Skip to main content
SpringerLink
Log in

Treatment of carcinoma in adenomas

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Invasive carcinomas in polyps removed during endoscopy are described. Most of them can be treated adequately by polypectomy alone, but some need additional surgical treatment. Incomplete excision, poorly-differentiated carcinoma, and lymphatic invasion are associated with increased risk of residual carcinoma and lymph node metastases, making colorectal resection more attractive; however, in elderly patients and poor-risk patients, the risks of surgery should be balanced against the possible advantage of curative surgery. Rectal polyps may be large but sphincter preservation can usually be achieved by different types of local excision. Recently described flat adenomas may contain carcinoma, but may also be treated by polypectomy using snare or hot biopsy.

Résumé

On décrit le cancer invasif dans les polypes enlevés par endoscopie. La plupart d'entre eux sont bien traités par la polypectomie seule mais certains ont besoin ensuite d'un traitement chirurgical. Une excision incomplète, un carcinome peu différencié, et une invasion lymphatique sont facteurs de risque de cancer résiduel et de métastases lymphatiques, rendant plus logique la résection intestinale correspondante. Toutefois, chez les patients âgés et à haut risque, on doit peser les dangers et avantages éventuels d'une chirurgie curative. MÊme si les polypes rectaux sont gros, la conservation du sphincter s'effectue en général grâce à différents types d'excisisons locales. Les adénomes plats décrits récemment peuvent Être cancéreux mais peuvent aussi Être traités par la polypectomie à l'anse diathermique ou par la biopsie chirurgicale.

Resumen

Se describen los carcinomas presentes en pólipos resecados por endoscopia. La mayoría de éstos puede ser tratada en forma adecuada mediante polipectomía solamente, pero algunos requieren terapia adicional. La resección incompleta, el carcinoma pobremente diferenciado, y la invasión linfática aparecen asociados con mayor riesgo de carcinoma residual y de metástasis ganglionares, lo cual hace más atractiva la resección colorrectal. Sin embargo, en los ancianos y en pacientes de alto riesgo quirÚrgico, el riesgo de la operación debe ser balanceado contra la posible ventaja de la cirugía realizada con propósito curativo. Los pólipos rectales pueden ser de gran tamaño, pero generalmente se puede lograr la preservación esfinteriana mediante diferentes tipos de resección local. Los recientemente descritos adenomas planos pueden contener carcinoma, pero éstos también son susceptibles de tratamiento por polipectomía mediante el asa de electrocauterio o la biopsia caliente.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morson, B.C., Dawson, I.M.: Gastrointestinal Pathology, Oxford, Blackwell, 1979, pp. 163–174

    Google Scholar 

  2. Fenoglio, C.M., Kaye, G.I., Lane, N.: Distribution of human colonic lymphatics in normal, hyperplastic and adenomatous tissue. Gastroenterology64:51, 1973

    Google Scholar 

  3. Ehrinpreis, M.N., Kinzie, J.L., Jaszewski, R., Peleman, R.L.: Management of the malignant polyp. Gastoenterol. Clin. North Am.17:837, 1988

    Google Scholar 

  4. Sugihara, K., Muto, T., Morioka, Y.: Management of patients with invasive carcinoma removed by colonoscopic polypectomy. Dis. Colon Rectum32:829, 1989

    Google Scholar 

  5. Furuswa, M.: Prognosis of patients with colon cancer limited to submucosal layer, who had undergone endoscopic polypectomy. Stomach and Intestine20:1087, 1985 (in Japanese with English abstract)

    Google Scholar 

  6. Wolff, W.I., Shinya, H.: Definitive treatment of “malignant” polyps of the colon. Ann. Surg.182:516, 1975

    Google Scholar 

  7. Coutsoftides, T., Sivak, Jr., M.V., Benjamin, S.P., Jagelman, D.: Colonoscopy and the management of polyps containing invasive carcinoma. Ann. Surg.188:638, 1978

    Google Scholar 

  8. Nivatvongs, S., Goldberg, S.M.: Management of patients who have polyps containing invasive carcinoma removed via colonoscope. Dis. Colon Rectum21:8, 1978

    Google Scholar 

  9. Colacchio, T.A., Forde, K.A., Scantlebury, V.P.: Endoscopic polypectomy: Inadequate treatment for invasive colorectal carcinoma. Am. Surgeon194:704, 1981

    Google Scholar 

  10. Langer, J.C., Cohen, Z., Taylor, B.R., Stafford, S., Jeejeebhoy, K.N., Cullen, J.B.: Management of patients with polyps containing malignancy removed by colonoscopic polypectomy. Dis. Colon Rectum27:6, 1984

