Outcome in patients with early colorectal carcinoma

Abstract

Twenty-four patients seen between 1978 and 1990 with early colorectal carcinoma were reviewed to determine the outcome of surgical treatment. The mean age was 62 (range 35-79) years; there were 16 men and eight women. The site of the tumour was the ascending colon in two patients, sigmoid colon in ten and rectum in 12. The polypoid and flat-elevated ulcerated (IIa+IIc) subtypes were detected in 14 and nine lesions respectively. Restorative colectomy was carried out in 19 patients, and five required Mile's operation. There were no postoperative complications or deaths at a mean follow-up of 71 (range 12-151) months. Neither recurrence nor distant metastasis was found during follow-up. There was a close relationship between the depth of submucosal invasion and presence of flat-elevated ulcerated subtype lesions with lymphatic infiltration. This association may play an important role in the mechanism of metastasis. Major surgical resection is probably required if longer disease-free intervals and better cure rates are desired.

Small Nonpolypoid Colorectal Carcinoma

“…Eighty-six percent of the patients had invasion of the submucosa, but lymphovascular permeation was detected in only 7%, which is much lower than that of other similar series, which have reported rates of 20 -41% [8,17,18]. This could be explained by the low rate of depressed-type lesions (type 0 IIc) in our series, which are known to be more invasive and aggressive [19].…”

“…Such small nonpolypoid colorectal cancers (SNPCCs) can easily be overlooked at endoscopy, even by experienced endoscopists. These lesions might appear as minimal mucosal irregularities (e.g., thickening of the mucosal fold, fading mucosal color, minute depressions and hemorrhagic spots, or small, flat sessile polyps often with a central depression and measuring Ͻ 15 mm at the longest diameter [6,8,9]. Diagnosis of these small colorectal cancers depends on the endoscopist's awareness of the existence of small nonpolypoid neoplasms in the colorectum and the use of high-resolution videoendoscopy with a magnifying capability of ϫ100 or more combined with advanced techniques such as chromoscopy (spraying the mucosa with indigo carmine to stress the typical grooves seen in normal mucosa) or brush cytology.…”

Colorectal de novo carcinoma: a review of its diagnosis, histopathology, molecular biology, and clinical relevance

“…The types include type I (polypoid), type IIa (slightly raised), type IIb (flat), type IIc (slightly depressed), and type III (depressed), along with combinations of these (i.e., IIc + IIa) [28,41]. The term "superficial colorectal carcinoma" is often used and comprises types IIa through III, or anything that is not polypoid (more than twice the height of the surrounding mucosa).…”

Expression of the p53 protein and clinical and pathologic correlation in adenocarcinoma of the rectum

“…Although its prognosis is related to the histopathologic aspects such as invasion into the rectal wall or perirectal fat and lymph node involvement, patients with tumors at early stages and operated with a curative intention, may present an undesirable outcome and on the other hand far advanced tumors may do well (1,10,12,18,23) .…”

“…The establishing of a correlation between genetic damage and prognosis has been the goal of extensive investigations in the last few years, as well as the mechanisms of the cell cycle (18,25) . p53 is a tumor suppressor gene, located in the short arm of chromosome 17 and produces a protein named p53 (2,14) .…”