Colon and rectal carcinoma

Incidence and mortality of carcinoids of the colon. Data from the Connecticut Tumor Registry

The aims of this study were to calculate the true incidence of colonic carcinoids in Connecticut from 1976 to 1986 and to determine the outcome of patients with these lesions. Fifty-four patients with carcinoids of the colon were identified (23 male and 31 female patients). Their average age was 64.1 +/- 2.1 years, with a range of 12 to 83 years. The age-adjusted incidence was 0.31 cases/100,000 population/year. Forty-eight percent of the carcinoids were located in the cecum; 16%, ascending colon; 6%, transverse colon; 11%, descending colon; 13%, sigmoid colon; and 6%, not assigned. Follow-up information was available in all cases. The crude 2-year survival rate was 63%, whereas the 5-year survival rate was 37%. Only one of six (16.6%) lesions that were 2 cm or smaller metastasized, whereas 23 of 31 lesions larger than 2 cm metastasized (74%). Six patients have survived an average of 43.5 months after local excision of their carcinoids. Fourteen patients died of their carcinoids. Metachronous gastrointestinal malignant neoplasms developed in six patients. These results suggest that, when found at an early stage, carcinoids of the colon (2 cm or smaller) can be treated by local excision. The vast majority of colonic carcinoids, however, are discovered at an advanced stage and should be treated aggressively with standard colonic resection. In addition, surveillance of the entire gastrointestinal tract should be initiated in these patients because of a high rate of other gastrointestinal malignant neoplasms.

Carcinoma of the anal region

Preservation of anorectal function makes chemoradiotherapy attractive as the primary treatment in patients with squamous cell carcinoma of the anal region. Despite variations in techniques of chemoradiotherapy administration, the accumulated experience of a number of institutions indicates substantial improvement over previous approaches, which included surgery or radiation therapy individually. Although no longer providing the definitive therapeutic role in this disease, the surgeon is frequently asked to evaluate lesions suspected of being anal malignancies. In addition, it is the surgeon who most often performs the diagnostic biopsy, consults on local complications of chemoradiotherapy, and manages complications of local recurrence. In this context, optimal care includes early organization of the medical oncologist, radiation therapist, and surgeon to participate in the initial diagnostic evaluations, examinations with the patient under anesthesia, and follow-up during therapy. A complete response is often not evident until 2 to 3 months after treatment. We recommend a follow-up schedule of monthly visits for the first 6 months, examinations every 3 months for the next 2 years, and assessment every 6 months thereafter. Evaluation during early routine visits includes manual and proctoscopic examination of the perineum and rectum and review of the hemogram and liver enzyme levels in the serum. CT, MRI, or lower endoscopy procedures are performed only if clinical examination or studies suggest the possibility of recurrence or a second primary tumor. Patients with an incomplete response to therapy after 3 months often undergo examination under anesthesia with biopsy of suspect areas. Chronic inflammatory changes in the area of previous carcinoma may be interpreted as persistent disease. Thus histologic proof of recurrent malignancy must be obtained before considering surgical or chemoradiotherapy salvage treatment.