Management of adenomas of the colon and rectum showing malignant changes

Summary and Conclusions

The anatomy and histology of adenomas have been reviewed, and special attention has been given to the muscularis mucosae and the important role that it plays. Complete biopsy and exhaustive histologic examination is necessary to distinguish between invasive and noninvasive carcinoma in an adenoma. There must be close cooperation between the pathologist and the surgeon, and coordinated clinicopathologic interpretation must be made to avoid not only inadequate local treatment, but needless radical surgery.

It has been our opinion for a number of years that adenomas showing superficial malignant changes could be adequately treated by local removal, and the results so far have been most rewarding.

There is no doubt that longer periods of observation will be necessary before definite conclusions can be drawn, but this report, coupled with the findings of others with similar experience, will do much to crystallize our thinking on the subject.

It should be understood that the principles set forth in this discussion are by no means always clear cut. Histologic interpretation will continue to vary, and tissues submitted may be inadequate; thus, when the facts at hand are inconclusive, there is no substitute for judgment and experience.