Tumour Characteristics and Prognosis

Colitis carcinoma occurs as a rule at an earlier age than does ordinary large-bowel cancer, the average age incidence being 41 years, compared with about 60 years in cases of ordinary carcinoma of the colon and rectum [9]. While most writers claim that the siting of colitis carcinomas does not differ materially from that of ordinary large bowel carcinomas, others have demonstrated that while approximately three-quarters of ordinary carcinomas are concentrated in the rectum and sigmoid, only one-quarter of the col-itic carcinoma occurs in the rectosigmoid segment

[10]. Another notable feature of colitis carcinomas is the high incidence of multiple primary growths which is about four times greater than that found with carcinoma of the colon in general. The individual growth may exhibit the gross features of an ordinary colorectal cancer but may sometimes be quite atypical, being flat and infiltrating with an ill-defined edge or sometimes appearing rather as a relatively inconspicuous thickening of the colon wall-like fibrous strictures.

Colitic cancers differ even histologically from sporadic cancer as they are more often high grade and mucinous or of a signet-ring cell type, and usually they have spread extensively by the time the patient comes to surgery [11]. Dysplasia in non-colitic cancers is almost always polypoid. In patients with colitis, however, there are flat dysplasia (mostly invisible to an endoscopist), raised dysplasia called DALM (dysplasia-associated lesion or mass) and incidental adenomas.

Because of the active nature of these colitic growths and the delay that often attends their diagnosis, many of them may have reached an advanced inoperable or incurable stage by the time they come to surgery. In the treatment of established colitis carcinomas, if the growth is operable, the ideal is pan-proctocolectomy since more limited resections are very liable to be followed by the development of further carcinomas in the remaining colon or rectum

[11].While reasonably good results may sometimes be achieved after surgery, the average 5-year survival rate is less than after idiopathic cancer [12].

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