Exfoliative cytology of the colon: Fifteen years of lost opportunity

A brief summary of the uses and limitations of morphological techniques in the study of colonic cancer is presented. Problems involved in the detection of "early" colonic cancer including its definition, are discussed, as well as the question of the relationship of colonic polyps and villous tumors to the development of carcinoma. The usefulness of cytology as an adjuvant to standard investigational techniques is considered. T h e place of morphology seems secure in future studies of the pathogenesis and early detection of large bowel cancer.Cancer 34:904-908, 1974. LL PARTICIPANTS IN THIS CONFERENCE SHAREA a common goal; the reduction of colonic and rectal cancer mortality. You will note, however, that each contributor's approach towards this goal is structured by his own acquired methodology. I am not suggesting that we can free ourselves from methodology, since scientific results probably have always been structured by investigative technique; but we can at least search for the over-all relevance of our specialty's contributions, as judged by its impact on other areas of investigation. This could help us speculate where our effort should be directed in the future and where they might he spent less profitably. T h e following is a limited attempt to do this, so far as it concerns pathology and early detection. POLYPSWhen one mentions the pathology of early colon cancer, one's attention is apt to be focused automatically on a topic which has consumed pathologists' attention for several decades; that is, whether or not colonic polyps are p r e c a n c e r o i i~. 7~~0 ,~~,~~~~~~ T h e diagnosis and management of colonic polyps have created numerous problems for the pathologist, some inherent in the nature of the disease, and some

„early” large bowel cancer(A morphologist's dilemma)

McDivitt¹

1974

Gastrointestinal cancer—colon (surgery-radiotherapy).The role of radiation therapy in the management of rectosigmoid cancer

Johnson

1977

The lack of an improvement in the gross survival statistics for colorectal cancer during the last decade and the negative results of randomized trials, suggests that 5-FU used as an adjuvant treatment has not increased survival. Current chemotherapeutic drug combinations, however, may prove effective in the adjuvant situation. The adjuvant use of preoperative radiation has shown improved survival in one randomized study and no change in the second study. Current preoperative radiotherapy studies using a more effective radiation dose will confirm the effect of preoperative radiation both on the primary tumor control and on metastases. Current postoperative adjuvant trials incorporating radiation, chemotherapy or a combination of the two, when completed, will provide clear indications for the physician as to the optimum treatment of Duke's B and C cancer of the colorectum. Three national randomized studies for inoperable, recurrent or residual carcinoma of the colorectum are testing the effect of radiation alone or in combination with chemotherapy or chemotherapy followed by immunotherapy.Cancer 40:595-603,1977 ARCINOMA OF T H E SICMOID COLON A N D REC-C tum requires a multimodality team for optimum care. Since an increase in the survival rate is the ultimate objective, all factors affecting the mortality rate of the disease must be recognized and quantitated in studies involving multimodality treatment. This paper will briefly review the epidemiology, incidence, etiology and screening procedures for carcinoma of the colon since they affect the clinical stage at'presentation. The importance of staging and a knowledge of areas of failure will be discussed and the factors affecting the cancer cure rate due to surgery and radiation will be presented. Incidence, Epidemiology and EtiologyCancer of the colon and rectum has the highest cancer incidence and is the cause of the second highest cancer mortality rate in the

The role of early diagnosis in controlling large bowel cancer.An overview

Sherlock¹,

Winawer²

1977

Since early diagnosis is essential to improve the cure rate for large bowel cancer, we must use all known investigative tools to make a diagnosis in symptomatic patients in addition to periodic selective investigation of high-risk groups, such a8 those with familial polyposis, inflammatory bowel disease, previous polyps or cancer. However, our goal must be more ambitious than this. If we wait until patients have symptoms of colorectal cancer, the cure rate will significantly decrease. A mass-screening approach, therefore, is needed for the asymptomatic patient. One such approach commences with the testing for occult blood in the stool followed by intensive investigation for the source of bleeding. Newer techniques. now under investigation, such as determination of CEA in colonic washings,.ptterns of enzymes in blood and other.body fluids, fluorescent cytology and tn u i h isotopic surface labeling of colonic cells, may help to identify individuals either harboring an occult neoplasm or at increased risk for the development of colon or rectal cancer. The application of these parameters and the early recognition of precancerous lesions may lead to earlier diagnosis or diagnosis in the incipient stage of disease, which, in turn, should lead to improved survival.