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. 1999 Dec;45(6):818–821. 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 1, N Boku 1, S Kato 1, I Koba 1, A Ohtsu 1, H Tajiri 1, A Ochiai 1, S Yoshida 1
PMCID: PMC1727756  PMID: 10562578

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.


Keywords: colorectal cancer; depressed cancer; carcinogenesis

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Figure 1  .

Figure 1  

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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  

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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  

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(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.

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