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Advanced proximal colon cancer.

C J Gannon1, D L Malone, R E Royal

  • 1Department of Surgery, Veterans Affairs Maryland Health Care System and University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Surgical Endoscopy
|April 3, 2002
PubMed
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Screening sigmoidoscopy may miss proximal colon cancers, as most patients with proximal colon cancer lack distal lesions. Full colonoscopy is recommended for early colon cancer detection.

Area of Science:

  • Gastroenterology
  • Oncology
  • Preventive Medicine

Background:

  • Sigmoidoscopy may fail to detect advanced proximal colonic neoplasms.
  • Previous studies highlight limitations of sigmoidoscopy for colorectal cancer screening.

Purpose of the Study:

  • To evaluate the prevalence of distal synchronous lesions in patients diagnosed with proximal colon cancer.
  • To determine if screening sigmoidoscopy would have missed these proximal colon cancers.

Main Methods:

  • Retrospective analysis of 305 colorectal cancer patients over 6 years.
  • Stratification by demographics, tumor characteristics, and presenting complaint.
  • Analysis of colonoscopy results for synchronous distal lesions in proximal colon cancer patients.

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Main Results:

  • Proximal colon cancer identified in 29% of patients (88/305).
  • 54% of proximal colon cancer patients lacked synchronous distal lesions.
  • Patients with proximal colon cancer were elderly, had advanced tumors (T3/T4), advanced AJCC stages (III/IV), and were symptomatic.

Conclusions:

  • Most proximal colon cancers occur without synchronous distal lesions.
  • Sigmoidoscopy-based screening would miss these proximal tumors.
  • Screening colonoscopy is supported for early colon cancer detection protocols.