Skip to main content

Advertisement

SpringerLink
Log in

Adenomas of the colon and rectum: Histopathology and management

  • Published:
Diseases of the Colon & Rectum

Summary

The histopathology of adenomas with changes from the simplest hyperplasia through atypism and various phases of carcinoma is presented. The extent of carcinomatous change present seems to bear a direct proportional relationship to the size of the lesion.

There is no controversy regarding the management of adenomas within reach of the sigmoidoscope. Small lesions less than 5 mm in diameter are safely treated by fulguration. Larger lesions are totally excised for biopsy, and further appropriate treatment carried out as indicated.

In cases of adenomas requiring laparotomy for removal, there seems fairly general agreement that when the lesions measure less than 1.0 cm it is safe to watch and follow with x-ray observation for changes in size and configuration. In larger colonic lesions, surgical removal is indicated except in those instances where age or poor health make the procedure an undue risk. It is acknowledged that following these precepts an occasional small early carcinoma will be missed.

With increasing experience with colonoscopy, we believe that soon most adenomas of the colon will be treated by this method. Transabdominal excision and resection may then be reserved for lesions that for some reason cannot be removed via colonoscopy, and those showing invasive malignancy.

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. Blatt LJ: Polyps of the colon and rectum: Incidence and distribution. Dis Colon Rectum 4: 277, 1961

    Google Scholar 

  2. Bockus HL, Tachdjian V, Ferguson LK, et al.: Adenomatous polyp of colon and rectum: Its relation to carcinoma. Gastroenterology 41: 225, 1961

    Google Scholar 

  3. Buie LA, Brust JC: Solitary adenomata of the rectum and lower sigmoid. Trans Am Proct Soc 36: 57, 1935

    Google Scholar 

  4. Camp TF Jr, Connolly JM: Colorectal polypoid lesions. Arch Surg 93: 625, 1966

    PubMed  Google Scholar 

  5. Cardin AB, Morson BC: Recurrence after local excision of malignant polyps of the rectum. Proc R Soc Med 57: 559, 1964

    Google Scholar 

  6. Castro AF: Management of small asymptomatic rectal polyps. Hosp Med 3: 99 (Feb) 1967

    Google Scholar 

  7. Crile G Jr, Turnbull RB Jr: The role of electrocoagulation in the treatment of carcinoma of the rectum. Surg Gynecol Obstet 135: 391, 1972.

    PubMed  Google Scholar 

  8. Dockerty MB: Pathologic aspects in the control of spread of colonic carcinoma. Mayo Clin Proc 33: 157, 1958

    PubMed  CAS  Google Scholar 

  9. Dockerty MB: Adenomatous polyps of the rectum and colon (panel discussion). Dis Colon Rectum 8: 85, 1965

    Google Scholar 

  10. Enquist IF: The incidence and significance of polyps of the colon and rectum. Surgery 42: 681, 1957

    PubMed  CAS  Google Scholar 

  11. Fisher ER, Turnbull RB Jr: The differentiation of noninvasive and invasive carcinoma arising in intestinal polyp: Desmoplastic tumor stroma. Cleveland Clin Q 19: 62, 1952

    CAS  Google Scholar 

  12. Grinnell RS, Lane N: Benign and malignant adenomatous polyps and papillary adenomas of the colon and rectum: An analysis of 1,856 tumors in 1,335 patients. Int Abst Surg 106: 519, 1958

    CAS  Google Scholar 

  13. Jackman RJ: Conservative management of selected patients with carcinoma of the rectum. Dis Colon Rectum 4: 429, 1961

    PubMed  CAS  Google Scholar 

  14. Jackman RJ, Mayo CW: The adenomacarcinoma sequence in cancer of the colon. Surg Gynecol Obstet 93: 327, 1951.

    PubMed  CAS  Google Scholar 

  15. Jackson BR: Adenomas of the colon: The rationale for resection as the treatment of choice. Dis Colon Rectum 13: 47, 1970

    PubMed  CAS  Google Scholar 

  16. Jackson BR: Coloscopy, the neglected procedure. Dis Colon Rectum 16: 278, 1973

    PubMed  CAS  Google Scholar 

  17. Jackson BR, Hill MR: Coloscopy: Endoscopic examination of the colon. J Int Coll Surg 25: 104, 1956

    PubMed  CAS  Google Scholar 

  18. Judd ES Jr, Carlisle JC: Polyps of the colon: Late results of transcolonic removal. Arch Surg 67: 353, 1953

    Google Scholar 

  19. Kalus M: Carcinoma and adenomatous polyps of the colon and rectum in biopsy and organ tissue culture. Cancer 30: 972, 1972.

