Familial cancer of the colon and rectum

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Familial polyposis of the colon with special reference to regression of rectal polyposis after subtotal colectomy

Two families with familial polyposis of the colon are reported. One family conforms to the established pattern and in the other there is a risk of an additional inheritance of sebaceous cysts and fibromata. Initially prophylactic surgery should usually consist of a one-stage subtotal colectomy with ileorectal anastomosis. Thereafter the polyps in the rectal remnant are left untreated for 6 months in the hope of spontaneous regression of some years' duration. This routine is preferable to immediate total colectomy and ileostomy for the adolescent or young adult. Fulguration of residual polyps is deferred but may be necessary if there is no spontaneous regression. A second-stage excision may be required if polyposis becomes uncontrollable or if there is malignant change. A case may be made for prophylactic rectal excision about 10 years after subtotal colectomy. The technique of ileorectal anastomosis is discussed briefly and a plan for family supervision is outlined. It is suggested that the phenomenon of spontaneous regression of polyps in the rectal remnant may be more frequent than accepted at present and that a long-term follow-up of patients with regression is required.

Carcinoma of the large intestine with survival in a child of nine and in his father. A study of carcinoma of the colon with particular reference to children

The case reports are presented of a child aged 9 and his father aged 43 both with colorectal cancer unassociated with polyposis.

A number of cases of carcinoma coli in children have been recorded but the outlook is depressingly poor; only I other long-term survival in a child appears to be authenticated.

The literature is reviewed and the reasons for the frequent errors and delays in diagnosis are analysed. The fact that the condition often masquerades as appendicitis or mesenteric adenitis in children is stressed.

A case is made for a positive approach when dealing with local recurrences even in anaplastic and colloid tumours.

It is suggested that certain bowel tumours may invade aggressively but not metastasize via the bloodstream or lymph channels; in these lesions the prognosis will be good if radical surgery is undertaken.

The evidence is in favour of a genetic basis for primary carcinoma of the colon and acceptance of this imposes the need for care in observing close relatives.

Chromosome abnormalities as primary events in human malignant disease: evidence from marker chromosomes

Observations on the chromosomes of cells from 5 human malignant tumors are reported. Each tumor had one or more distinctive marker chromosomes. Marker chromosomes were present in a total of 700 of 711 metaphases from these tumors, which included an early malignant lesion of the cervix showing minimal invasion. Two tumors (a Stage 4 carcinoma of the cervix and a reticulum cell sarcoma, both untreated) yielded preparations of high quality. The 7 best-spread metaphases from the former with the modal number of chromosomes (60) had identical karyotypes, as did 16 from the latter with the modal number of 49. Less extensive data on 13 other tumors, 8 of which had marker chromosomes, are also presented. The data presented here, together with the published data on the chromosomes of cells from human tumors, support the view that human malignant tumors frequently but not invariably arise from a single cell in which chromosome changes have occurred. A carcinoma of the corpus uteri, to which brief reference is made, is a possible exception: Most metaphases had apparently normal karyotypes. The role of chromosome abnormalities (particularly structural changes) in the malignant transformation is discussed. Possible parallels between the chromosome findings in the cells of malignant tumors and those in chronic myeloid leukemia are considered. It is suggested that in tumors there may be both specific changes (perhaps involving chromosomes structurally changed) and coincidental changes. Variation in the coincidental changes might largely account for the wide differences between the karyotypes of different tumors.