above this level. All patients were interviewed by a doctor using a standard questionnaire, and initial symptoms, duration of symptoms, and type of clinical examination leading to diagnosis were recorded. The results show that 16% of the patients in the recto/sigmoid group suffered from patient's delay as opposed to 20% in the group of patients with carcinoma above 25 cm from the anal verge. Doctor's delay was found in 27% of all cases, being evenly distributed in the two groups. The reason for doctor's delay was usually the doctor's neglecting to perform rectosigmoidoscopy or rectal palpation, and in some cases a false-negative X-ray. No significant correlation was found between tumor stage and doctor's or patient's delay.     

The significance of synchronous carcinoma and polyps in the colon and rectum

The relationship of colorectal carcinoma with polyps was studied retrospectively in 1202 patients. The incidence of synchronous carcinoma (SC) and metachronous carcinoma (MC), prognosis, and recurrence patterns were studied. Synchronous polyps (SP) were found in 36% of the patients. SC was found in 4.4% of the patients, and MC developed in 3.5% of patients. The incidence of SC and of MC increased with SP, and varied according to number, size, and histologic features of the polyps. The adjusted 5-year survival rate was improved in patients with SP compared with those without SP, both overall (79% versus 64%, respectively) and by Dukes' Stage B (87% versus 73%, respectively) and Dukes' Stage C (56% versus 39%, respectively). The pattern of relapse was the same for the SP and non-SP groups. Subtotal colectomy is recommended for colorectal carcinoma and SP in good-risk patients.     

The macrophage electrophoretic mobility test: Results on carcinoma of the colon and rectum.

The macrophage electrophoretic mobility (MEM) test was performed on guinea-pig macrophages treated with the interaction products of encephalitogenic protein and peripheral lymphocytes from 44 patients with colorectal cancer and 33 "healthy" controls. In 54/60 tests involving patients, statistically significant reductions in electrophoretic mobilities were observed, compared with 12/33 in controls. Our overall results on the reductions in macrophage mobilities by lymphocyte products are in accord with the work of some other workers, but not all. In contrast to many other studies, the standard procedures used here to express the results should permit an exchange of data on an international basis and allow a more rapid, general appraisal of the MEM test.     

Mucinous eccrine carcinoma of the eyelid.

BACKGROUND. Mucinous eccrine carcinoma (MEC) is a rare malignant tumor that typically arises in the periorbital area. METHODS. The authors report the 73rd case of primary MEC of the skin. This patient's clinicopathologic findings and the world literature are reviewed. RESULTS. Patient ages range from 8-84 years (median, 63 years). The male-to-female ratio was approximately 2:1. The racial distribution was 67% white, 32% black, and 4% Asian. Primary MEC originates in the head and neck region in approximately 75% of patients. The most common location was the periorbital area (40% or 29 of 73 patients). The local recurrence rate after conventional surgery was: eyelid, 34%; scalp, 36%; and face, 33%. CONCLUSIONS. Primary MEC is often a slow-growing tumor that may recur after traditional surgical excision. Recurrent eyelid MEC tends to be locally destructive with a regional metastatic rate of 3.5% (1 of 29). The regional metastatic rate for all sites was 11%, and the distant metastatic rate was 3%.     

A new approach in the immunotherapy of carcinoma of the colon and rectum

Although the therapy of carcinoma of the colon and rectum has been investigated, little progress has been made in prolonging the survival in these patients. Specific active immunotherapy may provide the answer. Previous investigators have shown that colorectal cancer elicits an immune response and may be susceptible to immunologic manipulation. My laboratory has shown that a live vaccinia virus-augmented (vaccinia oncolysate) tumor cell vaccine is safe and may be worthwhile in the surgical adjuvant treatment of colorectal cancer. Nine patients with advanced cancer were treated. 0/9 showed adverse effect and 3/9 showed lack of progression of disease. Randomized prospective trials are now underway.     

An assessment of the mucous component in carcinoma of the colon and rectum

It has been said that the prognosis of mucinous carcinoma of the colon and rectum is unfavorable. To determine the clinicopathologic significance of carcinomatous lesions with marked mucous production, the ratio of the area where there was significant mucous production (mucous component [MC]) to the area of the whole tumor on a tissue slice (area ratio) was determine by measurement with a digitizer in 281 patients with carcinoma of the colon and rectum. The MC was observed in the largest cross-section of the tumor in 85 patients (30.2%). Of these 85 patients the MC area ratio was less than 10% in 42. In the 43 patients with an area ratio of 10% or more, no particular relationship was observed between the area ratio and the frequency of cases. If no MC was observed in the largest cross section of the tumor, the MC ratio in other regions of the tumor was almost 0. In the patients in whom the MC area ratio in the largest cross-section was less than 10%, the MC area ratios in other sites of the tumor showed only a small variance, but in the patients with an MC area ratio of 10% or more, a large variance was observed according to the site. The prognosis for patients with an area ratio of 10% or more was less favorable than that for patients with no MC and with an MC area ratio of less than 10% (P less than 0.05). These results suggest that it is reasonable to handle the patients with an MC area ratio of 10% or more as a group.     

Clinical and pathological studies of multiple primary carcinoma of the colon and rectum

During a 5-year period from 1976-1981, we clinicopathologically studied 21 patients with 45 lesions of multiple primary colorectal carcinomas and compared our findings with those made in 288 single carcinomas of the large intestine. The frequency of multiple primary colorectal carcinoma was 6.8%. The pathological findings suggested an interrelationship between colorectal adenoma and carcinoma. Patients with multiple carcinomas of the large bowel had coexisting adenomas more than patients with single carcinoma. We suggest that it is necessary to do a thorough preoperative examination of cancer of the large intestine to detect double cancers or other adenomatous polypoid lesions with synchronous association.