Roentgen-Ray Diagnosis of Malignant and Potentially Malignant Lesions of the Colon and Rectum

For many years physicians have taught that the only hope of control or cure of cancer and allied malignant lesions lay in early diagnosis and adequate indicated therapy. This teaching is bearing fruit, and the public in general is becoming cancer conscious. In the past, many patients having cancer were first seen by a physician from six months to one year from the onset of symptoms. All too often the lesions were then far advanced and the probability of protracted arrest, or cure, was remote. Ten years ago we seldom saw a carcinoma of the left half of the colon without a high degree of partial obstruction or even complete obstruction; but during the past three years this rarely has been true. At present it is not at all uncommon for a patient to report for examination with symptoms of less than one month in duration. One such patient, for example, had been perfectly well until one week before our examination, when for twenty-four hours she experienced pain in the left abdomen, after which she was again symptom-free. A well developed annular carcinoma was found in the descending colon at the exact site of the pain. A resection was done and the patient is clinically well at present, two years later. As is indicated in the preceding paragraph, patients are being seen much earlier in the course of their disease and the difficulties in diagnosis have correspondingly increased. In far-advanced stages of cancer of the colon the diagnosis is usually obvious even after a more or less perfunctory examination by one with little training and limited experience. In the early stages of the same disease, however, the problem of diagnosis is very different and may challenge the ingenuity even of the most highly trained and widely experienced examiner. Patients are doing their part in reporting early for examination. They are placing themselves in our hands, trusting us to safeguard their future health, and we must not fail them. Whitehead (1) cites figures compiled by Dublin, of the Metropolitan Insurance Company, showing that 17 per cent of all deaths caused by cancer are traceable to cancer of the colon or rectum. This indicates the seriousness of the problem with which we are dealing. That much can be done to prevent or postpone many of these deaths is indicated by Rankin and Johnston (2) who, in an analysis of 453 operated cases of cancer of the colon, found 52.6 per cent clinically well five years later. Of the group without evidence of lymph node involvement, approximately 25 per cent more were well after five years than among those in whom the nodes had been invaded. This emphasizes the importance of early diagnosis and treatment if we hope to improve our results. Boehme and Hanson (3), in a review of 1,457 cancers of the large bowel, report that 75 per cent were found in the sigmoid, rectosigmoid, and rectum, approximately 50 per cent being in the rectum.