[The malignant degeneration of colorectal polyps]

The authors make a retrospective analysis of problems related to diagnosis and therapy raised by malignization of adenomatous rectocolic polyps representing 38.7% of the total number of adenomatous polyps (98 cases), and 5% of cancers of the large bowel (759 cases in all). It is stressed that the rate of malignization increases in direct proportion with the number of polyps, and it is higher in segmentary or diffuse polyposis, predominantly in the sigmoidorectal segment. The clinical, endoscopic and radiologic signs have an orientational value in the diagnosis of malignant polyps, but they are truly important for the detection of the polyps (the site, the number, the extent, and the morphology), and for certain indices of malignancy (density, bleeding, ulceration), which are not constantly found, and which occur at the later stage of the disease. The diagnosis is made by polypectomy and histologic examination of multiple sections, the major diagnostic condition being the identification of the malignancy in the initial stage. Directed partial endobiopsies is frequently followed by diagnostic errors (in 32.2% of the cases), and should be reserved for those cases where polypectomy is technically unfeasible. With regard to therapeutic problems the necessity for oncologic interventions is stressed, characterized by wide exeresis with ablation of all polyps, the type and the extension of the resections depending on the site of the malignancy, and the extent of the polyps. It is stressed that polypectomy, as a definitive therapeutic procedure, does not represent a radical type of surgery, and has exceptional indications for patients with major operatory risks and incipient malignancies. Detection and treatment of polyps in the benign stage is one of the preventive methods that can be applied in rectocolic cancers.