METASTATIC ‘EARLY’ COLORECTAL CANCER

Abstract

If colorectal carcinomas where the primary tumours are confined to the wall are considered 'early', the likelihood of lymph node metastasis in these tumours is 21% and for those that do not extend beyond the submucosa it is 13%. Because of the renewed interest in local treatment of small accessible rectal tumours and the use of colonoscopy for the removal of 'polyps' with invasive carcinoma, we analysed our long-term cancer survival figures for 'early' cancers in this combined surgical series spanning more than 30 years. The presence of regional lymph node metastasis in 'early' rectal cancer was associated with a significantly (P = 0.001) reduced proportion of long-term survivors (56%) compared to those without nodal involvement (79%). Long term survival in 'early' colonic cancer was less influenced (P less than 0.05) by whether lymph node metastasis was present (73%) or not (77%). The authors conclude that until more information is available with regard to the risk of lymph node spread from 'early' tumours, resection is advised for all invasive tumours of the colon in good risk patients, but the indications for local excision of 'early' rectal cancers can be extended in view of the ease of careful follow-up and the use of salvage procedures in those with recurrence.