    Google Scholar 

  11. Cooper, H.S.: Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am. J. Surg. Path.7:613, 1983

    Google Scholar 

  12. Webb, W.A., McDaniel, L., Jones, L.: Experience with 1000 colonoscopic polypectomies. Ann. Surg.201:626, 1985

    Google Scholar 

  13. Christie, J.P.: Malignant colon polyps—Cure by colonoscopy or colectomy? Am. J. Gastroenterol.79:543, 1984

    Google Scholar 

  14. Morson, B.C., Whiteway, J.E., Jones, E.A., Macrae, F.A., Williams, B.C.: Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut25:437, 1984

    Google Scholar 

  15. Bartnik, W., Burtruk, E., Orlowska, J.: A conservative approach to adenomas containing invasive carcinoma removed colonoscopically. Dis. Colon Rectum28:673, 1985

    Google Scholar 

  16. Cranley, J.P., Petras, R.E., Carey, W.D., Paradis, K., Sivak, K.V.: When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology91:419, 1986

    Google Scholar 

  17. Richards, W.O., Webb, W.A., Morris, S.J., Davis, R.C., McDaniel, L., Jones, L., Littauer, S.: Patient management after endoscopic removal of the cancerous colon adenoma. Ann. Surg.205:665, 1987

    Google Scholar 

  18. Rossini, F.P., Ferrari, A., Coverlizza, S., Spandre, M., Risio, M., Gemme, C., Cavallero, M.: Large bowel adenomas containing carcinoma—A diagnostic and therapeutic approach. Int. J. Colorect. Dis.3:47, 1988

    Google Scholar 

  19. Williams, B.C., Whiteway, J.E., Jass, J.R.: Practical aspects of endoscopic management of malignant polyp. Endoscopy19:31, 1987

    Google Scholar 

  20. Wilcox, G.M., Anderson, P.B., Colacchio, T.A.: Early invasive carcinoma in colonic polyps. Cancer57:160, 1986

    Google Scholar 

  21. Fried, G.M., Hreno, A., Duguid, W.P., Hampson, L.G.: Rational management of malignant colon polyps based on long-term follow-up. Surgery96:815, 1984

    Google Scholar 

  22. Eckhardt, V.F., Fuchs, M., Kansler, G., Remmele, W., Stienen, U.: Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Cancer61:2552, 1988

    Google Scholar 

  23. Christie, J.P.: Polypectomy or colectomy? Management of 106 consecutive encountered colorectal polyps. Am. Surg.54:93, 1988

    Google Scholar 

  24. Haggitt, R.C., Glotzbach, R.E., Soffer, E.E., Wruble, L.D.: Prognostic factors in colorectal carcinomas arising in adenomas: Implications for lesions removed by endoscopic polypectomy. Gastroenterology89:328, 1985

    Google Scholar 

  25. Fucini, C., Wolff, B.G., Spencer, R.J.: An appraisal of endoscopic removal of malignant colonic polyps. Mayo Clin. Proc.61:123, 1986

    Google Scholar 

  26. Muto, T., Kamiya, J., Sawada, T., Morioka, Y.: Morphogenesis of human colonic cancer. Dis. Colon Rectum26:257, 1983

    Google Scholar 

  27. Shatney, C.H., Lober, P.H., Gilbertsen, V.A., Sosin, H.: The treatment of pedunculated adenomatous colorectal polyps with focal cancer. Surg. Gynecol. Obstet.139:845, 1974

    Google Scholar 

  28. Kodaira, S., Ono, S., Purri, P., Takizawa, K., Kotake, K., Tsuyuki, A., Okuda, M., Abe, O.: Endoscopic polypecomy of the large bowel: Management of cancer-bearing polyps. Int. Surg.66:311, 1981

    Google Scholar 

  29. Stamm, B., Ristivojevic, B.: Small pedunculated tubular adenoma of the colon with carcinoma restricted to the head, invasion of lymphatics and widespread metastases. Case report and review of the literature. Virchows Arch.402:83, 1983

    Google Scholar 

  30. Gemsenjager, E.: Transverse pelvic floor division for the posterior approach to the rectum and anus. Int. J. Colorect. Dis.4:67, 1989

    Google Scholar 

  31. Muto, T., Kamiya, J., Sawada, T., Konishi, F., Sugihara, K., Kubota, Y., Adachi, M., Agawa, S., Saito, Y., Morioka, Y., Tanprayoon, T.: Small “flat adenoma” of the large bowel with special reference to its clinicopathological features. Dis. Colon Rectum28:847, 1985

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Tokyo, 7-3-1 Hongo Bunkyo-ku, 113, Tokyo, Japan

    Tetsuichiro Muto M.D., D.M.Sc, Toshio Sawada M.D., D.M.Sc & Kenichi Sugihara M.D., D.M.Sc.

Authors
  1. Tetsuichiro Muto M.D., D.M.Sc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshio Sawada M.D., D.M.Sc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenichi Sugihara M.D., D.M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muto, T., Sawada, T. & Sugihara, K. Treatment of carcinoma in adenomas. World J. Surg. 15, 35–40 (1991). https://doi.org/10.1007/BF01658958

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01658958

Keywords

Search

Navigation