Malignant Disease of the Rectum and Rectosigmoid Treated with Radium

Abstract

It is our impression that treatment of polyps and polypoid malignant disease of the rectum is an ever-widening field for the radiologist. It is already a major field and we believe from past experience (1) that aggressive preoperative and planned postoperative treatment offer much promise for the future. Treatment of this condition demands co-operation of the patient, general practitioner, surgeon, proctologist, and radiologist. The proper treatment of carcinoma of the rectum is of major importance if the high incidence of this disease is considered. Teperson (5) stated recently, after a study of records of several thousand patients who received treatment, that 5 per cent of all malignant lesions of the body occur in the rectum and colon and that the majority of these lesions are within reach of the examining finger. Buie (3) reported that in ten years at the Mayo Clinic a positive diagnosis of malignant rectal lesions was made in 2,723 cases at proctologic examination. It is known that in this serious disease prognosis is hopeless without aggressive treatment. If left untreated rectal carcinoma is attended by extreme pain, hemorrhage, foul rectal discharge, and total disability. Extension to neighboring pelvic organs, frequently with associated development of fistulas and distant metastasis to vital organs, usually occurs in cases in which treatment is not given. The early diagnosis and treatment of polyps of the rectum should reduce the incidence of carcinoma of the rectum. Fitz-gibbon and Rankin (4) studied these lesions and grouped them according to structural variations, as follows: Group 1 consists of the nodular, pedunculated tumors in which the epithelium remains normal. Group 2 consists of pedunculated or sessile tumors varying greatly in shape and size, in which the epithelium inevitably undergoes malignant change. This is the largest group. No sharp line of separation is seen between these lesions and those of group 3. The latter may attain the size of a split pea; the elementary epithelium proliferates so rapidly that morphologically it cannot be distinguished from outright car-cinomatous change. In brief, the lesions in group 1 are benign; the lesions in group 2 tend inevitably to undergo malignant change, and those in group 3 are immediate precancerous lesions. The therapeutic radiologist must be prepared to recognize the gross appearance of polyps and polypoid lesions occurring alone or associated with the characteristic malignant neoplasm. Determination of Type of Treatment Before outlining the technic employed in radiologic treatment of rectal carcinomas, it is well to consider the special difficulties encountered. These are as follows: 1. The disease is advanced at the time of diagnosis. Many surgeons consider the lesion inoperable in about 65 per cent of cases in which the condition is present.