Tumour With Ulceration Colon

Generalized lymphoma tends to occur in the left side of the colon and in the rectum. Viewed endoscopically, the affected mucosa appears friable, indurated, and erythema-tous; exophytic tumor growth is very rare. Another endo-scopic appearance is characterized by multiple small, slightly raised, or flat elevated, polypoid lesions (0 10.6).

Gastrointestinal Stromal Tumors (GIST tumors). In most cases, these are malignant leiomyomas, often accompanied by tumor bleeding.

Karzinom Sigmoid
Fig. 10.7 Malignant gastrointestinal stromal tumor (GIST tumor) in the colon with polypoid growth. Macroscopic differentiation from polypoid carcinoma impossible.

GIST tumors appear endoscopically as polypoid tumors with an irregular, eroded and partially ulcerated surface (Fig. 10.7). Macroscopic differentiation from polypoid carcinomas is not possible.

Colon metastases. Metastases of another primary tumor can infiltrate the colon directly, from an adjacent organ or via implantation metastasis in the colon wall.

If the colon is infiltrated by a malignancy from an adjacent organ, the bowel wall will show signs of edema that can cause stenosis of the lumen. In advanced stages, the tumor may project into the lumen, appearing as an ex-ophytic tumor, which in some cases cannot at first be clearly differentiated from a colorectal carcinoma.

Metastases in the colon wall occur first within the wall and then spread into the lumen. These are also exophytic tumors, often with surface ulcerations, as these tumors grow more rapidly than their blood supply (Fig. 10.8)

■ Surveillance

Guidelines for aftercare, as well as follow-up surveillance after operative treatment for colorectal carcinoma, were established

CT C

t5 c

TO U

Hepatic Flexure

Fig. 10.8 Colon wall, metastasis of gastric carcinoma

(adenocarcinoma) at hepatic flexure. Exophytic tumor with ulcerations cannot be clearly differentiated from a colorectal carcinoma macroscopically.

Fig. 10.8 Colon wall, metastasis of gastric carcinoma

(adenocarcinoma) at hepatic flexure. Exophytic tumor with ulcerations cannot be clearly differentiated from a colorectal carcinoma macroscopically.

by the German Society of Digestive and Metabolic Diseases based on a meeting of a consensus group on prevention, diagnosis, aftercare, and drug treatment of colorectal carcinomas (4).

Colon carcinoma. Colonoscopy surveillance should be performed after 24 and 60 months for colon carcinomas in UICC stages I—III. Following endoscopic resection of a malignant (low-risk) colon polyp (T1 N0 M0; G1-2), another endoscopic checkup must be performed after six months.

Rectal carcinoma. Surveillance colonoscopy is indicated for rectal carcinomas in UICC stages I—III at 24 and 60 months. After local excision, rectoscopy or sigmoidoscopy must be performed at six, 12, and 18 months (4).

References

1. Hohenberger W, HermanekJr. P, König HJ. Kolon-, Rektum- und Analkanaltumoren. In: Hahn G, Riemann J. Klinische Gastroenterologie. Stuttgart: Thieme 2000; pp. 991-1024.

2. Owen DA. Flat adenoma, flat carcinoma, and de novo carcinoma of the colon. Cancer 1996;77:3-6

3. Rembacken BJ, Fujii T, Cairns A et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet 2000;355:1211-4.

4. Schmiegel W, Adler G, Frühmorgen P et al. Kolorektales Karzinom: Prävention und Früherkennung in der asymptomatischen Bevölkerung - Vorsorge bei Risikopatienten - Endoskopische Diagnostik, Therapie und Nachsorge von Polypen und Karzinomen. Z Gastroenterol 2000;38:49-75.

5. Silverstein FE, Tytgat GNJ. Colon I: Polyps and Tumors. In: Silverstein FE, Tytgat GNJ. Gastrointestinal Endoscopy, 3rd ed. Mosby-Wolfe 1997; pp.261-91.

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