World Journal of Surgery

, Volume 21, Issue 7, pp 694–701

Endoscopic Diagnosis and Treatment of Early Colorectal Cancer

Authors

  • Shin-ei Kudo
    • Division of Gastroenterology, Akita Red Cross Hospital, 1-4-36 Nakadori, Akita 010, Japan
  • Hiroshi Kashida
    • Division of Gastroenterology, Kobe City General Hospital, 4-6 Nakachi Minatojima, Chuo-ku, Kobe 650, Japan
  • Takashi Nakajima
    • Division of Gastroenterology, Akita Red Cross Hospital, 1-4-36 Nakadori, Akita 010, Japan
  • Satoru Tamura
    • Division of Gastroenterology, Akita Red Cross Hospital, 1-4-36 Nakadori, Akita 010, Japan
  • Kazuo Nakajo
    • Division of Gastroenterology, Akita Red Cross Hospital, 1-4-36 Nakadori, Akita 010, Japan

DOI: 10.1007/s002689900293

Cite this article as:
Kudo, S., Kashida, H., Nakajima, T. et al. World J. Surg. (1997) 21: 694. doi:10.1007/s002689900293

Abstract. Colorectal adenomas and early cancers are grossly classified into three groups: protruded, flush or slightly elevated (so-called flat adenomas), and depressed. Protruded lesions and flat adenomas are not invasive until they are rather large, whereas depressed lesions can invade the submucosa even when very small. It is not difficult to detect protruded and flat adenomas, but depressed carcinomas are often overlooked. Keys to the detection of depressed carcinomas are a slight color change, bleeding spots, interruptions of the capillary network pattern, slight deformation of the colonic wall, shape change of the lesion with insufflation and deflation of air, and interruption of the innominate grooves by the lesion. Spraying of indigo carmine dye helps to clarify the lesions. Pit pattern analysis with magnifying colonoscopy is useful for diagnosis of early colorectal cancer. Pit pattern analysis and histologic examination suggest that depressed carcinomas probably have arisen de novo, without going through an adenomatous step. Some adenomas appear at first to have a depression, but such cancer-mimicking adenomas with pseudodepression must be distinguished from depressed carcinomas because they are quite different in nature. Protruded and flat adenomas can usually be removed with polypectomy or hot biopsy techniques. Depressed carcinomas are treated with an endoscopic mucosal resection (EMR) technique; but when they massively invade the submucosa, surgical resection is indicated. Some neoplastic lesions, which we call laterally spreading tumors, extensively and circumferentially spread along the colonic wall, although they are short in height. They tend to have a rather benign nature despite their large size; therefore EMR or a piecemeal EMR method is indicated.

Copyright information

© 1997 by the Société Internationale de Chir ugie