[Carcinoma of the transverse colon]

Carcinoma of the transverse colon accounts for 10% of all colorectal cancer. Diagnosis is often delayed and complicated forms (perforation, fistulization, obstruction) occur in 30-50% of cases. The progression of symptoms is often insidious and tumors may be voluminous by the time of diagnosis. Right sided tumors are typically bulky and late-stage; perforation may lead to abdominal wall or retroperitoneal abscess. Tumor can also extend or fistulize into adjacent organs. Distal transverse cancers may be small annular lesions which are prone to obstruction. Cancers present as T4 lesions in 20-40% of cases. Abdominal CT is the best test to evaluate the loco-regional extension of advanced tumors. Their central location and advanced stage at presentation results in an extensive differential diagnosis. This central location also poses difficult surgical choices for lymph node dissection, extent of resection, and re-establishment of intestinal continuity. Surgical series which focus on transverse colon cancer date from the 1970-80's; they show curative resections in only 50% with morbidity/mortality of 20% and a global five year survival of less than 35%; they were considered to have a particularly poor prognosis.