Abstract
PURPOSE AND BACKGROUND: Qualitative and quantitative analysis of many flat early cancers that have been discovered during the last decade led us to recognize that a flat route of cancer development de novo is as important a route as the polypoid one. We aim to prove through a longitudinal study that these flat early cancers indeed develop in flat mucosa and not in an adenomatous polyp. METHODS: From January 1, 1990, to July 31, 1994, 554 patients underwent at least two colonoscopies. These patients consisted of 364 males, and average age was 59 years. We searched for flat early cancers developing in polyp-free colorectal mucosa on or after a second colonoscopy. Polyp-free mucosa here means an intestinal segment proved to possess no adenomatous polyp during the preceding colonoscopies, irrespective of the presence of polyps else-where. RESULTS: Four flat early cancers were found developing in polyp-free colonic mucosa in four patients. Average age of the patients was 67 years. Locations of the cancers were the transverse (3) and descending colons (1). The shapes were all depressed, and average size of the lesions was 11 mm. Two lesions were endoscopically resected, and two by surgery. CONCLUSION: These four depressed cancers developing in polyp-free mucosa show that flat early colorectal cancers do arise de novo and not from an adenomatous polyp having collapsed on itself.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kuramoto S, Oohara T. Flat early cancers of the large intestine. Cancer 1989;64:950–5.
Kuramoto S, Oohara T. How do colorectal cancers develop? Cancer 1995;75:1534–8.
Iishi H, Kitamura S, Nakaizumi A,et al. Clinicopathologic features and endoscopic diagnosis of superficial early adenocarcinomas of the large intestine. Dig Dis Sci 1993;38:1333–7.
Matsumoto T, Iida M, Yao T, Fujishima M. Role of nonpolypoid neoplastic lesions in the pathogenesis of colorectal cancer. Dis Colon Rectum. 1994;37:450–5.
Kuramoto S, Ihara O, Sakai S, Shimazu R, Kaminishi M, Oohara T. Depressed adenoma in the large intestine: endoscopic features. Dis Colon Rectum. 1990;33:108–12.
Kuramoto S, Oohara T. Minute cancers arisingde novo in the human large intestine. Cancer 1988;61:829–34.
Scaborough RA. The relationship between polyps and carcinoma of the colon and rectum. Dis Colon Rectum 1960;3:336–42.
Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36:2251–70.
Kuramoto S, Ihara O, Oohara T. Minute depressed carcinomas of the large intestine [meeting abstract]. Dis Colon Rectum 1991;34:P2.
Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985;89:328–36.
Wolber RA, Owen DA. Flat adenomas of the colon. Hum Pathol 1991;22:70–4.
Vogelstein B, Fearon ER, Hamilton SR,et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988;319:525–32.
Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990;61:759–67.
Thibodeau SN, Bren G, Schaid D. Microsatellite instability in cancer of the proximal colon. Science 1993;260:816–9.
Haenszel W, Correa P. Cancer of the colon and adenomatous polyps—a review of epidemiological findings. Cancer 1971;28:14–24.
Snyder DN, Heston JF, Meigs JW, Flannery JT. Change in site distribution of colorectal carcinoma in Connecticut, 1940–1973. Am J Dig Dis 1977;22:791–7.
Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum 1994;37:1108–11.
Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique. Gastrointest Endosc 1991;37:128–32.
References
Nowell PC. The clonal evolution of tumor cell populations. Science 1976;194:23–8.
Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990;61:759–67.
Shibata D, Navidi W, Salovaara R, Li Z, Aaltonen LA. Somatic microsatellite mutations as molecular tumor clocks. Nature Med 1996;2:676–81.
Konishi M, Kikuchi-Yanoshita R, Tanaka K,et al. Molecular nature of colon tumors in hereditary nonpolyposis colon cancer, familial polyposis, and sporadic colon cancer. Gastroenterology 1996;111:307–17.
Koretz RL. Malignant polyps: are they sheep in wolves' clothing? Ann Intern Med 1993;118:63–8.
Ikegami M. A pathological study on colorectal cancer: fromde novo carcinoma to advanced carcinoma. Acta Pathol Jpn 1987;37:21–37.
Muto T, Kamiya J, Sawada T,et al. Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 1985;28:847–51.
Kuramoto S, Oohara T. Flat early cancers of the large intestine. Cancer 1989;64:950–5.
Kuramoto S, Oohara T. Minute cancers arisingde novo in the human large intestine. Cancer 1988;61:829–34.
Iishi H, Kitamura S, Nakaizumi A,et al. Clinicopathologic features and endoscopic diagnosis of superficial early adenocarcinoma of the large intestine. Dig Dis Sci 1993;38:1333–7.
References
Kuramoto S, Oohara T. How do Colorectal cancers develop? Cancer 1995;75:1534–8.
Lev R. Adenomatous polyps of the colon: pathobiological and clinical features. New York: Springer-Verlag, 1990:130–1.
Author information
Authors and Affiliations
Additional information
Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.
About this article
Cite this article
Kuramoto, S., Mimura, T., Yamasaki, K. et al. Flat cancers do develop in the polyp-free large intestine. Dis Colon Rectum 40, 534–542 (1997). https://doi.org/10.1007/BF02055374
Issue Date:
DOI: https://doi.org/10.1007/BF02055374