Polyps of the rectum and colon

Four hundred and thirty-three patients with adenomatous polyps were examined and followed up. It was found that well differentiated adenomas are stable but dedifferentiated polyps can lead to invasive cancer, usually over a long period of time. Thus the concept of malignant transformation becomes meaningless, and should be replaced by an initial histological evaluation of polyps of the rectum and colon so that their development can be predicted.     

Pseudocarcinomatous invasion in adenomas of the colon and rectum

Of 182 polyps retrieved from 100 patients who underwent colonoscopic polypectomies, 160 were adenomas; of these, 16 contained epithelial inclusions within the stalk. The importance of recognizing this lesion lies in the fact that it mimics invasive cancer. From histologic study, criteria are proposed for differentiating the pseudocarcinomatous lesion from invasive cancer. The differentiation from colitis cystica profunda is also discussed.     

Osseous metastases from carcinomas of the colon and rectum

Summary Of 765 patients with disseminated metastatic carcinoma of the colon and rectum treated at Memorial Sloan-Kettering Cancer Center during the ten-year period 1960–1970, 53 (6.9 per cent) had skeletal metastases. Of these, 14 (1.8 per cent) had osseous metastases only. In one case the osseous lesion was the first symptom of a cancer of the sigmoid colon, and one patient had metastasis in the fibula from a primary rectal cancer. In our series the incidences of osseous metastases were 8.9 per cent from rectal carcinoma and 5.1 per cent from colonic carcinoma. The mean period from manifestation of skeletal metastasis to death was 13.2 months.     

Bone scanning in carcinomas of the colon and rectum

Summary Bone scanning has been shown to have a higher rate of accuracy in diagnosing osseous metastatic lesions from carcinomas of the lung and breast. In the present report, we have demonstrated this to be true for osseous metastases from carcinomas of the colon and rectum. We found that a high percentage (75 per cent) of patients who have pelvic or back pain have positive^99mTc bone scans for metastases in spite of the negative radiographs. The previously reported incidence of 5–6 per cent of osseous involvement from these tumors is probably lower than the actual incidence, as these studies were reported without the benefit of bone scanning. Supported in part by PHS Research Grant No. 1-R10-CA-12252 of the National, Cancer Institute.     

Papillary adenomas of the colon and rectum: A twelve-year review

During a 12-year period, 185 patients with papillary adenomas of the colon and rectum were treated. The average age was 63 years and there was a 10 per cent female preponderance. Seventy-one per cent of the lesions occurred in the rectum and rectosigmoid, and 40 per cent of the patients had rectal bleeding. Fifty-two per cent of the lesions were malignant: however, only 9 per cent of the patients died with metastatic carcinoma. The five-year survival rate in patients with papillary adenocarcinoma was 75 per cent. The results of this review indicate that a conservative approach to the surgical management of papillary adenoma of the colon and rectum should be encouraged, unless the tumor contains or is suspected to contain invasive carcinoma.     

Polyps of the colon and rectum in children: experience with 27 cases

Summary Experience with polyps in 27 children less than 13 years of age treated at the Ochsner Clinic during a period of 16 years has been reviewed in an effort to increase our knowledge of polypoid disease. Our study indicates that these polyps are usually pedunculated and may be single, multiple or diffuse. In our series 16 children had single polyps, nine multiple polyps and two diffuse polyposis. The commonest complaint was bright red blood in the stools. Pathologically, these polyps are benign adenomas with inflammatory changes. Malignant polyps in children are rare and none were found in our series. The true malignant potential of single or scattered polyps in children is unknown, but is probably not great. All polyps in children should be removed regardless of size, mainly because of the symptoms they produce and because of their possible but unproved malignant potentiality. A positive family history may be lacking in some cases of familial polyposis. Read at the meeting of the American Proctologic Society, June 29 to July 3, 1958, Los Angeles, California.     

One-stage operation for obstructing carcinomas of the left colon and rectum

A conscutive series of 28 patients with acutely obstructing carcinomas of the left colon and rectum were encountered during the last three years. Two patients treated by loop colostomy only were excluded from the study. Fifteen patients received a one-stage operation of immediate resection and primary anastomosis without proximal colostomy. The remaining 11 patients were treated by a conventional staged operation. The operative mortality and complications were similar in both groups. The duration of hospital stay in the former was half of that in the latter. Of nine patients treated by subtotal or total colectomy with primary anastomosis, the average number of bowel movements three months after surgery was 1.8 per day. Intraoperative colonic irrigation was performed in five patients of the one-stage group and permitted a safe primary anastomosis. The immediate results of the one-stage operation were surpisingly good. The authors propose it as the treatment of choice for the majority of patients with obstructing carcinomas of the left colon and rectum.     

Fasting blood gastrin levels in colon adenomas and colorectal carcinomas]

The trophic effect of gastrin in the intestine has been shown. Fasting gastrin levels of patients with adenomatous polyps or adenocarcinoma and in control subjects were determined (n = 141). The mean value of fasting gastrin of control subjects (n = 75) was 47.1 pg/ml +/- 17.8, of patients with adenomatous polyps (n = 49) 49.8 pg/ml +/- 20.7, of patients with carcinoma (n = 17) 50.1 pg/ml +/- 23.3. Neither in the group of patients with adenomatous polyps nor in the group of patients with carcinoma, fasting gastrin levels were elevated compared to control subjects. Our study indicates that there is no significant difference in fasting gastrin between either group (control subjects, colon polyps and carcinoma).     

Comparative study of carcinoembryonic antigen and epithelial membrane antigen expression in normal colon, adenomas and adenocarcinomas of the colon and rectum.

The heterogeneous nature of tumour antigen expression may require selection of monoclonal antibodies on an individual patient or tumour basis to allow adequate tumour localisation. Carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) expression has not previously been compared in colorectal cancer patients. Sections of cancer (n = 52), adjacent normal colon (n = 45), synchronous adenomas (n = 11) and nodal metastases (n = 49) were examined by indirect immunoperoxidase staining in 51 consecutive patients with colorectal cancer using monoclonal antibodies to CEA and EMA. The percentage of cells with positive staining in the primary tumours was graded 1: less than 25%, 2: 25-49%, 3: 50-75%, 4 greater than 75%. All primary colorectal cancers expressed CEA and 43 of 52 expressed EMA (83%). Grading showed CEA greater than EMA in 39, equal in 11 and less in two. Well differentiated cancers were more frequently graded three or four for CEA staining (23 of 27) than moderately differentiated cancers (11 of 22) (p less than 0.01). Equivalent figures for EMA were four of 27 and three of 22 (not significant) (NS) although the majority (86%) were graded 1 and 2. Grade 1 CEA expression was found in six of 15 proximal and only two of 37 distal lesions (p less than 0.01, chi 2 test) while for EMA equivalent figures were three of 15 and six of 37 (NS). Nodal deposits all expressed CEA and 45 of 49 expressed EMA (92%); 29 of 45 normal colon sections showed CEA expression (64%) as did all adenomas. EMA was not expressed by normal colon or adenomas. These results suggest that EMA expression is more specific but less sensitive than CEA for colonic cancer and is independent of tumour differentiation and site. Thus selecting monoclonal antibodies to CEA or EMA based on tumour biopsies may allow improved tumour localisation for imaging or therapy in patents with colorectal cancer.