Surgical management of familial polyposis and Gardner's syndrome

Twenty-six patients with documented familial polyposis or Gardner's syndrome were followed up to twenty-eight years after total colectomy with ileorectal anastomosis. All patients were followed a minimum of five years. Patients were subjected to periodic proctosigmoidoscopies, and rectal polyps were electrocoagulated when found. In no patient in this series did an adenocarcinoma of the rectum develop during the follow-up period. Total abdominal colectomy with ileorectal anastomosis is the treatment of choice in patients with familial polyposis and Gardner's syndrome, provided adequate follow-up is assured and polyps are destroyed when encountered.

[Tumor surgery: principles of radical treatment (author's transl)]

The 5-year survival rate for curative radical resections of colorectal cancer including Dukes' stages A-C has not improved during the last 20 years. The main principles of surgical treatment have now been realized: en-bloc resection of the tumor together with its lymph drainage system, primary high ligature of the supplying blood vessels, prophylaxis of peroperative metastases and a high total resection rate with low operative mortality. In the future, an improved prognosis must come from prophylaxis, early diagnosis, and improved methods of irradiation and chemotherapy, because the limits of surgical treatment have been reached.

Colonic-rectal cancer: fiber and other dietary factors

The prevalence of colonic-rectal cancer is generally directly related to the fat content and inversely related to the fiber content of diet. In the few exceptions to this generalization, tumor prevalence is more closely related to fiber than to fat. Hypotheses have been postulated to explain the possible ways in which dietary fiber may protect against colonic-rectal cancer and to account for the close relationships between the geographical distribution of these tumors and that of certain other diseases.

The prevention of invasive cancer of the rectum

The results of the 25+ year Cancer Detection Center study, including 20,000 participants and 100,000+ patient-years experience, demonstrate the obviation of appearance of most lower bowel cancers associated with a program of proctosigmoidoscopy and adenomatous polyp removal. Once on a schedule of periodic examinations, study participants developed only a fraction of the anticipated number of rectal cancers; most of the cancers which did develop were detected while at an early stage and with involvement of only the mucosa. Not a single death from lower bowel cancer has occurred among active study participants or for 7+ years following the most recent examination at the Center.

Comparative educational approaches to screening for colorectal cancer

The purpose of the study was to evaluate the public's willingness to perform the do-it-yourself Hemoccult Test for colon-rectum cancer and to assess the relative effectiveness of alternative means of persuading people to do the test. American Cancer Society volunteers in four different part of the country contacted a total of 11,115 members of the American Association of Retired Persons, using five methods that differed in the extent of personal and impersonal contact involved. Other variables such as inclusion of postage and dietary restrictions were studied and cost efficiencies were estimated. The Group Meeting Method was the most effective personal distribution method. The Selective Mail-Out Method was the most effective impersonal method. The return rate was higher when postage was provided. Dietary restrictions did not markedly reduce participation. Including digital examinations did not affect the return rate. The findings suggest that the Hemoccult Test has the potential of reaching a significant proportion of the nation's older population.

The early detection of colorectal cancer

A review of the American Cancer Society's statistics for colorectal cancer indicates that there has been little improvements in the survival rate for this disease in the past 25 years. Although there have been advances in surgical techniques, radiation therapy, and chemotherapy, the key to improved survival rates is earlier diagnosis. A significant percentage of patients continues to present with regional or distal metastasis at the time of their initial diagnosis. Both proctosigmoidoscopy and guaiac impregnated filter slide paper methods have been productive in diagnosing this disease at an earlier stage. The "Hemoccult" test, however, is inexpensive, can be used on a routine basis, is easier for patients to perform themselves, and is aesthetically pleasing. It represents a significant cost savings compared to proctosigmoidoscopy and should be advocated for routine use in all patients over 40 years of age. Although there continues to be a role for local and regional mass screening programs, significant improvements in colorectal survival rates cannot be expected until routine application of this type of screening is practiced.

Communicating cancer control to the public

A fifty-year historical review of public communications research, an analysis of factors influencing communication effectiveness, descriptions of fifteen cancer public communication programs, and recommendations for future cancer communications programs are presented. The programs described were specific to five cancer sites, were targeted to six types of audiences and included several types of educational objectives and communication modes. Recommendations include greater use of social science literature and evaluative designs in program planning; cooperative research to provide data suitable for educational diagnosis; and standardization of evaluation results to document effectiveness of techniques and strategies.

The evolution of cancer of the colon and rectum

The malignant potential of adenomas of the colon and rectum varies with size, histological type and grade of epithelial atypia. The adenomatous polyp is usually small and has a low malignant potential, whereas tumors with a villous structure are usually larger and have a much higher cancer rate. Severe atypia is more common in villous adenomas than in adenomatous polyps. Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp-cancer sequence although the majority of adenomas do not becoma cancerous during a normal adult life span. The slow evolution of the polyp-cancer sequence is stressed. The implications of the polyp-cancer sequence for the design of cancer prevention programmes and the study of the aetiology of large bowel cancer are discussed.