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Clinico-pathological Studies on the Evolution of Large Bowel Carcinoma Yoshifumi Yokoyama 1 , Masakazu Maruyama 2 1The First Department of Internal Medicine, Medical School, Nagoya City University 2Departmnet of Internal Medicine, Cancer Institute Hospital pp.867-876
Published Date 1985/8/25
DOI https://doi.org/10.11477/mf.1403109837
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 The study revealed how adenoma and early cancer of the large bowel developed into advanced cancer.

 Method: Specimens used were those which had been operated on over a period of 35 years from 1946 to 1983 at the Cancer Institute Hospital. There were 86 specimens of mucosal cancer (m-ca). 54 specimens with submucosal invasion (sm-ca). 150 specimens in which the cancer was limited to the muscle layer proper (pm-ca).

 The specimens were classified by taking a cross-section of the muscularis mucosae and measuring the maximum diameter and comparing it with the depth to which the cancer had invaded the bowel.

 Results: 78% of the adenomas and 62% of the mucosal cancers were of the pedunculated type.

 Invasive pedunculated cancers decreased in size by 16%. Sessile and flat-elevation type cancers increased in size by 52%. Centrally depressed malignancy types increased in size by 33%. Advanced ulcerating cancers increased in size by 95%, in proportion to the depth of invasion into the bowel.

 m-ca were classified into five types, A, B, C, D and E taking into consideration whether they were sm-ca or pm-ca respectively.

 The average maximum diameters at each stage of cancerous invasion depth were able to be tabulated as shown in Fig.4.

 The maximum diameter of types A, B, and D increased by simple progression at each stage of invasion depth. No relationship between maximum diameter and invasion depth could be observed in types C and E. The course taken by E type is that of the so-called malignant villous tumor.

 Conclusion: Mucosal cancer was classified into five different types as they appeared in the muscularis mucosae. The forms of invasive and pm-ca can be classified according to the form of the original mucosal cancer. There were at least five courses taken in the evolution of mucosal cancer to advanced cancer. Almost all so-called malignant villous tumors invaded the lower layers without any changes of maximum diameter of the tumor.

 The most frequent course taken by adenoma on its way to advanced cancer was from being a pedunculated adenoma to becoming, through progressive stages, a pedunculated mucosal cancer. Following stalk invasion, sessile invasive cancer evolved, and this finally developed into advanced ulcerating cancer.


Copyright © 1985, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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