Carcinoma of the colon 2 years after endocarditis due to Streptococcus bovis

A patient with Streptococcus bovis endocarditis, on complete gastrointestinal evaluation had only an adenomatous polyp of the sigmoid colon. Twenty-eight months later she was found to have invasive cecal carcinoma. Periodic evaluation of the gastrointestinal tract is therefore recommended for all patients with a history of S. bovis septicemia.

Early diagnosis of colorectal cancer

Screening of asymptomatic patients at risk is potentially the most effective means for detecting early colorectal carcinoma. Sensitive and specific tests are available for this purpose. However, an aggressive approach by the physician and compliance by the patient population are necessary for the proper implementation of this screening process.

An argument for increased use of subtotal colectomy in the management of carcinoma of the colon

Subtotal colectomy (STC) is a safe operation because operative mortality rates are as good as, if not better than, conventional segmental colon resections. It is no more difficult to perform than conventional segmental resections. Suture line complications, such as fecal fistulas and suture line recurrences, are not as common before as they are after colocolic anastomoses. In addition to being used in cases with known synchronous carcinomas, and carcinoma associated with polyps, STC should be considered in selected patients with obstructing or partially obstructing lesions of the sigmoid or left colon when complete evaluation of the proximal colon has not been possible. STC can be combined with a preliminary transverse colostomy for obstructing left colon lesions when appropriate evaluation demonstrates suitable indications for the resection of the colostomy as a one-stage procedure with ileocolic anastomosis. It also should be considered if there is significant distal sigmoidal diverticular disease associated with proximal carcinomas. Statistically, STC does not appear to be indicated as a prophylactic operation to avoid the development of metachronous colon cancer when the entire colon can be surveyed colonoscopically to assure that there is no associated neoplasm.

Macroscopic lesions in dysplasia and carcinoma complicating ulcerative colitis

Visible changes associated with dysplasia or carcinoma have been assessed in 62 colectomy specimens from patients with ulcerative colitis. In 34 colectomy specimens with one or more carcinomas, there were 51 visible carcinomas and 65 macroscopic dysplastic lesions; only one carcinoma was found in flat mucosa. Among 28 specimens with microscopic dysplasia but no carcinoma, eight contained no visible dysplastic lesion, and the remaining 20 contained a total of 40 polypoid or elevated dysplastic areas. In 32 operative specimens removed for long-standing chronic colitis without dysplasia or carcinoma, nine contained visible inflammatory polypoid lesions. On radiological or endoscopic examination of the colon in long-standing colitis close attention should be given to the identification and biopsy of polyps, elevated nodular areas or plaques, strictures, and isolated ulcers. It is likely that colectomy specimens with visible polypoid or elevated dysplastic lesions will contain a carcinoma more often than those removed for dysplasia in flat mucosa.

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).

Colonoscopic diagnosis and management of rectal bleeding

The use of the colonoscope to evaluate the cause of rectal bleeding in a series of 2200 patients has been reviewed. The most common cause of bleeding in this series was found to be neoplastic polyps, which were present in 723 patients (32 per cent). Colonic carcinoma was detected as the source of the bleeding in 425 cases (19 per cent). Although a large number of barium enema films were false negatives, the patients reviewed are a highly select group. It is still believed that barium enema studies and colonoscopy are complementary rather than competitive procedures. Their continued combined use greatly enhances diagnostic accuracy. Various other causes of colonic bleeding, including inflammatory bowel disease, arteriovenous malformations, endometriosis, ovarian carcinoma, ischemic colitis, and radiation colitis, have been discussed and their endoscopic appearance described. Of particular significance is the coexistence of internal hemorrhoids or diverticular disease and neoplastic colonic lesions. Barium enema films and sigmoidoscopy have been frequently described as the twin pillars of diagnosis in the detection of colonic pathology. Colonoscopy, as the third pillar of diagnosis, should be an integral part of the evaluation of patients with rectal bleeding.

Basal cell carcinoma in a patient with intestinal polyposis

A 22-year-old female, with multiple polyposis of the colon and two central nervous system tumors, also suffered from recurrent basal cell carcinoma. The purpose of this report is to alert physicians to the possibility that basal cell carcinoma occurring at an unusually young age may be another manifestation of the familial polyposis syndromes.

Colonic polyps in patients with acromegaly

Seventeen patients with acromegaly were prospectively studied with barium enemas and colonoscopy to investigate the possibility that acromegaly is associated with an increased frequency of colonic polyps and colon cancer. Polyps were identified in nine patients and were removed and examined in eight. In five patients the polyps were adenomatous, and in four of the five there were multiple polyps. The presence of polyps closely correlated with the presence of skin tags (p = 0.041) and also with the age of the patient (p less than 0.01). No new cases of colonic cancer were discovered; however, reviewing the records of 44 patients with acromegaly, four cases were previously diagnosed with colon carcinoma. This study identifies a unique group of patients that are at risk for the development of colonic polyps and perhaps colon cancer.

The association of remote Streptococcus bovis bacteremia with colonic neoplasia

We prospectively studied five patients with a remote history of Streptococcus bovis bacteremia who had not previously been evaluated for colonic pathology. This study was prompted by several reports of concomitant neoplasia in patients with recent S. bovis bacteremia. The patients were studied at a mean of 32 months after bacteremia. Despite the absence of other signs or symptoms suggestive of bowel disease, a negative test for occult blood in stool and a negative fecal culture for S. bovis, two patients were found to have neoplastic polyps of the colon. These findings suggest that the risk of colonic neoplasia in patients with remote S. bovis septicemia is similar to that found in patients with recent bacteremia, but evaluation of a larger group of these patients will be necessary to establish this risk.

Atherosclerosis and polyps of the colon. Quantification of precursors of coronary heart disease and colon cancer

The prevalence of adenomatous and hyperplastic polyps of the colon and the degree of involvement of the aorta by atherosclerotic lesions were evaluated in 842 autopsies from New Orleans. A positive statistical association between the two variables was found in white males under 75 years of age. In black males a positive correlation between atherosclerotic lesions and adenomatous (but not hyperplastic) polyps was found. The most extensive involvement of the aorta by atherosclerosis was found in patients in whom adenomatous and hyperplastic polyps coincided. The possibilities that dietary factors may account for these findings and its relevance in relation to colon cancer and coronary heart disease are discussed.