Cecum Tumor Colonoscopy

Enlarged Sigmoid Colon

Fig. 10.1 a-c Carcinoma: stenosis with irregular surface, swollen mucosa, vulnerable or spontaneously bleeding mucosa.

Fig. 10.1 a-c Carcinoma: stenosis with irregular surface, swollen mucosa, vulnerable or spontaneously bleeding mucosa.

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can be difficult. Malignant stenoses generally have an irregular surface, the mucosa is swollen and destroyed, vulnerable, or bleeding spontaneously (Fig. 10.1). Inflammatory stenoses have an edematous mucosa, a glassy, livid surface, and are without significant irregularities.

If endoscope passage is not possible, a smaller-caliber instrument should be used to attempt passage and to effectively assess the stricture. To do so, the instrument should be withdrawn slowly and multiple biopsy samples should be taken. If passage is not possible even with a smaller instrument, multiple biopsies should be taken from the distal part of the stricture that can be visualized. Further information about the malignant/ benign nature of the stenosis must be then ascertained using a computed tomography scan and contrast enema.

Flat tumor: A more rare form of colorectal carcinoma is flat prominent or slightly elevated tumors with a depression in the center and/or ulceration. The tumor margins are either at the level of the mucosa or raised a few millimeters ( 0 10.4a). These changes can be easily missed and are diagnosed better using chromoendoscopy or an instrument capable of producing a high resolution image ( 0 10.4b-e, see also Chapter 3).

This type of tumor develops from a flat adenoma that, according to the literature, comprises 8.5-11 % of all adenomas (2). This subgroup of adenomas can have a high incidence of high-grade intraepithelial neoplasia, depending on size. In a recent prospective study of a large patient sample, 36% of all adenomas found during routine colonoscopy were "flat adenomas." Four

- 0 10.4 Macroscopic growth form of colorectal carcinoma: flat tumor -

- 0 10.4 Macroscopic growth form of colorectal carcinoma: flat tumor -

Flat Polyps Found During Colonoscopy
a Flat elevated tumor with irregular, bumpy b, c Tumor margins of same tumor emphasized using chromoendoscopy. surface; tumor margins raised a few millimeters above the mucosa.
Colonoscopy Colon CarcinomaSigmoid Colon ConstipationValve Cancer Photos
Fig. 10.2a-c Double carcinoma in cecum, originating at two bowlshaped growing tubulovillous adenomas. The tumor edges are not touching. The ileocecal valve is involved in tumorous process.
Fig. 10.3 Synchronous colon polyps, colorectal carcinoma. On the left edge of the image, a carcinoma is recognizable and on the right edge a larger polyp, partly obstructing the lumen.
Sigmoid Colon Constipation
Fig. 10.4 Synchronous polyp, colorectal carcinoma.
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