Simultaneous transition of multiple polyps into carcinoma in the large intestine

Clinical significance of the preoperative plasma carcinoembryonic antigen (CEA) level in patients with carcinoma of the large bowel

Preoperative levels of perchloric acid extractable plasma CEA were measured in 911 patients with complaints of the digestive system. A final diagnosis of benign disease was made for 579 patients; 332 patients were found to have cancer. Data for the preoperative CEA values were examined for clinical significance as an aide to diagnosis, preoperative disease staging, and prognosis. The results of our analysis support the conclusions of many investigators that the CEA assay is not a clinically useful diagnostic test, but it shows limited value in preoperative staging and a somewhat stronger correlation with prognosis.

Repeat colonoscopy after endoscopic polypectomy

The records of all patients undergoing endoscopic polypectomy between December 1979 and December 1982 were reviewed. One hundred seventy-two patients underwent colonoscopic polypectomy in the absence of carcinoma or inflammatory bowel disease. Of these, the polyp could not be retrieved in 4, and 19 were lost to follow-up. One hundred forty-nine patients underwent subsequent endoscopy from one to four years after the initial polypectomy. Seventy-five (50.3 percent) of the patients developed new polyps. Although 61 of the 75 patients with new polyps were identified in the first two years, new polyps were noted throughout all four years. The presence of multiple polyps on the initial examination was statistically significant in predicting new polyps. The age and sex of the patients, size of the polyps, and the presence of atypia did not identify patients at higher risk for new polyps. The data indicate that new polyps are more likely to develop in patients who had a previous polyp. It would appear that annual examinations should be performed until two successive examinations are negative. Following a second negative examination, reexamination at two- or three-year intervals, unless symptomatic, would appear to be adequate.

Experience with 1000 colonoscopic polypectomies

Experience with 1000 consecutive polypectomies in 591 patients, from December 1975 to October 1982, is reviewed. There were 633 adenomas, 292 hyperplastic, and 75 miscellaneous polyps. While eight minor bleeding episodes (0.8%) occurred, there were no major complications (perforations or bleeding requiring transfusion). The polyp retrieval rate was 97.9%. Of the 633 adenomas, seven (1.1%) had in situ carcinoma and ten (1.6%) invasive. Eight of the invasive group underwent colon resection with no positive nodes present. Anatomic location demonstrated a shift to the right side of the colon. Three hundred thirty-six (53.1%) were in the rectosigmoid; 134 (21.3%) were in the left colon; 79 (12.3%) were in the transverse colon; and 84 (13.3%) were in the right colon and cecum. Patients who have undergone benign polypectomy are colonoscoped again in 1 year, and, if negative, every 3 years thereafter. Postpolypectomy patients with malignant adenomas require closer observation. Endoscopic polypectomy, with its lower morbidity and mortality, has revolutionized the treatment of the colon polyp. It is also more cost-effective, with outpatient polypectomy being 29 times less expensive and inpatient polypectomy four times less expensive than transabdominal polypectomy.

Clinical evaluation of the Makari Intradermal Test in patients with cancer of the colon and rectum

A clinical study to evaluate the Makari Intradermal Test (MIT) involved 180 patients seen with symptoms suggestive of malignant disease, 85 of whom were subsequently shown to have carcinoma of the large bowel, and 66 asymptomatic volunteers. The prognostic value of initial and serial studies relative to patient-survival rate and the efficacy of serial studies in detecting disease in long-term follow-up of patients with resected malignant lesions were evaluated. On the basis of this study, the MIT appears to merit further investigation, not as a definitive diagnostic procedure, but as a survey for identifying patients with early malignancy or individuals at high risk to malignant epigenesis.

Morphology and histochemistry of large intestinal polyps

In order to assess the progress of the growth of large intestinal polyps into cancer, the epithelial height and the size of the epithelial nuclei were measured. Mucin histochemistry was also carried out. The increase of the histologic grade was based on the extent of epithelial pseudostratification; epithelial height became greater and epithelial nuclei increased in size. The histochemical mucin values were as follows: the total amount of murin in a given area increased in grade I epithelia in comparison with its behaviour in normal ones, and then decreased gradually with the increase in histologic grade. Neutral mucin became more conspicuous with the increase of epithelial pseudostratification. The amount of sulphated mucin decreased with the increase in histologic grade. In normal epithelia, sialomucin was rarely seen, but in grade I and II epithelia which did not show nuclear stratification the amount of sialomucin increased strikingly. It then decreased in amount with the increase in histologic grade. The noticeable increase of the amount of sialomucin in grade I and II epithelia can be thought of as a temporary pheomenon which appears in an early stage of carcinogenic process. The large intestinal polyps go through several stages before turning into cancer.