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. 1999 Dec;45(6):818-21.
doi: 10.1136/gut.45.6.818.

Clinicopathological differences between colonic and rectal carcinomas: are they based on the same mechanism of carcinogenesis?

K Konishi  1 , T Fujii, N Boku, S Kato, I Koba, A Ohtsu, H Tajiri, A Ochiai, S Yoshida
Affiliations

Clinicopathological differences between colonic and rectal carcinomas: are they based on the same mechanism of carcinogenesis?

K Konishi et al. Gut. 1999 Dec.

Abstract

Background: There is a difference in the location of colorectal mucosal lesions and invasive cancers.

Aims: To ascertain whether the location of colorectal neoplasms reflects the carcinogenesis pathway.

Methods: The subject material consisted of 4147 neoplastic lesions that had been resected endoscopically or surgically from 5025 patients. Mucosal lesions and submucosal cancers were classified into depressed and non-depressed types endoscopically or histologically. The relations between macroscopic type, size, histology, and location were investigated.

Results: (a) Non-depressed type. A total of 1774 of 3454 (51%) mucosal lesions were located in the right colon, 1212 (35%) in the left colon, and 468 (14%) in the rectum. The incidence of mucosal lesions larger than 10 mm was 10% (185/1774) in the right colon, 21% (254/1212) in the left colon, and 27% (127/468) in the rectum. The incidence of mucosal lesions with villous components was 2% (32/1774) in the right colon, 5% (63/1212) in the left colon, and 13% (62/468) in the rectum. The ratio of submucosal cancers to mucosal lesions was significantly higher in the rectum (0.064, 30/469) than in the left (0.034, 43/1279) or right (0.010, 18/1857) colon. (b) Depressed type. The incidences of depressed type mucosal lesions and submucosal cancers were 5% (83/1857) and 17% (3/18) in the right colon, 5% (67/1279) and 5% (2/43) in the left colon, and 0.2% (1/469) and 0% (0/30) in the rectum, respectively.

Conclusion: There may be some mechanisms that promote the progression of mucosal lesions to invasive cancers in the left colon and rectum, whereas a de novo pathway from depressed type lesions may be implicated in some cancers of the right colon.

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Figures

Figure 1
Figure 1
Morphological appearance of the depressed type of submucosal cancer. (A) Endoscopy shows a depressed cancer 11 mm diameter in size; (B) in the cross section of this lesion, the edge is depressed compared with the surrounding normal mucosa.
Figure 2
Figure 2
Comparison of the incidence of depressed and non-depressed types of neoplastic lesion in the rectum, left colon and right colon. (A) Mucosal lesions; (B) submucosal cancers. A significant difference in the macroscopic type was noted between the rectum and colon (p<0.001). The incidence of depressed submucosal cancers in the right colon was significantly higher than that in the rectum (p = 0.0472).
Figure 3
Figure 3
(A) Relation between the location and size of non-depressed mucosal lesions. (B) Relation between the location and incidence of villous components in the non-depressed mucosal lesions. (C) Location of mucosal lesions and submucosal cancers.
See this image and copyright information in PMC

Comment in

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