若年者の下部消化管癌―若年者大腸癌

Carcinoma of the Colon and Rectum in the Young

　若年者大腸癌は，たとえばBaconによると全大腸癌の2.6％，後述のごとくわれわれの症例では3.4％と症例が少なく，本邦の諸報告中にも充分な統計的資料に乏しい．とくに小腸の若年者癌は稀で，われわれには経験がない．本稿では若年者大腸癌について述べたい．

　若年者大腸癌は，一般に予後がわるいと考えられているようであるが，若年者大腸癌はとくに病理学的悪性度がたかいのか，若年宿主においてはとくに癌の進行が速かであるのか，あるいは若年者においてとくに癌診断の遅延しやすい事実があるのか，検討を必要とするところである．

　In persons under the age of 30, carcinoma of the colon was seen in 8, that of the rectum in 22, and double carcinoma of the colon and rectum in 2, all together accounting for about 3.4 per cent of all the operated cases of large bowel carcinoma. The female outnumbered the male in a ratio of 20 to 12. Cancer originated in the right colon in 4 cases, left colon in 4, pelvic rectum in 3 and rectal ampulla in 19. Of 2 multiple carcinoma of the colon, the one was double cancer of the rectum and sigmoid, and other was triple carcinoma in the rectum, ascending and transverse colon. Of 34 cases of cancer of the colon, 18 (59%) had cancer patients in the family line. Characteristics common to these cancers in the young were not seen either in the duration of complaints, clinical symptoms or in diagnosis. The tumor in general tended to enlarge and in rectum about 50 per cent displayed growth all the way through the entire circumference, while it was only 27 per cent in rectum cancer as a whole. Infiltration extended extramurally in 76%, a number far exceeding that of rectum cancer in all ages, which was only 54%. Macroscopically,15 were of localized variety, and 17, of diffuse type. In rectum cancer as a whole localized type was seen 86.7%, while diffuse type was seen only in 13.3%. Histologically, 3 out of 8 colon cancer showed partial colloid carcinoma, while in rectum cancer only 3 out of 19 displayed typical, highly infiltrative nodular colloid carcinoma. Histological findings in these two groups have each characteristics of its own. The other 2 cases showed no colloid carcinoma, mostly consisting instead of adenocarcinoma papillotubulare that presented thick hyperplasia of well differetiated papillotubular glands. Neither marked anaplasy nor scirrhus-like infiltration was seen. The degree of progressiveness was high : 2 in stage Ⅰ, 7 in Ⅱ, 7 in Ⅲ and 14 in Ⅳ. The rate of curative operation was 80 per cent. In 6 cases of palliative operation, liver metastasis was seen in 3 and disseminated metastases were found in the remaining 3. Curative resection was done in 7 cases of colon cancer, and non-curative one in 1.

　The procedures in curative operation of rectum cancer are as follows : Abdominoperineal resection in 12, including 1 of total excision of the organs within the pelvis, pull-through resection in 3, anterior resection in 1 and the whole removal of the colon in 1 (familial polyposis). In non-curative operations of rectum cancer, rectum resection was done in 2, and artificial anusin 3.

　In simultaneous multiple cancer of the sigmoid and rectum (familial polyposis of the colon), the total colon was excised, while in non-synchronous triple cancer of the rectum, ascending and transverse colon, the rectum was initially resected, followed 3 years later by excision of the right half of the colon.

　Death from direct results of operation was seen in 1 (non-curative operation of rectum cancer). The five-year survival rate is 35.3 per cent, or 6 cases out of 17.