Japanese

Carcinoid Tumor of the Colon and Rectum Akimichi Imamura 1 , Sei Kurokawa 1 , Shinji Yoshii 1 1Division of Gastroenterology, Sapporo Kosei General Hospital Keyword: 大腸カルチノイド , 診断 , 治療 pp.592-600
Published Date 2004/4/24
DOI https://doi.org/10.11477/mf.1403100500
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 We described carcinoid tumor of the colon and rectum based on analysis of Japanese literature including our own results.

 In Japan, carcinoids of the gastro-intesinal tract are thought to be in the category of endocrine cell tumors with low-grade malignancy. They are mostly asymptomatic because their size is monthly less than10mm in diameter, so most of such tumors are incidentally found in the course of colon cancer screening or in follow-up colonoscopy after endoscopic treatment. The rectum is the most common site, however, colon carcinomas are rare in our country.

 Typical endoscopic view is an Is-like submucosal tumor with yellowish color and visible vascular pattern. They are apt to have uneven, central depression or ulceration on the surface and to be enlarged in size.

 Over about50percent of the carcinoids beyond20mm in diameter invade is the proper muscle layer. The most important factor indicating possible metastasis is size : less than10mm is very rare, between10and20mm occasionally, greater than20mm almost always.

 Therefore, as for management, if the size is under10mm, and if it is shown to be limited to the submucosa by endoscopic ultra-sonography(EUS)and not to be an endocrine cell carcinoma by biopsy, endoscopic mucosal resection or local excision is appropriate. If from10to20mm, the patient should on principle have radical operation, though, especially in the range of from10to15mm is the controversial zone for clinical treatment, and leaves room for less radical treatment based on age, complication of other diseases, operative risk and necessity of permanent colostomy, including evaluations of macroscopic findings with or without central depression or ulceration. If the size is close to20mm, radical operation is needed. EUS,CT,MRI are important and helpful as is also barium enema and colonoscopy before any management procedures are decided.

 1) Division of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan


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