    Article  PubMed  CAS  Google Scholar 

  20. Lescher TC, Dockerty MB, Jackman RJ, et al.: Histopathology of the larger colonic polyp. Dis Colon Rectum 10: 118, 1967

    PubMed  CAS  Google Scholar 

  21. Lillehei RC, Wangensteen OH: Bowel function after colectomy for cancer, polyps, and diverticulitis. JAMA 159: 163, 1955

    CAS  Google Scholar 

  22. Madden JL, Kandalaft S: Electrocoagulation: A primary and preferred method of treatment for cancer of the rectum. Ann Surg 166: 413, 1967

    Article  PubMed  CAS  Google Scholar 

  23. Malt RH, Ottinger LW: Current concepts: Carcinoma of the colon and rectum. N Engl J Med 288: 772, 1973

    Article  PubMed  CAS  Google Scholar 

  24. Marshak RH: The pedunculated adenomatous polyp. Am J Dig Dis 10: 958, 1965

    Article  PubMed  CAS  Google Scholar 

  25. Monge JJ: Malignancy in a longstanding colon polyp. Minn Med 55: 986, 1972

    PubMed  CAS  Google Scholar 

  26. Morson BC: Precancerous lesions of the colon and rectum: Classification and controversial issues. JAMA 179: 316, 1962

    PubMed  CAS  Google Scholar 

  27. Myers TB, Bacon HE: Adenomas of the colon and rectum. Dis Colon Rectum 3: 523, 1960

    PubMed  CAS  Google Scholar 

  28. Pagtalunan RJ, Dockerty MB, Jackman RJ et al: The histopathology of diminutive polyps of the large intestine. Surg Gynecol Obstet 120: 1259, 1965

    PubMed  CAS  Google Scholar 

  29. Smith TR, Maeir DM, Metcalf W, et al.: Transformation of a pedunculated colonic polyp to adenocarcinoma: Report of a case. Dis Colon Rectum 13: 382, 1970

    PubMed  CAS  Google Scholar 

  30. Spratt JS Jr: Adenomatous polyps of the rectum and colon (panel discussion). Dis Colon Rectum 8: 85, 1965

    Google Scholar 

  31. Spratt JS Jr, Ackerman LV, Moyer CA: Relationship of polyps of the colon to colonic cancer. Ann Surg 148: 682, 1958.

    Article  PubMed  Google Scholar 

  32. Welch CE: Polypoid lesions of the gastrointestinal tract, Major Problems in Clinical Surgery. Philadelphia, W. B. Saunders, 1964, 148 pp

    Google Scholar 

  33. Welch CE, McKittrick JB, Bchringer G: Polyps of the rectum and colon and their relation to cancer. N Engl J Med 247: 959, 1952

    Article  PubMed  CAS  Google Scholar 

  34. Wilson GS, Dale EH, Brines OA: An evaluation of polyps detected in 20,847 routine sigmoidoscopic examinations. Am J Surg 90: 834, 1955

    Article  PubMed  CAS  Google Scholar 

  35. Wolff WI, Shinya H: Colonofiberscopic management of colonic polyps. Dis Colon Rectum 16: 87, 1973

    PubMed  CAS  Google Scholar 

  36. Youker JE, Welin S, Main G: Computer analysis in the differentiation of benign and malignant polypoid lesions of the colon. Radiology 90: 794, 1968

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colon and Rectal Surgery, St. Vincent's Hospital, 2206 West Third St, 90057, Los Angeles, California

    B. Richard Jackson M.D.

Authors
  1. B. Richard Jackson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Jackson, B.R. Adenomas of the colon and rectum: Histopathology and management. Dis Colon Rectum 17, 656–667 (1974). https://doi.org/10.1007/BF02587116

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02587116

Keywords

Search

Navigation